Search Results (242)

Introduction: Peanut oral immunotherapy (P-OIT) is an emerging treatment strategy for peanut allergy (PA). Although a standardized pharmaceutical product, Peanut (Arachis hypogaea) Allergen Powder-dnfp, has been approved in several countries, it is not universally available. In such contexts, real-world protocols using readily utilizable peanut products may represent an alternative approach. This study aimed to describe the feasibility, safety, and clinical outcomes of P-OIT using toasted peanuts in a real-world effort in a pediatric population. Methods: This single-center retrospective cohort study enrolled children who initiated P-OIT at our tertiary pediatric hospital Allergy Unit between April 2015 and December 2024. Demographic and clinical features, allergy test results, and information about P-OIT were recorded. Desensitization was defined as tolerance of 630 mg of peanut protein (PP). Results: Sixty patients (51.7% male; median age 8.2 years) were included. 22/60 (36.7%) achieved desensitization within a median time of 22.7 months. 21/60 (35%) were still undergoing P-OIT at a median tolerated dose of 100 mg of PP, and 17/60 (28.3%) discontinued treatment, most commonly due to loss to follow-up (44%). At least one adverse reaction occurred in 43/60 (71.7%) patients, predominantly mild and self-limiting (68.3% resolved spontaneously, 39.5% occurred at home). However, 11/60 (18.3%) showed anaphylaxis, and 3/60 (5%) received adrenaline. A reduction in Ara h 2 serum-specific IgE levels compared to the baseline was observed in patients completing escalation (p = 0.03). Conclusions: In this real-world single-center cohort, P-OIT using toasted peanuts was feasible in a subset of patients and was associated predominantly with mild adverse reactions, although systemic reactions were also recorded. Treatment discontinuation and adherence remain relevant challenges. These findings highlight the need for prospective, controlled studies to better define the role, safety profile, and patient selection criteria for food-based P-OIT protocols in settings where standardized products are not available. Full article

Background and Clinical Significance: Mucopolysaccharidosis type VI is a rare lysosomal storage disorder due to arylsulfatase B enzyme deficiency, leading to progressive multisystem disease and complex airway. Acute respiratory infections can precipitate airway embarrassment. A structured treatment guideline is currently lacking. We present a 7-year-old MPS VI male with respiratory distress, highlighting the challenges in management. Case Presentation: Case review focusing on clinical presentation, imaging findings, and multidisciplinary decision-making during acute deterioration. A child diagnosed with MPS VI at the age of 3.5 years old, due to low arylsulfatase B enzyme activity and homozygous for c.275C>A p.(Thr92Lys) variant in the ARSB gene. At 7 years of age, he showed the signs of dyspnoea, increased respiratory effort with bilateral crepitations, and noisy breathing. Initial management included facemask oxygen, nebulised adrenaline, corticosteroids, and bronchodilators. Computer tomography scan of the neck and chest showed a complex upper airway, multiple tracheal narrowing, tortuosity, and an extra loop of truncus brachiocephalicus from the arch of the aorta. Potential interventions carried substantial risks due to abnormal airway and multisystem disease. Following extensive multidisciplinary discussion after careful consideration of the significant risks associated with invasive airway interventions, a shared decision was reached with the family to adopt a comfort-focused palliative care approach. Despite the best supportive care, the child unfortunately passed away after 3 months. The family was involved in every decision process and was fully supported. Conclusions: MPS VI is associated with complex airways and multisystem disease. Multidisciplinary decision-making with family is critical to safe and appropriate care. The rarity of the disease, lack of guidelines, complex airways, and multiple comorbidities make management challenging. Full article

Background/Objectives: Patients with food allergy (FA) may exhibit dysfunctional eating behaviours and/or food aversions that extend beyond the necessary allergen elimination diet and may result in avoidant/restrictive food intake disorder (ARFID) or food neophobia (FN); however, no data are available on adults. This study aimed to explore ARFID, FN, FA anxiety, and eating styles in adults with FA, analysing influences of sociodemographic and clinical factors. Methods: This cross-sectional preliminary study involved 79 adults with FA, who completed the Nine Item ARFID screen (NIAS), Food Neophobia Scale (FNS), Scale of Food Allergy Anxiety (SOFAA), and Dutch Eating Behaviour Questionnaire (DEBQ—brief). Pearson and Spearman correlation coefficients and multiple linear regressions were performed (p < 0.05). Results: In total, 25% and 73% of participants scored positively for ARFID and FN, respectively. A positive correlation was observed between FN and ARFID levels (p < 0.006), and between FN and FA anxiety (p < 0.001). Current psychological problems positively correlated with ARFID (p = 0.004), FN (p = 0.006), and FA anxiety scores (p = 0.03). Restrained eating was positively associated with female gender (p < 0.001), and ARFID (p = 0.002) and FN scores (p = 0.028). External eating was negatively correlated with ARFID (p = 0.004). Adrenaline auto-injector (AAI) prescription was negatively associated with ARFID (p < 001) and restrained eating (p = 0.006), while previous anaphylaxis was negatively associated with ARFID (p = 0.020) and positively associated with external eating (p = 0.021). Multiple logistic regression models confirmed that restrained eating was associated with a higher probability of both ARFID (p = 0.031) and FN (p = 0.074). Conclusions: Clinicians should be aware of the risk of ARFID and FN among adult patients with FA and recommend appropriate psychological and dietary support. Further studies are needed to better understand the protective and precipitating factors of ARFID and FN to develop effective prevention and treatment strategies. Full article

Background and Objectives: The role of tourniquet use in arthroscopic partial meniscectomy remains debatable. While traditionally adopted to enhance visualization and reduce intraoperative bleeding, concerns were raised regarding its impact on postoperative outcomes and potential adverse effects, such as muscle damage or delayed recovery. This systematic review aimed to evaluate whether the use of a tourniquet offers advantages in terms of surgical efficiency, patient recovery and complication rates in arthroscopic partial meniscectomy. Materials and Methods: A systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42025644740). A comprehensive literature search was performed in 5 databases including studies from the past 20 years. Only randomized controlled trials (RCTs) comparing tourniquet-assisted versus non-tourniquet procedures in adolescent and adult patients undergoing isolated arthroscopic partial meniscectomy matched our inclusion criteria and the analysis was performed on those. Methodological quality was assessed using the Cochrane RoB 2.0 tool. Data were synthesized either quantitatively or narratively, depending on the availability of statistical details. Results: Three RCTs with a total of 243 patients met the inclusion criteria. Operative time was shorter in tourniquet-assisted procedures in one study (p = 0.001), though comparable outcomes were achieved in non-tourniquet groups when pharmacological agents such as intra-articular adrenaline were used. No significant differences were observed between groups regarding postoperative pain (p = 0.22, p = 0.43), knee effusion (p = 0.96), range of motion (p = 0.91, p = 0.96), or time to return to functional activities (p = 0.9, p = 0.34, p = 0.23). Muscle damage, assessed by serum creatine phosphokinase CPK levels, did not differ between groups (p = 0.3, p = 0.093, p = 0.079). Intraoperative visibility and surgeon satisfaction rated higher in tourniquet groups (p = 0.002), although this was subjective and reported variably. No major tourniquet-related complications were recorded. Conclusions: The routine use of a tourniquet in arthroscopic partial meniscectomy provides limited intraoperative advantages and does not improve postoperative outcomes. Current evidence supports a selective rather than routine use of tourniquets, especially when pharmacological alternatives are available. Further high-quality studies are needed to define standardized protocols and assess long-term outcomes. Full article

Background/Objectives: Hip fractures among elderly patients are associated with significant morbidity and mortality. Delayed surgery is common and often results in inadequate pain control and increased opioid consumption, which may have adverse effects. This study evaluates the effectiveness of preoperative intra-articular injection of multimodal analgesics (IA MDI) for reducing pain caused by a displaced femoral neck fracture (FNF). Methods: A prospective randomized controlled trial was conducted using 18 geriatric patients with displaced FNFs scheduled for hip arthroplasty. The patients were randomized into two groups: IA MDI and control groups (n = 9 each). The IA MDI group was administered a preoperative intra-articular injection of ropivacaine, morphine, and adrenaline, in addition to standard oral and intravenous (IV) analgesics, while the control group was administered standard oral and IV analgesics alone. The primary outcome was the perioperative pain score assessed via the 10-point numerical rating scale (NRS). The secondary outcomes were morphine consumption, perioperative complications, length of hospital stay, and functional outcome. Results: During the first 24 h preoperative period after admission, the IA MDI group exhibited a significant reduction in the average NRS at all timepoints (p < 0.05 all) and in the median dosage of morphine consumption (0 mg vs. 6 mg, p = 0.033) compared to the control group. There was no significant difference between groups in terms of postoperative pain and complications, length of hospital stays, or functional outcomes (p > 0.05 all). Conclusions: Preoperative IA MDI significantly reduced pain intensity and opioid consumption during the preoperative 24 h window among elderly patients with FNFs without provoking a corresponding increase in observed complications in this pilot randomized controlled study. IA MDI is a feasible option and could be a useful adjunct for preoperative pain management for FNFs. Full article

Disaggregating end-use electricity consumption from aggregate meter data remains a fundamental challenge in non-intrusive load monitoring, particularly in smart buildings where heating, ventilation, and air-conditioning systems dominate demand and direct sub-metering is often unavailable. Contextual variables such as weather and calendar information provide valuable explanatory signals, but in low-frequency settings, these drivers are typically insufficient to fully characterise building operation. As a result, attribution strategies that implicitly assume complete explainability can lead to unstable driver contributions and reduced physical interpretability when building behaviour is non-stationary or partially unobserved. This paper introduces MD-ADD, a multi-driver automatic dependency disaggregation framework designed for low-frequency smart meter data in commercial and public buildings. The framework supports joint attribution of multiple contextual drivers. It explicitly represents unexplained energy as a meaningful component of the decomposition. It combines robust baseline estimation, leakage-resistant out-of-fold contextual modelling, conservative driver attribution without hard mass-balance constraints, and uncertainty quantification using block bootstrap resampling. A consistency mechanism is included to restrict driver attributions to temporal scales compatible with their expected physical influence. The framework is evaluated on the ADRENALIN Load Disaggregation Challenge dataset, which contains multi-resolution electricity and weather data from commercial and public buildings, using normalized mean absolute error alongside stability and residual-structure diagnostics. Rather than optimising solely for pointwise accuracy, the proposed formulation emphasises robustness, interpretability, and diagnostic transparency, making it suitable for decision-support and analytical workflows under realistic low-frequency monitoring conditions. Full article

Background: Cerliponase alfa is an intracerebroventricular (ICV) enzyme replacement therapy (ERT) and the only approved treatment for neuronal ceroid lipofuscinosis type 2 (CLN2) disease. While generally well tolerated, infusion-associated reactions (IARs), including hypersensitivity events and anaphylaxis, remain a recognized safety consideration. Methods: This single-center, retrospective study describes the incidence and management of IARs in pediatric patients with CLN2 receiving long-term ICV cerliponase alfa at Great Ormond Street Hospital, London, United Kingdom. Results: Over a 10-year period (2014–2024), 31 patients received approximately 2705 ICV infusions. Eleven patients experienced at least one IAR. Most reactions were mild and transient, typically consisting of pyrexia, vomiting, or rash, and were managed conservatively with antipyretics and antihistamines. Four patients required steroid intervention following recurrent or more pronounced symptoms, which led to improved infusion tolerance. One patient experienced a single episode of anaphylaxis that required treatment with intramuscular adrenaline and intravenous hydrocortisone. Therapy was continued with a revised pre-medication regime, with no further severe reactions. Conclusions: These findings demonstrate that IARs to ICV cerliponase alfa are typically mild and readily manageable within a multidisciplinary framework. They highlight the importance of structured infusion protocols, vigilant monitoring strategies, and a coordinated management approach to ensure the long-term safety of ERT for children with CLN2 disease. Full article

Background/Objectives: Anaphylaxis is a rare occurrence in dental practice, yet when it happens, it demands swift management, as untreated cases can be fatal. The aim of this study is to evaluate the level of knowledge among dental students and residents regarding the symptoms and management of anaphylactic emergencies in dental surgery. Methods: The study involved a sample of 236 students from the 3rd and 5th years, and residents in their 1st and 2nd years of the General Dentistry programme at the Faculty of Dental Medicine in Iași, Romania. The response rate to the invitation was 85.8%. Knowledge was assessed using a self-administered questionnaire consisting of 18 questions organised into three sections, which were tested for internal consistency, yielding a Cronbach’s alpha value of 0.731. Results: Statistically significant differences in the responses provided by the three categories of participants were observed for the following items: management of patients with an allergic background (p = 0.033), factors aggravating allergic predisposition (p = 0.001), the correct dose of epinephrine (p = 0.001), secondary medication (p = 0.001), and the timing of treatment initiation (p = 0.009). Questions where answers indicated moderate to low levels of knowledge (25–50% correct answers) concerned the therapeutic approach for patients with an allergic background, the site of adrenaline administration, and secondary medication. Conclusions: Overall, it can be observed that students demonstrated a high level of knowledge in questions related to the symptomatology of anaphylaxis and the therapeutic management of allergic patients, whereas residents showed better performance in questions addressing the therapeutic management of anaphylaxis. However, significant knowledge gaps were identified across all participant categories, suggesting that there must be periodic supplementary training. Full article

Differences in metabolic traits between traditional and modern pig breeds may influence their physiological responses to stress hormones. This study evaluated the in vivo metabolic effects of an acute adrenaline challenge in Iberian (obese, slow-growing) and Landrace (lean, fast-growing) pigs (Sus scrofa domesticus). Four Iberian and five Landrace barrows (≈50 kg body weight; BW) fitted with a carotid catheter received an injection of adrenaline (3 µg/kg BW), and serial blood samples were collected for 105 min. Adrenaline transiently increased plasma glucose (p < 0.001) and lactate (p < 0.001) concentrations, both peaking at 5 min post-injection. Iberian pigs showed higher plasma lactate (1.26 vs. 1.03 mM; p = 0.002), triglycerides (0.34 vs. 0.27 mM; p < 0.001), and non-esterified fatty acids (NEFA; 0.38 vs. 0.29 mM; p = 0.021), but lower glucose (4.80 vs. 5.03 mM; p = 0.010) than Landrace pigs, while cholesterol remained unaffected (p > 0.10). No breed × time interaction was detected for any metabolite. The relative increase in glucose reached +47% in Iberian and +27% in Landrace pigs, whereas lactate rose +140% and +113%, respectively, indicating stronger glycolytic activation in Iberian pigs. Despite the limited sample size, the results provide physiologically relevant evidence supporting increased metabolic flexibility in Iberian pigs, characterized by a heightened sensitivity to adrenergic stimulation and associated with enhanced lipolytic and glycolytic responses; however, these conclusions should be interpreted within the specific experimental conditions under which the study was conducted. These findings demonstrate that Iberian pigs have higher metabolic sensitivity to adrenergic stimulation, with enhanced lipolytic and glycolytic activity. In conclusion, breed-dependent differences in stress-related metabolism suggest that Iberian pigs are furnished with increased metabolic flexibility to face short-term stress. Full article

Background/Objectives: Hemodynamic and neurohormonal factors, including renal perfusion and venous pressure, may affect diuretic response, which may be modulated by body position. This study aimed to assess whether supine versus upright positioning influences diuretic efficacy and neurohormonal activation during early decongestion in patients with AHF and reduced ejection fraction (HFrEF). Methods: This single-center, prospective, pilot randomized study enrolled 12 hospitalized patients with decompensated HFrEF receiving guideline-directed medical therapy. Participants were randomized (1:1) to remain in either the supine or upright/seated position during intravenous furosemide administration (1 mg/kg: half of the dose administered as a bolus, half as a 2-h infusion). Serial measurements of urine volume, electrolyte excretion, and neurohormonal biomarkers (renin, aldosterone, catecholamines) were performed at baseline, 2, and 6 h after diuretic administration. Results: No significant differences were found between supine and upright groups in total urine output, urine dilution, sodium excretion, or weight change after 6 h. There were no statistically significant differences in renin and aldosterone levels across subsequent timepoints; however, renin concentration tended to be higher in upright than in supine individuals. Interestingly, supine participants demonstrated greater urinary adrenaline concentration after furosemide administration, alone and after adjustment for urinary creatinine. Conclusions: No clinically meaningful differences were found between supine versus upright position patients with AHF, receiving neurohormonal blockade. Full article

Background/Objectives: Evidence-based recommendations are vital in healthcare to standardize care, reduce variability, and improve patient outcomes. In children, anaphylaxis, allergy to antibiotics, and hymenoptera venom allergy are among the commonest reasons for allergological evaluation. This work was intended to optimize the prescriptions for allergological evaluation and for the related diagnostic tests with the aim of improving the management of children with allergic diseases and promoting resource efficiency. Methods: A systematic literature review of the literature was performed to formulate recommendations on the diagnostic management of children with anaphylaxis, drug allergy, and hymenoptera venom allergy. Results: Effective management of anaphylaxis involves rapid assessment and specialist follow-up to identify triggers, prevent recurrence, and ensure patients and caregivers are educated and equipped with an adrenaline auto-injector. Integrating skin testing, specific serological assays, and oral provocation tests into the diagnostic process for children with suspected beta-lactam allergy enhances diagnostic accuracy and minimizes unnecessary avoidance of first-line antibiotics. Children and adolescents with systemic reactions to hymenopteran stings should be referred to an allergy specialist for diagnosis, risk assessment, management education, and adrenaline prescription. Conclusions: These recommendations may enhance care quality, minimize inappropriate prescriptions, and support standardized methods of diagnosis of allergological diseases in children. Full article

The prevalence of food allergy continues to rise worldwide. The allergen profile of affected individuals changes with age: milk, egg, wheat, and soy allergies are more common in early childhood and often resolve before adolescence, whereas peanut, tree nut, fish, and shellfish allergies tend to persist and become more apparent in teenagers. The aim of this narrative review is to discuss the impact of food allergy and elimination diets on the nutritional status, psychological functioning, and quality of life of adolescents. Although an elimination diet remains the main way of treatment, it may lead to the risk of vitamin D, calcium, iron, and protein deficiencies, and potentially to growth disorders. In adolescents, irregular eating habits and poor adherence to dietary recommendations pose additional challenges. The psychological burden of living with food allergy include fear of accidental contact with the allergen, difficulties in peer relationships, and reduced quality of life, particularly in terms of social and emotional functioning. Lack of training in using an adrenaline autoinjector and embarrassment about its use are further risk factors in this age group. Optimal care for adolescents with food allergies requires a multidisciplinary approach, including an allergist, dietitian, and psychologist. Education, psychological support, and gradual development of self-management skills are crucial to improving the safety and quality of life of adolescents with food allergies. Further efforts by medical societies are warranted to advance the development of alternative therapeutic approaches for food allergy, including immunotherapy and biologic therapies, as well as to strengthen public health strategies for individuals affected by food allergies. Full article

Inhibition of glycogen phosphorylases (GP) has been regarded as a therapeutic strategy for blood glucose control in diabetes. In this study, a series of novel dibenzoxazepinone derivatives was synthesized. The in vitro activity screening results indicated that compound Id most significantly inhibited glycogen phosphorylase (GP) activity, with an IC₅₀ of 266 ± 1 nM, which was superior to the positive control drug PSN-357, a Phase II clinical GP inhibitor from Japan’s OSI Corporation. In vivo experiments showed that Id could significantly reduce blood glucose levels in adrenaline-induced acute hyperglycemic mice and high-fat-diet-induced obese and diabetic (DIO) mice. Full article

The ADRENALINE pilot study explores the role of physical activity in health outcomes among patients with Chronic Lymphocytic Leukemia (CLL), focusing on disease markers, functional capacity, immune parameters, and quality of life. This baseline analysis includes treatment-naïve participants enrolled between September 2023 and August 2024, prior to randomization. Eleven patients (aged 47–78 years) underwent assessments of body composition, cardiovascular fitness, muscular strength, and immune profiling. Quality of life was evaluated using validated questionnaires (FACIT-F, EORTC QLQ-30/CLL17), and daily activity was objectively measured via accelerometry. Correlation analyses examined associations between physical activity, muscle strength, lean mass, and physical aptitude. Despite high self-reported physical function, participants demonstrated suboptimal body composition and cardiovascular fitness. Accelerometry revealed marked sedentary behavior, particularly among females, and overall activity levels were below current recommendations. Moderate-to-vigorous physical activity correlated positively with muscular strength and lean mass. Immune profiling identified a variability in key markers, warranting further investigation of their relationship with physical activity. These findings highlight the need for tailored interventions to increase activity and reduce sedentary time in CLL patients and support incorporating functional and immune monitoring into survivorship care. Full article

Background/Objectives: Vortioxetine is a multimodal antidepressant that modulates serotonergic, noradrenergic, and dopaminergic systems, yet its effects on female reproductive physiology remain incompletely defined. This study investigated how short- and long-term vortioxetine exposure influences reproductive function in female rats, integrating measurements of oxidative-stress biomarkers, catecholamines, and endocrine endpoints (prolactin and corticosterone). Methods: Forty-two female Wistar albino rats were randomized into seven groups (n = 6): healthy control; short-term vortioxetine; long-term vortioxetine; and the same two regimens each combined with metyrosine or metyrapone. Metyrosine and metyrapone (50 mg/kg, oral gavage) were given 1 h before vortioxetine (10 mg/kg). Treatments lasted one week (short-term) or four weeks (long-term). Serum MDA, tGSH, SOD, CAT, adrenaline, noradrenaline, dopamine, serotonin, prolactin, and corticosterone were measured. Fertility outcomes were assessed by co-housing females with males for one month. Results: Vortioxetine increased MDA, catecholamines, and serotonin and decreased antioxidant markers and prolactin versus controls (p < 0.001). Long-term vortioxetine produced a marked rise in corticosterone that coincided with infertility and delayed parturition. Metyrosine lowered oxidative stress and catecholamines but did not reverse infertility. In contrast, metyrapone blunted corticosterone elevation and preserved reproductive capacity. Conclusions: Long-term vortioxetine induced infertility in female rats, likely mediated by corticosterone elevation consistent with hypothalamic–pituitary–adrenal axis dysregulation. These findings suggest the need to monitor reproductive risk when considering vortioxetine in women of reproductive age and warrant further mechanistic and translational studies. Full article