Relationship between recurrent croup and airway hyperreactivity

The relationship between recurrent croup and bronchial asthma was evaluated by measuring bronchial hyperreactivity (methacholine challenge), physiologic parameters of upper airway obstruction, and skin response to environmental allergens. Patients with recurrent croup (n = 10) had a significantly higher degree of airway hyperreactivity and atopy than healthy children (n = 15), but significantly less than the patients with bronchial asthma (n = 30). No physiologic signs of upper airway obstruction could be detected at rest or following methacholine. It is suggested that bronchial asthma and recurrent croup share a few characteristics.     

Effect of endothelin-1 on alpha-smooth muscle actin expression and on alveolar fibroblasts proliferation in interstitial lung diseases

Endothelin-1 (ET-1) is a potent constrictor and mitogen peptide which is expressed in several pulmonary diseases. To elucidate the involvement of ET-1 in lung interstitial pathologic events, we assessed ET-1 secretion by alveolar macrophages (AM) and fibroblasts recovered from the bronchoalveolar lavage (BAL) of patients with idiopathic pulmonary fibrosis (IPF), sarcoidosis (SA) and from control subjects. We characterized in vitro alveolar fibroblasts of all subjects using monoclonal antibody specific to alpha-smooth muscle actin (alpha-SM actin) and human fibroblast marker. We also examined the effect of ET-1 on the fibroblasts' mitogenesis and on their cytoskeletal phenotype. The AM recovered from IPF patients showed increased spontaneous secretion of ET-1 compared with cells from SA and control subjects. The expression of alpha-SM actin in the fibroblasts from IPF patients was significantly higher than in SA fibroblasts and normal lung fibroblasts. Assessing alveolar fibroblasts purity revealed a negative staining for alpha-SM actin in all SA and control fibroblasts, while alveolar fibroblasts recovered from IPF were 100% positive for alpha-SM actin, a reliable differentiation marker of myofibroblastic cells. Exposure of SA alveolar fibroblasts to ET-1 resulted in an increased expression of alpha-SM actin. Addition of exogenous ET-1 to alveolar fibroblasts culture stimulated DNA synthesis and proliferation in all groups. Moreover, neutralization of ET-1 by monoclonal antibody was shown to decrease 3H-thymidine incorporation in fibroblasts cultured with AM supernatants. These results suggest possible interactions between AM, myofibroblasts and fibroblasts in interstitial lung diseases (ILD). By modulating alpha-SM actin expression and exertion of the mitogenic effect on alveolar fibroblasts, ET-1 might play an important role in the fibrogenesis of ILD.     

Reproductive Rights Denied: The Hyde Amendment and Access to Abortion for Native American Women Using Indian Health Service Facilities

Restrictions on the use of federal funds to provide abortions have limited the access to abortion services for Native American women receiving care at Indian Health Service facilities. Current data suggest that the vast majority of Indian Health Service facilities are unequipped to provide abortions under any circumstances. Native American women experience disproportionately high rates of sexual assault and unintended pregnancy. Hyde Amendment restrictions systematically infringe on the reproductive rights of Native American women and present a pressing public health policy concern.Unlike many cultures in which access to abortion is limited, gender norms in Native American cultures traditionally support and respect women’s autonomy with regard to reproductive health decisions. In more recent times, federal regulation and deepening social problems have largely usurped Native American women’s control over their reproductive health.Active colonization of Native American communities and lands has not only marginalized traditional healing practices and resulted in devastating poverty but also disrupted traditional family structures and matriarchal gender norms, leading to high rates of sexual assault, intimate partner violence, and unintended pregnancy.1For many Native American women living in the United States, Indian Health Service (IHS) facilities are the primary source of reproductive health care.2 Made possible by the 1921 Snyder Act,2 federal funds are used to provide free health services for 1.9 million American Indians and Alaska Natives (AI/ANs) belonging to 564 federally recognized tribes in 35 states.3 Because it receives federal dollars, however, the IHS is subject to congressional regulation of the provision of abortion services, as stipulated under the Hyde Amendment.2,4,5Passed in 1976 and amended in 1993, the Hyde Amendment bans the use of federal funds for abortion services, except in cases of pregnancies resulting from rape or incest or those that pose a threat to the mother’s life.4,6 IHS regulations codified Hyde Amendment restrictions in 1982 and were then updated in 1996 to match the current amendment.7 Because the IHS is often the sole provider of reproductive health services for Native populations, Hyde Amendment restrictions effectively deny Native American women access to full-scope women’s health care that includes access to abortion.     

Erythromycin inhibits respiratory glycoconjugate secretion from human airways in vitro

Erythromycin and other antibiotics have been used empirically in the treatment of patients with chronic obstructive pulmonary disease (COPD). We studied whether this empirical role of antibiotics might not be related to a possible direct effect on respiratory glycoconjugate (RGC) secretion. The effect of erythromycin on RGC secretion and hypersecretion was studied in an in vitro preparation of human airways that were secreting [3H]glucosamine respiratory glycoconjugate (RGC), and on a human endometrial adenocarcinoma cell line secreting a glycoconjugate (tumor glycoconjugate = TGC) chemically similar to the RGC secreted by the airways. Erythromycin at 10(-5) M reduced RGC secretion by 35 +/- 4% (n = 9, p less than 0.001) in both human airways and the adenocarcinoma cells, and was increasingly active in the pharmacologic range of 10(-7) to 10(-4) M. The inhibitory effect of erythromycin was maximal within 16 h and was still evident 34 h after incubation. Erythromycin was noted to reduce both spontaneous (baseline) and stimulated RGC secretion (by histamine and methacholine) from airways in culture. The blocking effect appeared to be more selective for histamine than methacholine. These effects were not associated with any toxicity to the tissues and were not associated with the inhibition of protein synthesis. Dexamethasone also inhibited RGC release in both assay systems and exhibited dose-related effects in the physiologic ranges (10(-9) to 10(-5) M). When administered together, erythromycin and dexamethasone had an additive inhibitory effect on RGC secretion (68.0 +/- 3.0%, n = 7, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of specific allergen sensitization on the prevalence of asthma in patients with allergic rhinitis from adjacent distinct geographic areas

BACKGROUND: Patients with allergic rhinitis (AR) and perennial allergen sensitization are at increased risk for asthma. OBJECTIVES: To determine the allergic profile of patients with clinical AR in regions of the coastal Mediterranean compared with the inland southern desert area of Israel and the impact of specific allergen sensitization on the prevalence of asthma in these patients. METHODS: Retrospective evaluation of medical records from patients referred for evaluation during 2002 and 2003 to the allergy clinics of 3 medical centers located in different geoclimatic areas. RESULTS: A total of 479 patients with AR were included (64% from the humid Mediterranean coast and 36% from the arid desert area), with a mean age of 32.8 years (range, 6-84 years). Sixty percent of the patients were male, and 33% had an additional diagnosis of asthma. Mite sensitization was 84%; cockroach, 34%; trees, 43%; weeds, 40%; grasses, 53%; and fungi, 30%. There were no significant differences in the prevalence of sensitization to any of the evaluated allergens except for weeds, which was higher in the arid region. A diagnosis of asthma was significantly associated with mite sensitization in the Mediterranean area (odds ratio, 2.24; 95% confidence interval, 1.14-4.4; P = .02) and mold sensitization in the arid climate zone (odds ratio, 2.18; 95% confidence interval, 1.05-4.6; P = .04). CONCLUSION: Although sensitization to mites is high in the coastal areas and in the Negev desert-like environment, the presence of asthma in patients with AR is associated with mite sensitization in the humid environment but with fungal sensitization in the more arid environment.