Constantine Saadeh

Peripheral ulcerative keratitis in the setting of rheumatoid arthritis: Treatment with immunosuppressive therapy

Peripheral ulcerative keratitis (PUK) is a rare but serious inflammatory eye condition that can complicate rheumatoid arthritis. PUK can be a warning sign of impending vasculitis, and cytotoxic therapy may be necessary to induce remission. We have encountered three patients with PUK in the past year. Two patients had long-standing quiescent rheumatoid arthritis who developed photophobia. Diagnosis was made by slit lamp examination. Treatment with local cyclophosphamide and prednisone resulted in prompt remission of the ulcer within 8 weeks. Cytotoxic therapy was discontinued altogether within 6 months. The third patient was also treated successfully with oral steroids and azathioprine. In all patients, sicca was noted. None of them had any evidence of systemic vasculitis. PUK, when recognized early and treated aggressively, can result in remission of the ulcer and in the prevention of vasculitis. Keratoconjunctivitis sicca can accompany PUK independent of the activity of rheumatoid arthritis.

Asthma Remission in a Patient with Rheumatoid Arthritits While on Antiangiogenesis Therapy During a Rheumatoid Arthritis Trial Demonstrated by Forced Oscillation and Spirometry

Asthma is a chronic inflammatory condition. An integral part of the inflammation is angiogenesis (neovascularization). This report describes a patient with rheumatoid arthritis (RA) and moderately severe asthma despite maintenance on inhaled corticosteroids (ics) and intermittent systemic steroids (ss). While enrolled in a clinical trial for RA employing MEDI-522 (Vitaxin), her asthma symptoms remitted substantially, with significant improvement in spirometry and airflow resistance measured by forced oscillation. The patient was able to discontinue ics and required no ss while taking MEDI-522. After termination of the clinical trial, the patients asthma symptoms again increased and required reinstitution of ics for control.

Advantage of impulse oscillometry over spirometry to diagnose chronic obstructive pulmonary disease and monitor pulmonary responses to bronchodilators: An observational study

Objectives: This retrospective study was a comparative analysis of sensitivity of impulse oscillometry and spirometry techniques for use in a mixed chronic obstructive pulmonary disease group for assessing disease severity and inhalation therapy. Methods: A total of 30 patients with mild-to-moderate chronic obstructive pulmonary disease were monitored by impulse oscillometry, followed by spirometry. Lung function was measured at baseline after bronchodilation and at follow-up (3–18 months). The impulse oscillometry parameters were resistance in the small and large airways at 5 Hz (R5), resistance in the large airways at 15 Hz (R15), and lung reactance (area under the curve X; AX). Results: After the bronchodilator therapy, forced expiratory volume in 1 second (FEV1) readings evaluated by spirometry were unaffected at baseline and at follow-up, while impulse oscillometry detected an immediate improvement in lung function, in terms of AX (p = 0.043). All impulse oscillometry parameters significantly improved at follow-up, with a decrease in AX by 37% (p = 0.0008), R5 by 20% (p = 0.0011), and R15 by 12% (p = 0.0097). Discussion: Impulse oscillometry parameters demonstrated greater sensitivity compared with spirometry for monitoring reversibility of airway obstruction and the effect of maintenance therapy. Impulse oscillometry may facilitate early treatment dose optimization and personalized medicine for chronic obstructive pulmonary disease patients.

Retrospective Observations on the Ability to Diagnose and Manage Patients with Asthma through the Use of Impulse Oscillometry: Comparison with Spirometry and Overview of the Literature

Objective. Impulse oscillometry (IOS) is an evolving technology for the diagnosis and followup of patients with asthma. Our objective is to review the findings on patients who underwent both spirometry and IOS during clinical evaluations of their asthma. The goal was to retrospectively evaluate IOS during the initial diagnosis and followup of patients with asthma in comparison with spirometry. Methods. We routinely perform IOS and spirometry evaluation in patients with suspected asthma during baseline visits and at followup. We reviewed the data on 39 patients over the age of 13 with asthma at baseline and following treatment with inhaled corticosteroids. IOS and spirometry were both done at baseline, following short acting bronchodilator administration, and at followup after at least three months of inhaled corticosteroid treatment. Results. IOS showed improvement in airway function both initially, following short acting bronchodilator introduction, and later after initiation of long term inhaled corticosteroid treatment, even when the spirometry did not reveal improvement. We noted the IOS improvement in the reactance or AX as well as the resistance in smaller airways or R5. Conclusion. IOS may provide a useful measure towards identifying an asthma diagnosis and followup without inducing the extra respiratory effort spirometry requires.

Color Doppler ultrasound of the hand: observations on clinical utility in rheumatoid arthritis.

The use of ultrasound with color Doppler in the evaluation of rheumatoid arthritis was followed in 25 patients with joint complaints. Small joint ultrasound of the metacarpophalangeal joints (MCPs) as well as the wrists was performed with supplementation by color Doppler. In addition, 6 patients were followed for at least 3 months after start of treatment of rheumatoid arthritis using the same technique. In patients with what appeared to be definite rheumatoid arthritis, ultrasound supported this diagnosis as evidenced by the finding of cortical defects, extensor tendon sheath thickening, and synovial proliferation. Increased activity by color Doppler ultrasonography was the most common finding. Significant decrease in color Doppler activity was noted in the 6 patients who were followed up after 3 months of therapy with disease-modifying agents. Therefore, the use of ultrasound with color Doppler could aid in the diagnosis and follow up of patients with rheumatoid arthritis.

Aeroallergen survey of the Texas panhandle using a burkard volumetric spore trap

Our objective is to survey the type and concentration of pollen and spores on a daily basis and correlate these concentrations with both the weather on a part icular day and the incidence of allergic reactions. Aeroallergens are often the cause of serious allergic and asthmatic reactions, affecting millions of peopl e each year. The analysis of air was performed through the collection of pollen and spores using a Burkard Volumetric Spore Trap. We mounted the trap on the f lat roof of the Agriculture and Natural Sciences building of West Texas AM University in Canyon, Texas. This area has adequate exposure to the prevailing winds of West Texas, and is above the trees of the surrounding community. Collection and transfer of the pollen sampling tape takes place at the same time, 9:00 a.m. CDT, on a daily basis. Tapes are analyzed with a minimum of five latitudinal traverses, and daily concentration is assessed. The most significant aeroallergens present during these summer months were fungal spores like Alternaria, ascospores, Cladosporium, Dreschlera, Curvularia, and pollens like short ragweed (Ambrosia artemisiifolia ), Pine (Pinus) (Figures 1 A−F), pollens from Asteraceae ( Helianthus ciliaris, Helianthus annuus, Helianthus hirsutus ), from Solanaceous plants (Solanum rostratum, Solanum elaeagnifolium ) and from Chenopodiacae (Chenopodium album ) (Figures 2 A−F). Temperature was found to have an inverse relationship with mold spores. Rainfall was found to affect the mold count directly, with increases in precipitation bringing subsequent higher mold spore concentrations. The number of reported cases of allergic rhinitis increased proportionally to the increases in overall allergen counts. Most significant was the increase in number of patients corresponding with increases in mold and A. artemisiifolia counts. Figure 1 A−F. Showing the Most Frequent Allergens of the Texas Panhandle. Fungal Spores: A. Alternia sp., B. Cladosporium sp., C. Drechslera sp., D. Culvularia sp., Pollens: E. Ambrosia artemisiifolia, F. Pinus sylvestris Abstract (cont.) Figure 2 A−F. Showing the most frequent allergens of the Texas Panhandle. Pollens: A. Helianthus ciliarus, B. Helianthus annuus, C. Helianthus hirsutus, D. Solanum rostratum, E. Solanum elaeagnifolium, F. Chenopodium album

Increase in 2.5 Micron Airborne Particulate Matters, AHPCO® and Plasma Nanotechnology in Reducing the Symptoms of Asthma and Allergic Rhinitis

This study explored the food expenditure patterns of college students. Information on monthly food expenditures and income from a sample of students was used to estimate the proportion of income that the average student spends on food and analyze the Engel relation between food expenditures and income. The average college student was found to spend about 30 percent of income on food. The estimated marginal share is 0.076. These findings indicate that food and related establishments that sell mostly to college students will receive very little of any potential increases in student income. However, increases in student income may be a boon for businesses that sell non-food items.European integration is one of the most demanding processes for Kosovo institutions and society. While citizens of Kosovo overwhelmingly support membership in the European Union, assessment reports specify that Kosovo and its institutions still need serious reform to achieve this goal. The integration process offers mechanisms that civil society namely NGO sector can use in order to monitor and give direct contribution for this process, which could also impact to transform Kosovo institutions and society. The Annual Progress Report of the European Commission requires from governments and institutions of countries aspiring for integration to the EU to pursue sound governance practices that allow civil societies to have an impact on policy and decision-making processes. Relying on this requirement, NGOs can use the process as a way to shape the organization and function in their society and institutions. At this stage the role of Kosovo NGO’s whose focus is political activism that tends to increase demands for democratic participation in the political system is more than needed. These NGO’s apart from monitoring role towards the Government, they can become one of the main partners for EU Integration Process, especially to the European Commission (EC). The aim of this paper is to analyze the role of NGO’s as part of civil society in the whole process of EU integration and current possibilities for improving their capacities and contributions towards the public policy and decision making process.Psychological contract is composed of employees’ beliefs about what they owe to the organization and what does the organization owe to them in return. However, the psychological contract which is supposed to be between employee and employer and exists in employee’s mind as mutual obligations; is sometimes broken and damaged. When the employer does not fulfill or delayed in fulfilling some obligations, these obligations being either obviously promised or implied, the employee thinks that psychological contract is breached. Organizational cynicism is seen at the employee who perceives a psychological contract breach as a reaction behavior. Organizational cynicism is defined as the negative attitude of an employee towards the organizations (s)he is employed by; which is composed of believing that the organization lacks integration, negative feelings towards the organization, and consistently, humiliating and hypercritical behavior tendency. Organizational cynicism has three dimensions called cognitive, affective and behavioral. In this context, the objective of the research is to reveal the effects of psychological contract breach which is gaining importance for organizations; on organizational cynicism and its dimensions. The data collection method of the research is determined as a survey, and the universe is restricted as research assistants working in a state university. According to the descriptive analysis results, the level of psychological contract breach and organizational cynicism levels of research assistants are low. According to analysis results, psychological contract breach effects both organizational cynicism and its dimensions. Consequently, organizational cynicism increases while psychological contract breach increases.The Albanian labour market has changed drastically during the last two decades as a result of technological developments, labour force mobility, structural unemployment etc. New skills are required by firms and many types of skills turned to be obsolete and no longer in demand. The article tries to analyze the situation in the Albanian labour market, in order to identify the actual trend and to explain theoretical reasons and determinants that cause it. Using Labour Force Survey data it’s aimed an empirical model to evaluate the determinants of employees’ participation in vocational training in Albania. Based on the empirical literature such determinants can be person related, job related, and employer related. The findings from this paper will be compared with findings from the literature in order to see differences and similaritiesare.Human capital theory states that the incidence of training should be higher among men than women. Literature have confirmed it in different empirical studies. Recently, there is a small number of studies that have reported the reversed trend: women are now more likely to participate in training than their male counterparts. Using Labour Force Survey data we present a descpritive analysis to evaluate if there are evidences of discrimination; if it’s measurable and which are the determinants of vocational training of men and women employees in the Albanian labor market. Determinants such as improvements in the labour market status of women (Vanden Heuvel, 1997) increased labour force participation rates among women (Green and Zanchi, 1997) are detected in the paper. This paper should be seen as a actual scan of Albanian labour market in context of vocational training incidence and evidences of discrimination among gender.Nine-Year Schooling is the new educational concept developed in Mauritius by the Ministry of Education and Human Resources with the perspective of favouring holistic learning aimed at the future of the Mauritian workforce. With its main intention of being a strategy that aligns Mauritius with international learning standards, this concept should be an effective one although its outcomes have not yet been developed. It is expected that higher learning might be affected by the inputs of the NineYear Schooling namely in terms of competences and skills that are likely to be developed by learners in the new system. This research work analyses how Nine-Year Schooling will impact higher education in terms of prerequisites developed by existing learners, the new paradigm of secondary school education and the new challenges of tertiary education. It also analyses the challenges that the Nine-Year Schooling might pose to higher education. Assuming that outcomes are not yet available, the research seeks expert advice from various stakeholders and a panel of expert opinion to see how the Nine-Year Schooling posits itself in the future and how universities will have to embrace such a new concept.

Proceedings of the 2015 WAO Symposium on Food Allergy and the Microbiome

Table of contentsA1 Characterization of the immunoallergic profile towards the proteins of the wheat flour in Cuban populationRaúl Lázaro Castro Almarales, Mary Carmen Reyes Zamora, Beatriz Tamargo, Damaris Torralba Averoff, Raysa Cruz, Yunia Oliva Diaz, Mirta Alvarez Castello, Alexander Ciria, Alexis Labrada, Maytee MateoA2 Are peanuts causing food allergy in Cuba?Maytee Mateo, Damaris Torralba Averoff, Raysa Cruz, Yunia Oliva Diaz, Mirta Alvarez Castello, Alexander Ciria, Mary Carmen Reyes Zamora, Beatriz Tamargo, Alexis LabradaA3 Prick test and immunoallergic profile to soy allergens in Cuban populationOmar Herrera, Maytee Mateo, Raysa Cruz, Mirta Alvarez Castello, Alexander Ciria, Raúl Lázaro Castro Almarales, Mary Carmen Reyes Zamora, Alexis LabradaA4 Skin sensitization and immunoallergic profile to hens egg in Cuban populationJosé Severino Rodríguez Canosa, Raysa Cruz, Maytee Mateo, Mirta Alvarez Castello, Alexander Ciria, Raúl Lázaro Castro Almarales, Mary Carmen Reyes Zamora, Alexis LabradaA5 Sensitization to three domestic mites in patients with adverse food events to shellfishMirta Alvarez Castello, Raúl Lázaro Castro Almarales, Alexis Labrada, BiocenA6 Diagnostic efficacy by skin prick test with allergenic extracts of legumes in Cuban patientsYamilet Ibizate Novales, Ilonka Estruch Fajardo, Alexis Labrada, Maytee Mateo, Armando GinardA7 Baked egg goods without wheat flour carry an increased risk of reactionBruce Lanser, Anna Faino, Erwin Gelfand, Pia HaukA8 Prevalence, incidence and associated risk factors of adverse reaction to food in Cuban infants - a population-based prospective studySilvia Venero Fernández, Julia Urbina, Mirta Alvarez Castello, Raúl Lázaro Castro Almarales, Ramón Suárez Medina, Hermes Fundora Hernández, John Britton, Andrew William FogartyA9 Microbiome in ice machines and assessing the plasma nanotechnology in breaking the biofilm and improving air qualityNabarun Ghosh, Clinton Ross Bell, Chandini Revanna, Constantine Saadeh, Jeff Bennert, Danius Bouyi, Mitsy Veloz, Nelofar SheraliA10 Characteristics of patients with food allergy in health public serviceMagna CoelhoA11 Allergic rhinitis and asthma index increased in Texas panhandle and AHPCO and plasma nanotechnology as solutionsNabarun Ghosh, Jeff Bennert, Danius Bouyi, Constantine Saadeh, Clinton Ross Bell, Mitsy Veloz, Chandini Revanna, Nelofar SheraliA12 Antigen-specific T follicular helper cells mediate peanut allergy in miceJoseph J. Dolence, Takao Kobayashi, Koji Iijima, Hirohito Kita, Hirohito Kita, Ashli Moore, James KrempskiA13 Production of recombinant Mal d 3, a major apple allergen, in Pichia Pastoris, to investigate the impact of the food matrix and post-translational modifications on Mal d 3 immuno-reactivityRoberta Aina, Riccardo Asero, Sabine Pfeifer, Pawel Dubiela, Merima Bublin, Christian Radauer, Piotr Humeniuk, Karin Hoffmann-SommergruberA14 Reaction to sports drink: no whey! Whey allergy in absence of clinical cow’s milk allergyFrank Eidelman, Ves Dimov, Charl KhalilA15 Food allergy on Tumblr: focus on teenage audience may increase educational impactVes Dimov, Frank Eidelman, Charl KhalilA16 Changes in IgE levels following one-year immunizations in two children with food allergyAlice E. W. Hoyt, Peter Heymann, Alexander Schuyler, Scott Commins, Thomas Platts-MillsA17 IgE and IgG4 antibodies to cows milk components in children with eosinophilic esophagitis: higher specific IgG4 antibodies and IgG4:IgE ratios compared with subjects with IgE-mediated food allergyAlexander Schuyler, Patrice Kruszewski, John Russo, Lisa Workman, Thomas Platts-Mills, Elizabeth Erwin, Anubha TripathiA18 Frequency of Sensitization to Food Allergens in Patients with Rhinitis and Asthma in the National Medical Center La Raza “Dr. Antonio Fraga Mouret”, Mexico CityGabriela Yvette Castellanos, Elizabeth Mendieta, Martín Becerril-Angeles

Characterization of aeroallergen of Texas panhandle using scanning and fluorescence microscopy

Aeroallergens cause serious allergic and asthmatic reactions. Characterizing the aeroallergen provides information regarding the onset, duration, and severity of the pollen season that clinicians use to guide allergen selection for skin testing and treatment. Fluorescence Microscopy has useful approaches to understand the structure and function of the microscopic objects. Prepared slides from the pollen were observed under an Olympus BX40 microscope equipped with FITC and TRITC fluorescent filters, a mercury lamp source, an Olympus DP-70 digital camera connected to the computer with Image Pro 6.0 software. Aeroallergens were viewed, recorded and analyzed with DP Manager using the Image Pro 6.0 software. Photographs were taken at bright field, the fluorescein-isothiocyanate (FITC) filter, and the tetramethylrhodamine (TRITC) filter settings at 40X. A high pressure mercury lamp or UV source was used to excite the storage molecules or proteins which exhibited autofluorescence. The FITC filter reveals the green fluorescent proteins (GFP and EGFP), and the TRITC filter for red fluorescent proteins (DsRed). SEM proved to be useful for observing ultra-structural details like pores, colpi, sulci and ornamentations on the pollen surface. Samples were examined with an SEM (TM-1000) after gold coating and Critical Point Drying. Pollen grains were measured using the TM-1000 imaging software that revealed the specific information on the size of colpi or sulci and the distance between the micro-structures. This information can be used for classification and circumscription in Angiosperm taxonomy. Data were correlated clinical studies established at Allergy A.R.T.S. Clinical Research Laboratory.