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Background: To determine the relationship between physiological fatigue and the quality of cardiopulmonary resuscitation (CPR) in trained resuscitators in hostile thermal environments (extreme cold and heat) simulating the different conditions found in an out-of-hospital cardiorespiratory arrest. Methods: Prospective observational study involving 60 students of the health sciences with training in resuscitation, who simulated CPR on a mannequin for 10 min in different thermal environments: thermo-neutral environment (21 &deg, C and 60% humidity), heat environment (41 &deg, C and 98% humidity) and cold environment (&minus, 35 &deg, C and 80% humidity). Physiological parameters (heart rate and lactic acid) and CPR quality were monitored. Results: We detected a significant increase in the number of compressions per minute in the &ldquo, heat environment&rdquo, group after three minutes and in the mean rate after one minute. We observed a negative correlation between the total number of compressions and mean rate with respect to mean depth. The fraction of compressions (proportion of time in which chest compressions are carried out) was significant over time and the mean rate was higher in the &ldquo, Physiological parameters revealed no differences in heart rate depending on the resuscitation scenario, however, there was a greater and faster increase in lactate in the &ldquo, (significant at minute 3). The total proportion of participants reaching metabolic fatigue was also higher in the &ldquo, Conclusions: A warm climate modifies metabolic parameters, reducing the quality of the CPR maneuver.

Asthma is the most common chronic disease in childhood. The presence of this pathology in children leads to the appearance of different alterations (physical, psychological, social, etc.). Due to their high influence, the aim of this study is to understand these psychological and sociocultural determinants and their impact on the quality of life of asthmatic children. In order to determine the influence of these determinants on quality of life, a narrative review of 48 articles collected in different databases was carried out. Emotions are the most powerful precursor to producing an asthmatic attack. Anxiety and depression are the pathologies that appear frequently associated with childhood asthma, together with Attention-Deficit/Hyperactivity Disorder. In addition, the personality of these children seems to be characterized by shyness and impulsivity, although exceptionally it has been associated with psychopathic behaviors, aggressiveness, and cases of psychosis. School performance is impaired and bullying occurs more frequently. Likewise, dysfunctional family relationships and lower socioeconomic status have a negative impact on the severity and management of asthma. In short, the quality of life of asthmatic children is lower due to the presence of the aforementioned psychological and sociocultural determinants.

Anisakis simplex is a fish parasite responsible for gastrointestinal and allergic symptoms in humans. The Ani s 11-like protein has been proposed as an Anisakis allergen because its primary structure is similar to that of Ani s 11. The aims of this work were to analyse the frequency of detection of the Ani s 11-like protein and assess its diagnostic value.rAni s 11-like protein, rAni s 5 and rAni s 4 were expressed in Escherichia coli and rAni s 1 was produced in Pichia pastoris. Recombinant allergen detection patterns in 37 Anisakis-sensitised patients were determined. The stability to pepsin digestion and heat treatment of rAni s 11-like protein was also analysed by IgE immunoblotting.Ani s 11-like protein is a major allergen detected by 78% of Anisakis-allergic patients, and 13.5% of patients detect only the rAni s 11-like allergen. This allergen is heat stable because it retains its capability of binding IgE after boiling for 30 min and it is resistant to pepsin digestion for 120 min.These data indicate that the Ani s 11-like protein is a pepsin- and heat-resistant major allergen (Ani s 11.0201) of Anisakis spp. and a valuable tool for Anisakis allergy component-resolved diagnosis.

We read with interest the article by Azofra et al regarding off-label treatment of some patients with idiopathic nonhistaminergic acquired angioedema (InH-AAE) with omalizumab. 1 Besides describing the response to omalizumab of some patients with InHAAE, this article opens the discussion on the need to improve the classification of patients with angioedema without wheals. 2 Concerning InH-AAE, Cicardi et al in their consensus report claim that the term bradykinin mediated should be substituted for nonhistaminergic because, although bradykinin is assumed to mediate this type of angioedema, experimental evidence supporting this mechanism is limited. On the other hand, idiopathic acquired angioedema is classified into histaminergic and nonhistaminergic based on the prevention of angioedema by antihistamines. This way, InH-AAE comprises a heterogeneous group of patients with angioedema mediated by bradykinin but also by other mediators, such as cysteinyl leukotrienes, prostaglandins, or platelet-activating factor, and therefore with very different treatment approaches. This classification could lead to misunderstanding because the term nonhistaminergic is not synonymous of an assumed bradykinin-mediated angioedema. When reading the article by Azofra et al, physicians not very familiar with angioedema consensus and guidelines could interpret that bradykininmediated angioedema could be treated with omalizumab. InH-AAE has therefore been described as a heterogeneous group and should not be assumed to be bradykinin mediated. 1,2 The response to omalizumab of some patients with InH-AAE 1 supports that this type of angioedema is not synonymous with idiopathic bradykinergic angioedema. Moreover, it should be clarified which patients with InH-AAE should be treated with immunosuppressors or omalizumab and which ones with bradykinin-targeting drugs. In this regard, clinical characteristics of angioedema and response to corticosteroids or epinephrine in acute episodes should be considered. The patients described by

Since raw egg may cause digestive toxic infections, we assessed whether pasteurized raw egg white is as reliable as fresh raw egg white in the diagnosis of egg allergy.Thirty-two egg-allergic children were challenged with both pasteurized and fresh raw egg white. Open challenges were carried out with increasing doses of pasteurized raw egg white and fresh raw egg white administered every 60 min.Eleven children (34.4%) had positive challenges with pasteurized raw egg white. Twenty-one children (65.62%) who tolerated pasteurized raw egg white also had a negative challenge with fresh raw egg white. If the challenge with pasteurized raw egg white resulted positive, the study was stopped. The protein profile and IgE-binding capacity of both pasteurized and fresh egg white were almost identical as observed by SDS-PAGE and IgE immunoblotting. In the IgE immunoblotting-inhibition and ImmunoCAP-inhibition assays, both extracts behaved in a similar way.We did not find any relevant allergenic differences between fresh and pasteurized egg white. This study supports the use of pasteurized egg white in the diagnosis of allergy to fresh raw egg proteins.