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Primary Prevention of Allergy – Is It Feasible?
Ng Pauline Poh-Lin Chan,Tham Elizabeth Huiwen,LEE Bee Wah 대한천식알레르기학회 2023 Allergy, Asthma & Immunology Research Vol.15 No.4
The allergy epidemic has been attributed to environmental influences related to urbanization and the modern lifestyle. In this regard, various theories exploring the role of microbes (hygiene, old friends, microbiota, and biodiversity hypotheses), and the epithelial barrier (epithelial, dual allergen exposure and vitamin D hypotheses) have been proposed. These hypotheses have guided clinical studies that led to the formulation of intervention strategies during the proposed window of opportunity dubbed as the “first thousand days.” The most significant intervention is a paradigm shift from allergen avoidance to early introduction of allergenic foods, particularly egg and peanut, around 6 months of age for the prevention of food allergy. This recommendation has been adopted globally and included in allergy prevention guidelines. Other strategies with less robust clinical evidence include: encouraging a healthy balanced diet, rich in fish, during pregnancy; continuing allergenic food intake during pregnancy and lactation; vitamin D supplementation in pregnant women with asthma; discouraging social indications for caesarean section delivery; judicious use of antibiotics in early childhood; daily emollient use from birth in high risk babies; and avoiding cow’s milk formula use in the first week of life. However, if early supplementation with cow’s milk formula is required, continuing at least 10 mL of formula daily until age 2 months may be considered. Translating these strategies to public health and clinical practice is still a work in progress. Long-term population studies are crucial to assess the feasibility of these measures on allergy prevention.
S-204 : Coronary artery intramural hematoma following stent implantation
( Ji Hyun Kim ),( Min Kim ),( Eun Bee Kim ),( Ju Hee Lee ),( Sang Yeub Lee ),( Jang Whan Bae ),( Kyung Kuk Hwang ),( Dong Woon Kim ),( Myeong Chan Cho ),( Sang Min Kim ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
An intramural hematoma formation is a rare complication of percutaneous coronary intervention (PCI). A 72 year-old woman who has treated for rheumatoid arthritis (RA) transferred to our hospital due to suspicious acute coronary syndrome with resting chest pain for 6 hours. Emergent coronary angiogram (CAG) showed 3 narrowed coronary arteries of which culprit lesion was a right coronary artery (RCA). After predilatation with conventional balloon, drug eluting stents (DES) 3.0×28 mm for proximal RCA and 2.75×28 mm for distal RCA were implanted. After implantation of a distal stent, no-reflow phenomenon was developed. Although an improvement was observed in the TIMI flow grade from grade 0 to grade 2 after injection of nicorandil, and abciximab, PCI for other residual lesions was withheld. After 3 days, she was discharged and readmitted for elective PCI for residual lesions because of exertional chest pain 1 month later. CAG showed left anterior descending artery (LAD) was concerned about an only target at first, because of complexity of mid LAD. After implantation of 2.75×23 mm DES for proximal LAD, a type B dissection was developed just below the distal edge of stent. Therefore, additional DES implantation should be considered for dissecting lesion. Although 2.75×23 mm DES for mid LAD was implanted by dual wire support, fluoroscopy showed the staining of dye with luminal narrowing in LAD ostium during positioning of stent for implantation which was suspicious of new formation of dissection. Therefore, intravascular ultrasound (IVUS) was performed and identified differentially not a dissection but an extensive coronary intramural hematoma (CIH). An additional 3.0×18mm DES was implanted for CIH of LAD ostium. Followed IVUS revealed the lumen was preserved and size of CIH was decreased. After PCI, the patient was followed without symptoms. We present a case who had several critical complications especially CIH during sequential PCI and IVUS-guided differential diagnosis and additional stent implantation was successful.