Exhaled Levels Research Articles

Job Stress Can Lead to Intestinal Inflammation and Subsequent Gut-Originated Extraoral Halitosis.

Reports on stress-associated halitosis are scarce and have only focused on intraoral halitosis. This work aimed to study stress-associated extraoral halitosis (EOH) and further investigate its potential association with stress-induced intestinal inflammation. This retrospective study included 664 white-collar employees with self-reported stress-associated halitosis. They underwent the organoleptic score (OLS) to assess halitosis, modified Brief Job Stress Questionnaire (BJSQ) score to assess job stress, OralChroma breath test to measure volatile sulfur compounds (VSCs) in breath, and hydrogen/methane breath test (HMBT) and nitric oxide breath test (NOBT) to detect intestinal inflammation. They were classified into high-stress and low-stress groups based on their modified BJSQ score. Totally, 106 eligible patients were identified as having stress-associated EOH, and 61 of them had high stress. Additionally, 70 (66.04%) and 73 (68.87%) of them tested positive for HMB and NOBT, respectively. Dimethyl sulfide (DMS) was found to be the predominant VSC in breath. High-stress patients had significantly higher positivity rates for HMBT and NOBT, OLS, and exhaled DMS levels compared to low-stress patients. HMBT-positive patients and NOBT-positive patients had significantly higher OLS and exhaled DMS levels compared to their respective negative counterparts. Job stress can lead to intestinal inflammation and subsequent gut-originated EOH.

Photoionization ion mobility analyzer for on-site measurement of exhaled acetone by coupling miniature thermoelectric cooling dehydration

The breath concentration of acetone holds significant clinical importance, the development of on-site and accurate analyzer for exhaled acetone is highly demanded. A photoionization ion mobility analyzer based on a low-pressure krypton discharge lamp has been developed for direct and rapid determination of the acetone concentration. The difficulty for sensitive measurement of acetone by vacuum ultraviolet photoionization was the strong absorption of water molecules in the breath air. An online dehydration device with a miniature thermoelectric cooling quartz trap has been developed, which was capable for reducing the relative humidity from over 90 % to below 1 %. The dehydration could enhance the signal intensity of acetone about 85 times. The response time of current thermoelectric cooling dehydration was only 1/20 of the Nafion tube dehydration. A limit of detection 0.02 ppmV and linear response up to 2.0 ppmV were achieved. The interferences from ammonia in exhaled breath was eliminated using a calibration method based on ion number density, achieving recoveries ranging from 90 % to 110 %. In the final, the variation trends of exhaled acetone level in healthy individuals following the ingestion of glucose under fasting conditions were carried out to demonstrate the potential application of the analyzer.

Could exhaled methane be used as a possible indicator for hemodynamic changes in trauma induced hemorrhagic shock? Scientific basis supported by a case study

IntroductionIdentification of severe blood loss and hemorrhagic shock in polytrauma patients poses a key challenge for trauma teams across the world, as there are just a few objective parameters, on which clinicians can rely. We investigated the relationship between exhaled air methane (CH4) concentration and blood loss in a polytrauma patient. Decreased blood flow in the superior mesenteric artery (SMA) is one of the first compensatory responses to blood loss. Gases produced by the anaerobic flora of the intestinal segment supplied by the SMA are the primary source of exhaled CH4, which diffuses through the intestinal microvessels into the circulation and is finally eliminated through the lungs. We hypothesized that diminution of exhaled CH4 indicates blood loss and tested our theory in a severely injured patient. MethodsExhaled CH4 concentrations of a severely injured patient were measured using a photoacoustic spectroscope (PAS) attached to the exhalation side of the breathing circuit. The primary objective was to investigate the relationship between exhaled CH4 and conventional indicators of hemorrhage including hemoglobin (Hb) levels, base deficit (BD) values and vital parameters (heart rate and systolic blood pressure) in the early phase of in-hospital care (first 4 h). ResultsA severely injured patient was admitted with unstable hemodynamic parameters and incomplete left lower limb amputation, (Injury Severity Score: 38, 74/36 mmHg, 76 bpm). At the time of arrival, considerably lower CH4 levels were detected (22,800 PAU) in the exhaled air. During the first 4 h fluid and massive blood resuscitation, the exhaled CH4 levels were continuously rising in parallel with Htc and Hb values. Corresponding to these changes, BD values displayed a decreasing tendency. DiscussionOur study was conducted to characterize the changes in exhaled air CH4 concentration in response to hemorrhagic shock and to provide data on a viable clinical use of an experimental technique. According to our results, the real-time detection of exhaled air CH4 concentration is an applicable and promising technique for the early detection of bleeding and hemorrhagic shock in severely injured patients. Further research on large sample size and refinement of the PAS technique is required.

Impact of environmental exposures on exhaled breath and lung function: NELA Birth Cohort

Exposure to environmental exposures (i.e.air pollution and second-hand tobacco smoke) have been associated with impaired lung function. However, the impact of environmental factors on lung health is usually evaluated separately and not with an exposomic framework. In this regard, breath analysis could be a non-invasive tool for biomonitoring of global human environmental exposure.Data come from 337 mother–child pairs from the NELA birth cohort. Levels of BTEX (benzene, toluene, ethylbenzene and xylenes) in exhaled breath from mothers and children at 3 months after birth were estimated using gas chromatography-mass spectrometry. Short-term residential exposures (breath sampling day and 15 days before breath sampling) to nitrogen dioxide (NO2), particulate matter (PM2.5), and ozone (O3) were determined by chemical dispersion/transport modelling. Forced vital capacity (FVC), forced expiratory volume at 0.5 s (FEV0.5) and forced expiratory flow at 75% of FVC (FEF75) and at 25%–75% of FVC (FEF25-75) were measured in infants according to the raised-volume rapid thoracoabdominal compression technique.The results showed significant associations between short-term exposure to external agents and levels of benzene and toluene in exhaled breath. It was observed that exhaled levels of benzene and toluene were influenced by smoking status and outdoor air pollution in mothers, and by air pollution in infants (3 months of age). No significant relationship was observed between exposure to maternal tobacco smoking and/or short-term air pollution and lung function in healthy infants. However, there was a significant relationship between FEV0.5and exhaled toluene in children.These findings indicated a significant relationship between environmental exposures and exhaled levels of benzene and toluene, suggesting that breath analysis could be a helpful exposure biomonitoring tool.

Predictors of exacerbation in Japanese patients with severe asthma: Analysis of the severe asthma research program (Okayama-SARP) cohort

BackgroundBecause exacerbation of severe asthma decreases patients’ quality of life, this study aimed to identify predictive factors for asthma exacerbation. MethodsJapanese patients with severe asthma requiring treatment according to the Global Initiative for Asthma (GINA) guidelines ≥ Step 4 between January 2018 and August 2021 were prospectively enrolled and followed up for one year at facilities participating in the Okayama Respiratory Disease Study Group (Okayama Severe Asthma Research Program). ResultsA total of 85 patients (29 men and 56 women) were included. The median age was 64 (interquartile range [IQR], 51–72) years. Treatment according to GINA Steps 4 and 5 was required in 29 and 56 patients, respectively, and 44 patients (51.8%) were treated with biologics. The median peripheral-blood eosinophil count, fractional exhaled nitric oxide, IgE level, and percent predicted FEV1 (%FEV1) at enrollment were 204 (IQR, 49–436)/μL, 28 (IQR, 15–43) ppb, 172 (IQR, 56–473) IU/mL, and 80.0 (IQR, 61.1–96.1) %, respectively. Exacerbation during the previous year, asthma control test (ACT) score <20, %FEV1 <60%, and serum IL-10 level >6.7 pg/mL were associated with exacerbation during the observation period. ConclusionsExacerbation during the previous year, low ACT score, and low %FEV1 were predictive factors of future exacerbation, even in a cohort with >50% of patients treated with biologics. Furthermore, high serum IL-10 levels might be a new predictive factor.

MASLD can cause halitosis by small intestinal bacterial overgrowth.

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) exhibit varying degrees of halitosis. The author speculated that small intestinal bacterial overgrowth (SIBO) might lead to MASLD and subsequent extra-oral halitosis and aimed to test this hypothesis. This retrospective cross-sectional study reviewed 885 extra-oral halitosis patients. Halitosis and exhaled dimethyl sulfide (DMS) were measured by organoleptic score (OLS) (0-5) and OralChroma, respectively. SIBO and MASLD were diagnosed by hydrogen breath test and Fibroscan combined with cardiometabolic criteria. In this study, 133/885 (15.05%) of the halitosis patients otherwise healthy had MASLD, while 87/133 (65.41%) of the MASLD patients were SIBO-positive. No significant differences were observed in physical parameters such as age, serum biochemical parameters such as lipids, or Fibroscan parameters between the SIBO-positive and SIBO-negative patients. However, the OLS was 4 (interquartile range: 3-4) and exhaled DMS level was 56 (43-75) parts per billion (ppb) in the SIBO-positive patients, significantly greater than 2 (2-3) and 43 (25-51) ppb in the SIBO-negative patients (both p < 0.001). Exhaled hydrogen levels positively correlated with the OLS and exhaled DMS levels (r = 0.774, r = 0.740, both p < 0.001). MASLD can cause halitosis by SIBO.

Lactase for infantile colic: A systematic review of randomized clinical trials.

Infantile colic is excessive crying for no apparent reason in an otherwise healthy infant. Although its physiopathology is not completely understood, therapies usually target gastrointestinal symptoms. This systematic review of randomized controlled trials (RCTs) analyzes the efficacy of lactase supplementation in infantile colic.PubMed, Embase, and Cochrane were searched for RCTs evaluating lactase supplementation in infants up to 6 months old with infantile colic. Out of six RCTs including 394 patients, three reported a significantly shorter crying time in the lactase group than in the placebo group, while the other three found no significant difference between groups. Of the two studies that performed the hydrogen breath test, only one reported a significant reduction in exhaled hydrogen levels.The pharmacological approach to infantile colic remains debatable, and new studies with standardized diagnostic criteria and outcomes are required to guide lactase supplementation in clinical practice.

The adaptive features of cardiohemodynamic and gas exchange readjustment under test load in young northern natives of different generations

The research aimed to study the restructuring of hemodynamics, gas exchange, and heart rate variability parameters in response to the stress test with breathing in confined space in different generations of young Caucasoid natives permanently residing in Russia’s Magadan region. Material and methods. Two hundred 18–21 year old male migrants and those born to them in 1–3 generations, all Caucasians by origin, participated in the Magadan city survey. During the resting and confined space rebreathing sessions we registered subjective heart rate, blood pressure, oxygen and carbon dioxide level. The heart rate variability was recorded by the Varicard complex coupled with the Iskim-6 software. The exhaled gas level was determined by the Karbonik analyzer. The blood oxygen saturation was measured by a pulse oximeter. An electronic tonometer was used for the blood pressure control. Results and discussion. Both resting and rebreathing tests revealed lower HRV rates in the group of migrants (zero generation): not only did they exhibit a decrease in the activity of the autonomic regulation contour – they also reported an imbalance in the sympathetic and parasympathetic regulation of cardiac hemodynamics. However, the 3rd generation subjects showed an optimal and stable balance between the links of autonomic regulation, both at rest and during functional exercise with rebreathing, which is reflected in the parameters of arterial pressure and gas exchange. Interestingly, the most informative indicators of adaptation are not the absolute values of the studied indicators but the difference between their background and testing values, which to a greater extent hold information on the body functional reserves of those born in the North in different generations constantly living in the extreme conditions of the North. It was found that the increase in parasympathetic activity and its influence on the cardiac rhythm both at rest and in response to a breathing test was most pronounced in the group of natives of the 3rd generation, which reflects a deeper degree of their adaptation to the northern conditions. Apparently, this is a manifestation of the general strategy of functional restructuring of the body’s regulatory systems aimed at the formation of optimal compensatory-adaptive restructuring of gas homeostasis during an increased period of residence in the North.

Effectiveness of sublingual immunotherapy with house dust mite drops in asthmatic children at different ages.

Respiratory allergies in children, such as asthma and rhinitis, are becoming progressively common every year. Recent studies found that pediatric patients with asthma receiving regular medication and specific immunotherapy (SIT) had improved therapeutic outcomes in a wide age range. However, there are few studies that have examined the effectiveness of SIT treatment in children with allergic asthma at different ages in terms of the degree of asthma control, improvements in lung function, and changes in exhaled nitric oxide (FeNO). A total of 200 asthmatic pediatric patients who had been receiving regular treatment for at least a year were split into the observation and the control groups, which depended on whether sublingual immunotherapy was added based on conventional treatment medicines. The children who were divided by an age cut-off of 6 years old in these two groups were compared before and after therapy based on the exhaled levels of FeNO, pulmonary function, visual analog scale, medication scores, daytime and nighttime ratings of asthma symptom, and rhinitis symptom scores. Before treatment, there was no significant difference between the observation group and the control group in various indicators of the patients under 6 years old; and in the older children (6-16 years old) group, the scores of FVC, FEV1, and FEF25 in the observation group were significantly lower than those in the control group (P < 0.05). The FEF75, FEF50, FEF25, and MMEF75/MMEF25 indexes in the observation group were significantly higher than those in the control group after treatment (P < 0.05), but there was no statistical significance in other indexes (P > 0.05). The scores of ACT, FEF75, FEF50, MMEF72/MMEF25, and FeNO in the observation group were all higher than those in the control group after treatment (P < 0.05), and the differences in other indexes were not statistically significant (P > 0.05). Between the young-age group and the elder group, there was no significant difference in all indexes in the observation group before and after treatment (P > 0.05). Children with asthma of all ages can considerably benefit from sublingual immunotherapy. Specifically, younger patients showed greater tendency on the improvement of small airway resistance, whereas school-age children with asthma significantly improved their small airway resistance as well as their asthma control and inflammation alleviation.

Radon mapping, correlation study of radium, seasonal indoor radon and radon exhalation levels in communities around Ghana atomic energy commission

Radon mapping and seasonal radon studies have been carried out within the communities around the Ghana Atomic Energy Commission (GAEC), using ArcMap geostatistical interpolation tool. The correlation analysis was done using Pearson's correlation tools. Average seasonal indoor radon variations for CR (rainy) and CD (dry) with mean values ranging from 28.9 to 177.2 Bq/m3 (78.1 ± 38.7 Bq/m3) and 24.4–125.5 Bq/m3 (69.9 ± 24.2 Bq/m3). Average seasonal soil radon exhalation for ER (rainy) and ED (dry) with mean values ranging from 39.6 to 100.3 (68.9 ± 24.2 μBq/m2 h) and 55.2 to 111.9 (77.1 ± 18.7 μBq/m2 h). Radium concentrations ranged from 8.1 to 42.2 Bq/kg (21.3 ± 9.9 Bq/kg). Annual effective dose and resultant effective dose to lungs were found to be 0.9 to 2.9 (1.9 ± 0.8 mSv/yr), 2.1 to 9.2 (4.6 mSv/yr). The study recorded the highest and lowest positive correlation coefficient was found in the study with higher and lower coefficient values of 0.81 and 0.47 recorded in radium concentration with radon exhalation and indoor radon concentration within the dry season respectively. Pearson correlation result recorded values 0.81 and 0.47 as the highest and lowest positive coefficient values for the radium concentration correlation between radon exhalation and indoor radon concentration. One directional principal component was observed in radium concentration, seasonal radon exhalation, and indoor radon concentration. Two clusters originated from radium and seasonal radon concentrations present in dwellings as well as soils. Pearson's correlation results were in agreed with the principal component and cluster factor analysis. The study obtained the highest and lowest indoor radon concentrations with radon exhalation in rainy and dry seasons. Radium concentration was found to have a considerable effect on indoor radon and radon exhalation in dwellings and soils.

Studying the Role of Alveolar Exhaled Nitric Oxide in Combination with Bronchial Nitric Oxide to Predict Asthma Control in Children with Asthma: A Real-Life Prospective Study

Background: Fractional exhaled nitric oxide (FENO) is currently used as a biomarker of airway inflammation in patients with asthma. However, the role of alveolar nitric oxide (CANO) in asthmatic children has not been clearly demonstrated Methods: It was a prospective and descriptive study. The measurement of FENO and CANO, spirometry, blood eosinophil counts (BEC), and total IgE levels were performed for each study subject. Results: This study included 109 uncontrolled asthmatic children without inhaled corticosteroid (ICS) treatment. The exhaled NO level in asthmatic patients was significantly higher than in control subjects: FENO: 22.5 vs. 8.4 ppb; CANO: 5.9 vs. 2.8 ppb; J’awNO (maximum airway nitric oxide flux): 56.9 vs. 18.7 ppb; respectively. The sensitivities and specificities for asthma diagnosis with the cut-off of CANO at 3.5 ppb and 5.0 ppb were 74.3% and 73.3%, and 46.0% and 83.3%, respectively. There were the moderate and the weak correlations between CANO with FENO and CANO with IgE in asthmatic patients (r = 0.465, 95%CI (0.133-0.659), P=0.001; r=0.133, 95%CI (0.068- 0.497), P=0.184; respectively). The percentage of controlled asthma in patients with CANO ≥5 ppb at inclusion was higher than that in CANO &lt;5 ppb group. Conclusion: Exhaled NO is a relevant biomarker of allergic asthma. The level of FENO and CANO might be used to predict asthma control in children.

Influence of ventilatory parameters on the concentration of exhaled volatile organic compounds in mechanically ventilated patients.

Analysis of volatile organic compounds (VOC) within exhaled breath is subject to numerous sources of methodological and physiological variability. Whilst breathing pattern is expected to influence the concentrations of selected exhaled VOCs, it remains challenging to investigate respiratory rate and depth accurately in awake subjects. Online breath sampling was performed in 20 mechanically ventilated patients using proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS). The effect of variation in respiratory rate (RR) and tidal volume (TV) on the VOC release profiles was examined. A panel of nineteen VOCs were selected, including isoprene, acetone, propofol, volatile aldehydes, acids and phenols. Variation in RR had the greatest influence on exhaled isoprene levels, with maximum and average concentrations being inversely correlated with RR. Variations in RR had a statistically significant impact on acetone, C3-C7 linear aldehydes and acetic acid. In comparison, phenols (including propofol), C8-C10 aldehydes and C3-C6 carboxylic acids were not influenced by RR. Isoprene was the only compound to be influenced by variation in TV. These findings, obtained under controlled conditions, provide useful guidelines for the optimisation of breath sampling protocols to be applied on awake patients.

Real-world outcomes of an innovative digital therapeutic for treatment of panic disorder and PTSD: A 1,500 patient effectiveness study.

Prior clinical trials have shown consistent clinical benefit for Capnometry Guided Respiratory Intervention (CGRI), a prescription digital therapeutic for the treatment of panic disorder (PD) and post-traumatic stress disorder (PTSD). The purpose of this study is to report real-world outcomes in a series of patients treated with the intervention in clinical practice. This paper reports pre- and post-treatment self-reported symptom reduction, measures of respiratory rate and end-tidal carbon dioxide levels, drop-out and adherence rates drawn from an automatic data repository in a large real-world series of patients receiving CGRI for panic disorder and PTSD. Patients used the intervention in their homes, supported by telehealth coaching. Patients meeting symptom criteria for panic disorder (n = 1,395) or posttraumatic stress disorder (n = 174) were treated following assessment by a healthcare professional. Capnometry Guided Respiratory Intervention is a 28-day home-based treatment that provides breath-to-breath feedback of respiratory rate and exhaled carbon dioxide levels, aimed at normalizing respiratory style and increasing patients' mastery for coping with symptoms of stress, anxiety, and panic. Health coaches provide initial training with weekly follow up during the treatment episode. Remote data upload and monitoring facilitates individualized coaching and aggregate outcomes analysis. Self-reported Panic Disorder Severity Scale (PDSS) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) scores were obtained at pre-treatment and post-treatment. Panic disorder (PD) patients showed a mean pre-to-post-treatment reduction in total PDSS scores of 50.2% (P < 0.001, d = 1.31). Treatment response rates for PD (defined as a 40% or greater reduction in PDSS total scores) were observed in 65.3% of the PD patients. PTSD patients showed a pre-to-post-treatment reduction in total PCL-5 scores of 41.1% (P < 0.001, d = 1.16). The treatment response rate for PTSD (defined as a ≥10-point reduction in PCL-5 scores) was 72.4%. In an additional analysis of response at the individual level, 55.7% of panic disorder patients and 53.5% of PTSD patients were classified as treatment responders using the Reliable Change Index. Patients with both normal and below-normal baseline exhaled CO2 levels experienced comparable benefit. Across the 28-day treatment period, mean adherence rates of 74.8% (PD) and 74.9% (PTSD) were recorded during the 28-day treatment. Dropout rates were 10% (PD) and 11% (PTSD) respectively. The results from this cohort of 1,569 patients treated with the CGRI intervention demonstrate significant rates of symptom reduction and adherence consistent with prior published clinical trials. The brief duration of treatment, high adherence rates, and clinical benefit suggests that CGRI provides an important addition to treatment options for panic disorder and PTSD.

Peculiarities of indicators of the respiratory system in women at rest and their changes during the burning of the next cigarette

One of the important problems facing modern society is the increase in the number of people with various types of addictions, the most common of which is smoking. Smoking and its medical-demographic and economic consequences are in the circle of scientific interests of many domestic and foreign scientists. That is why the aim of the scientific article is to study the peculiarities of the state of the respiratory system in women at rest and during the burning of another cigarette. The study was conducted in the Laboratory of Medical and Biological Monitoring and Public Health at the Department of Human and Animal Physiology, Faculty of Biology and Forestry, Lesya Ukrainka Volyn National University for 60 women aged 17-21. At the first stage of the study, absolute anthropometric indicators were measured, such as height, weight, chest circumference. In the second stage women were interviewed on the Fagerström test. According to its results, the study is divided into 3 groups: Group I – women who have a history of smoking more than 3 years, burn more than 10 cigarettes per day and have a high level of dependence, Group II – women who have a history of smoking 1-3 years, up to 10 cigarettes are smoked per day and have a low and medium level of dependence, Group III – (control) women who do not smoke. The next stage of the study involved a functional diagnosis of the external respiratory system in women at rest and 15 minutes after smoking a cigarette using the functional method of pneumotachography (PTG). Registration and analysis of relevant indicators was carried out using a diagnostic automated complex “Cardio+”. Statistical data processing was performed using generally accepted methods of variation statistics (because the distribution of the results was normal) using MS Excel 2007 software. This article presents a study of the state of external respiration at rest and 15 minutes after burning another cigarette, which revealed the negative effects of smoking on the respiratory system of women who smoke. The study made it possible to make a detailed analysis of indicators of respiratory function in women aged 17-21 years, smokers and compare them with non-smokers. Based on the obtained results, it was found that in women smokers (groups I and II) there is a significant decrease in volume (FVC, VC, FEV1) indicators of external respiration, as well as the Tiffeneau-Pinelli test at p&lt;0.05, compared with the group of women control group both at rest and 15 minutes after firing the next cigarette. Analysis of velocity (MEF at the level of exhalation 25 %, 50 %, 75 %, PEF) of airflow through the bronchi to the lungs indicates a gradual decrease from MEF 25 % to MEF 75 % in women of the experimental groups, but a significant decrease is observed only at the level sight of 75 % in 15 min after burning of the next cigarette between I and III groups (at p&lt;0.05). A statistically significant difference between the values of the calculated Tiffeneau-Pinelli index, which characterizes the presence of obstructive respiratory failure, in women of groups II and III both at rest and 15 minutes after burning another cigarette. Thus, a decrease in these indicators indicates the presence of bronchial obstruction of the middle and small bronchi, as well as a violation of respiratory muscle strength and bronchial patency. It has also been shown that the reactivity (reduction) of volumetric and velocity indicators of external respiration to cigarette burning was higher in the group of women who do not smoke (control).

Efficacy and Safety of a Novel Therapeutic of Natural Origin (NTN) in Adult Patients with Lactose Intolerance: A Multicenter, Randomized, Crossover, Double-Blind, Placebo-Controlled Study.

Background: Film-forming substances, such as natural polysaccharides (NP) and pea proteins (PP), act as a protective barrier for treating various gastrointestinal conditions. We assessed the efficacy and safety of a novel therapeutic of natural origin (NTN) containing NP and PP for symptomatic treatment of lactose intolerance. Methods: In this multicenter, randomized, double-blind, parallel-group study, patients with lactose intolerance received NTN (n = 30) or placebo (n = 30) for 7 days, then the alternate treatment for 7 days. Patients rated their gastrointestinal symptoms using a 7-point Likert scale. The lactose hydrogen breath test was used to assess exhaled hydrogen. Results: NTN as primary or crossover treatment significantly improved patient-reported symptoms of bloating, distension, and abdominal pain. Abdominal pain also improved under primary treatment with placebo. Primary treatment with NTN, but not placebo, normalized mean exhaled hydrogen levels. In the group allocated initially to placebo, crossover to NTN attenuated the increase in hydrogen production. No treatment-related adverse effects were reported in either group. Conclusions: Subjective improvements in bloating, distension, and abdominal pain with NTN were supported by objective evidence of hydrogen production normalization. NTN appears to be a useful alternative to lactose avoidance or enzyme replacement in patients with lactose intolerance.

Detection of exhaled methane levels for monitoring trauma-related haemorrhage following blunt trauma: study protocol for a prospective observational study

IntroductionEarly recognition and effective treatment of internal bleeding impose a cardinal challenge for trauma teams. The reduction of the superior mesenteric artery (SMA) blood flow is among the first compensatory...

Oxidative Stress: Assessment of Thiobarbituric Acid Reactive Substances Value in Overweight Asthmatic Children

Nowadays bronchial asthma and increased body weight represent major problems in children. Asthmatic attacks in obese patients are not well controlled using the conventional treatment regimens. Asthma has been associated with increased systemic and exhaled levels of hydrogen peroxide and thiobarbituric acid-reactive products in expired breath condensate of asthmatic patients. Thiobarbituric acid reactive substances formed from peroxidation of lipids. The aim of the Study is to show the action of Thiobarbituric acid reactive substances activity in asthma among overweight children suffering from asthma and to detect the connection between this biomarker and the etiology, degree of severity among children with bronchial hypereactivity. The study is cross-sectional study, was conducted on Egyptian children on regular follow up at the outpatients pediatric allergy clinic in Bab El-shariea university Hospital, Al-Azhar University. The study group included 96 child divided into 4 groups. Group A which included overweight children with (mild persistent asthma). Group B which included non-overweight children with (mild persistent asthma).Group C which included overweight non-asthmatics children and Group D The control group (non-overweight non-asthmatics). The results showed significant increase in the Thiobarbituric acid reactive substances level in Overweight asthmatic patients in relation to non-overweight patients with asthma. We found that they can distinguish asthma controlled patients from non-asthma controlled patients. This study showed high level of oxidative stress with high asthma severity as measured by Thiobarbituric acid reactive substances. These substances were good markers of relation between bronchial hyper activity and oxidative stress which became high with asthma severity.

Peppermint protocol: first results for gas chromatography-ion mobility spectrometry

The Peppermint Initiative seeks to inform the standardisation of breath analysis methods. Five Peppermint Experiments with gas chromatography-ion mobility spectrometry (GC-IMS), operating in the positive mode with a tritium 3H 5.68 keV, 370 MBq ionisation source, were undertaken to provide benchmark Peppermint Washout data for this technique, to support its use in breath-testing, analysis, and research. Headspace analysis of a peppermint-oil capsule by GC-IMS with on-column injection (0.5 cm3) identified 12 IMS responsive compounds, of which the four most abundant were: eucalyptol; β-pinene; α-pinene; and limonene. Elevated concentrations of these four compounds were identified in exhaled-breath following ingestion of a peppermint-oil capsule. An unidentified compound attributed as a volatile catabolite of peppermint-oil was also observed. The most intense exhaled peppermint-oil component was eucalyptol, which was selected as a peppermint marker for benchmarking GC-IMS. Twenty-five washout experiments monitored levels of exhaled eucalyptol, by GC-IMS with on-column injection (0.5 cm3), at t = 0 min, and then at t + 60, t + 90, t + 165, t + 285 and t + 360 min from ingestion of a peppermint capsule resulting in 148 peppermint breath analyses. Additionally, the Peppermint Washout data was used to evaluate clinical deployments with a further five washout tests run in clinical settings generating an additional 35 breath samples. Regression analysis yielded an average extrapolated time taken for exhaled eucalyptol levels to return to baseline values to be 429 ± 62 min (±95% confidence-interval). The benchmark value was assigned to the lower 95% confidence-interval, 367 min. Further evaluation of the data indicated that the maximum number of volatile organic compounds discernible from a 0.5 cm3 breath sample was 69, while the use of an in-line biofilter appeared to reduce this to 34.

Helicobacter pylori infection and lactose intolerance increase expiratory hydrogen.

Infection with Helicobacter pylori (H.pylori) may cause dyspepsia and/or unexplained functional nonspecific, gastrointestinal complaints of the irritable bowel syndrome (IBS) spectrum. Hitherto, in H. pylori infected patients with symptoms of the IBS spectrum the occurrence of additional food intolerance/malabsorption is not evaluated. We used a retrospective analysis of charts from 548 patients who presented with gastrointestinal complaints of the irritable bowel syndrome spectrum. An enzyme-linked IgA immunosorbent assay or histologic evaluation of gastric mucosa were used to detect H. pylori infection. A hydrogen breath (H2) test was performed to evaluate fructose malabsorption (FM) and lactose intolerance (LIT). Serum diamine oxidase value of <10 U/ml and a response to a histamine-reduced diet was used to identify histamine intolerance (HIT). We found 293 patients infected with H. pylori, within these were 58 H. pylori patients with LIT, 23 H. pylori LIT patients with FM and 46 H. pylori LIT patients with HIT. Additionally, 13 H. pylori, lactose- and histamine intolerance patients also had FM. The Kruskal Wallis test and pairwise comparison were used to analyze differences of the area under the curve of expiratory hydrogen. In lactose H2 breath tests compared with LIT-only patients, LIT with H. pylori, LIT and H. pylori with HIT, LIT and H. pylori with FM showed significantly higher exhaled H2 levels (p=0.022). Pairwise comparison demonstrated H. pylori infected patients with LIT exhaled more H2 compared to LIT-only (p=0.029). H. pylori with lactose- and histamine intolerance, and H. pylori with lactose-, histamine intolerance and FM compared to H. pylori-only patients indicated a significantly higher occurrence of stomach pain during lactose H2 breath tests (p=0.012 and p=0.005, respectively). We demonstrate that LIT patients with high expiratory H2 levels in lactose breath tests may have H. pylori infection and possibly additional food intolerance/malabsorption. Subsequently, besides H. pylori eradication, a dietician is necessary for an individually tailored reduction- or exclusion diet of symptom triggering food components.

The Effect of Water-Pipe and Cigarette Smoking on Exhaled Nitric Oxide

Context:Fractional exhaled nitric oxide can be used as a biomarker of some respiratory diseases.Aims:This study was conducted to compare exhaled nitric oxide in cigarette and water-pipe smokers with nonsmokers.Methods:This cross-sectional study was conducted on 549 adult subjects as a sub-study of Shahedieh cohort in Yazd. Participants were divided into 5 groups according to their smoking habits: non-smokers (n = 202), cigarette smokers (n = 121), water-pipe smokers (n = 129), cigarette ex-smokers (n = 58), water-pipe and cigarette smokers (n = 39). The smokers were also categorized into heavy and light smokers. Fractional exhaled nitric oxide was compared between the groups.Statistical Analysis Used:The data were analyzed by SPSS (ver. 20) using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests.Results:Fractional exhaled NO was lower in all smokers than nonsmokers, but cigarette smokers showed the least level of NO than other groups. Fractional exhaled NO was not significantly lower in water-pipe smokers than nonsmokers.Conclusions:Cigarette smoking significantly affect fractional exhaled NO, but water-pipe smoking did not significantly affect exhaled NO level.