Factors associated with allergic rhinitis and combined allergic rhinitis and asthma syndrome (CARAS) in children aged 5–18 years undergoing immunotherapy in a tropical low- or middle-income country

Background: Tropics have some particularities that can impact the natural history and factors associated with allergic diseases. However, few studies described the characteristics of patients with allergic rhinitis (AR) and combined AR and asthma syndrome (CARAS) in Latin American tropical countries. Objective: This study aimed to determine the medical, social, and environmental factors associated with AR and CARAS in children aged 5–18 years treated with immunotherapy in two allergy referral centers in Bogotá (Colombia). Material: and methods: An observational, cross-sectional study was conducted between January 2018 and January 2019. International Study Asthma Allergies Childhood-III and sociodemographic questionnaires were applied to adolescents and parents of children undergoing immunotherapy at the allergy consult in the Hospital Universitario Fundación Santa Fe de Bogotá and UNIMEQ-ORL. Results: Among 830 children aged 5–18 years, 38.1% (n = 316) were women. Up to 63.25% of the population had a positive skin prick test for house dust mites: 63.25% for Dermatophagoides pteronyssinus, 61.81% for Dermatophagoides farinae, and 31.57% for Blomia tropicalis. The factors associated with AR were male sex (PR: 1.31, 95% CI: 1.08–1.57), antibiotic consumption during the first year of life (PR: 0.80; 95% CI: 0.63–0.99), and exposure to dogs (PR: 1.32; 95% CI: 1.06–2.66). The factors associated with CARAS were older age (PR=0.95; 95% CI: 0.95–0.99), acetaminophen consumption over four times a year (PR: 1.31; 95% CI: 1.03–1.55), and antibiotic consumption during the first year of life (PR: 1.21; 95% CI: 1.06–1.34). Conclusion: A high prevalence of B. tropicalis was found in this study. The factors associated with AR and CARAS are like those described in high-income tropical countries. Further studies are needed in low- or middle-income tropical countries to identify modifiable factors associated with allergic diseases (AU)

Aqueous intradermal low-dose house dust mite immunotherapy in tropical settings: a valid cost-effective approach for developing nations?

Introduction Aqueous allergen injections, an effective and century-old technique, is considered a second-line approach in daily clinical practice. Inconveniences still surround conventional subcutaneous immunotherapy (SCIT) administration, such as a need for frequent injections, prolonged up-dosing schedules, elevated costs, and the unlikely possibility of a systemic reaction. The intradermal immunotherapy route (IDR) might favorably impact many of the aforementioned issues (Table 1). House dust mite (HDM) allergens are the main perennial sensitizers in the tropics, and as such, are solely employed in immunotherapy treatments. Methods We carried out a year-long real-life study in 25 perennial allergic rhinitis children, symptomatic on exposure to house dust, employing an intradermal low-dose allergen mix consisting of 50 ng of Dermatophagoides pteronyssinus/Dermatophagoides farinae and 120 ng of Blomia tropicalis, under a unique cost-wise protocol. Basal symptoms/signs and face Visual Analog Scale (fVAS) scores were recorded for 2 weeks and later compared with those registered throughout the 1-year treatment. Serum-specific IgG4 and IL-10 levels were employed in the assessment of the immune responses. Results Symptoms/signs and fVAS scores were significantly reduced from days 42 and 49, respectively, and remained so until treatment completion. Increases in specific IgG4’s and IL-10 levels reflected significant immune responses. Injections were well tolerated and families reported improved health status (quality of life, QoL). Conclusions A unique cost-effective immunotherapy alternative for deprived allergic communities in tropical settings is depicted; further research is needed (AU)

Direct medical costs of RSV-related bronchiolitis hospitalizations in a middle-income tropical country

Introduction and objectives: With the objective of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating respiratory syncytial virus (RSV)-related bronchiolitis, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with bronchiolitis hospitalizations caused by infection with RSV in Bogota, Colombia. Material and methods: We reviewed the available electronic medical records (EMRs) for all infants younger than two years of age who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis of RSV-related bronchiolitis over a 24-month period from January 2016 to December 2017. Direct medical costs of RSV-related bronchiolitis were retrospectively collected by dividing the infants into three groups: those requiring admission to the pediatric ward (PW) only, those requiring admission to the pediatric intermediate care unit (PIMC), and those requiring to the pediatric intensive care unit (PICU). Results: A total of 89 patients with a median (IQR) age of 7.1 (3.1-12.2) months were analyzed of whom 20 (56.2%) were males. Overall, the median (IQR) cost of infants treated in the PW, in the PIMC, and in the PICU was US$518.0 (217.0-768.9) vs. 1305.2 (1051.4-1492.2) vs. 2749.7 (1372.7-4159.9), respectively, with this difference being statistically significant (p < 0.001). Conclusions: The present study helps to further our understanding of the economic burden of RSV-related bronchiolitis hospitalizations among infants of under two years of age in a middle-income tropical country

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Epidemiologic studies about food allergy and food sensitization in tropical countries. Results and limitations

The variety of foods and methods of preparation are part of the cultural identity of each population, and thus the main foods that cause symptoms vary among different regions. Due to their increasing frequency, Adverse Reactions to Food (AFR) have been the subject of extensive study, especially in North America and Europe but few studies have been conducted in other areas, especially in populations located in the tropics and subtropics. In this article, we review available information on the epidemiology of food sensitization and food allergies in tropical regions and explore the different epidemiological data considering the major food involved, the underlying immune mechanism and clinical symptoms partners. In addition, we identify the possible limitations and questions that arise from studies conducted in tropical countries, which helps to generate objectives for future research

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Sweating and core temperature in athletes training in continuous and intermittent sports in tropical climate / Sudoración y temperatura interna en atletas durante entrenamiento para deportes continuos e intermitentes en clima tropical

Higher sweat rate values have been reported during intermittent compared to continuous type exercise in hot conditions in the laboratory. Studies in the training field are scarce. Objective: Document sweat rate, rehydration and core temperature (Tc) during training in long duration-continuous (CON) and intermittent (INT ) type sports, and determine the presence of a mutation in the CFTR gene in athletes with high sodium concentration ([Na+]) in sweat.Methods: Athletes (CON =50 and INT=123) were tested during training in tropical climate. Sweat rate, sweat [Na+], Tc, de-hydration level, and presence of ∆ F508 gene mutation in the CFTR gene in athletes with high sweat [Na+] were evaluated. Results: Sweat rate was higher in CON (1.5 ± 0.4 L/h) compared to INT (1.2 ± 0.5 L/h) and CON athletes finished training with higher dehydration (2.1 ± 0.8 vs 1.2 ± 0.7%) P < 0.05. Sweat [Na+] was higher in INT (62.0 ± 21.1 mmol/L) compared to CON (53.9 ± 18.1 mmol/L), P < 0.05. A tennis player with high [Na+] was heterozygous for the ΔF508 mutation. Average and highest Tc was similar for CON (38.4 ± 0.3 and 38.8 ± 0.4 oC) and INT (38.3 ± 0.3 and 38.7 ± 0.4 oC), P > 0.05. Conclusion: During training in a tropical climate, sweat loss and dehydration level are lower, and fluid intake is higher in intermittent compared to continuous type sports. Core temperature may rise to a similar level in intermittent type sports due to the repeated high intensity bouts and/or the effects of clothing worn while training in hot venues. Healthy athletes with high [Na+] in sweat who are heterozygous carriers of CFTR mutations may be at increased risk for hyponatremic dehydration and whole-body muscle cramps

Se reportan tasas de sudoración más altas durante ejercicio intermitente comparado con continuo en condiciones de calor en el laboratorio. Estudios en el campo de entrenamiento son escasos. Objetivo: Documentar la tasa de sudoración, rehidratación y temperatura central (Tc) durante entrenamiento para deportes de tipo continuo (CON) e intermitente (INT ), y determinar presencia de mutación genética en el gen CFTR en atletas con alta concentración de sodio ([Na+]) en sudor.Metodología: Se evaluó la tasa de sudoración, la [Na+] en sudor, la Tc, y el nivel de deshidratación en atletas (CON = 50; INT =123) durante entrenamiento en clima tropical, y la presencia de la mutación genética ∆F508 en el gen CFTR en aquellos con alta [Na+] en sudor.Resultados: La tasa de sudoración fue mayor en CON (1,5 ± 0,4 L/h) comparado con INT (1,2 ± 0,5 L/h) y los atletas en CON terminaron el entrenamiento con mayor deshidratación (2,1 ± 0,8 vs 1,2 ± 0,7%) P < 0,05. La [Na+] en sudor fue más alta en INT (62,0 ± 21,1 mmol/L) comparado con CON (53,9 ± 18,1 mmol/L), P < 0,05. Un tenista con alta [Na+] era heterocigoto para la mutación ΔF508. La Tc promedio y más alta fueron similares para CON (38,4 ± 0,3 y 38,8 ± 0,4 oC) e INT (38,3 ± 0,3 y 38,7 ± 0,4 oC), P > 0,05. Conclusión: Durante el entrenamiento en clima tropical, la pérdida de sudor y el nivel de deshidratación son más bajos, y la ingesta de líquido es más alta en deportes intermitentes que en deportes continuos. La temperatura interna puede aumentar a nivel similar en deportes intermitentes debido a periodos repetidos de alta intensidad y/o la vestimenta usada durante el entrenamiento. Atletas saludables con alta [Na+] en sudor que son heterocigóticos para mutaciones de CFTR pueden estar en mayor riesgo de deshidratación hiponatrémica y calambres musculares

Mite hypersensitivity in patients with rhinitis and rhinosinusitis living in a tropical environment

PURPOSE: Rhinitis and rhinosinusitis are major concerns in public health. Mites are important aetiological agents in the tropics. The present study investigated the in vivo response to mite allergens in patients with rhinitis and rhinosinusitis. METHODS: All patients with presumptive nasal allergy were included. Skin tests were done with inhalants and mite extracts. Patients were classified as allergic or non-allergic according to skin tests and history. RESULTS: Out of 229 patients, 175 (76.4%) showed positive skin tests. Allergic patients showed positivity to mites in 97.1% of cases, 51.4% to dog dander; 40.5% to cat dander; 36.5% to German cockroach; 22.8% to moulds; and 21.1% to grass pollens. Dermatophagoides farinae induced responses in 90.8% of patients, D. pteronyssinus in 90.1%, Blomia tropicalis in 74.8%, Glycyphagus domesticus in 62.2%, Chortoglyphus arcuatus in 58.2%, Acarus siro in 46.2%, Lepidoglyphus destructor in 35.4%, and Tyrophagus putrescentiae in 35.0%. Higher correlations were found between skin test diameters induced by mites from the same family. CONCLUSIONS: Sensitisation to inhalant allergens is present in 76% of allergy clinics' patients with rhinitis or rhinosinusitis. Our results confirm previous observations showing that mites constitute the most important cause of respiratory allergy in tropical settings and suggest that mite allergen cross-reactivity is responsible for the positivity of skin tests to mites not present in the patient's environment since the species Glycyphagus, Chortoglyphus, Acarus, Lepidoglyphus and Tyrophagus have not been found in Caracas house dust

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Socio-environmental conditions and geographical variability of asthma prevalence in Northeast Brazil

Background: This study aims to evaluate the association between environmental and socio-economic conditions with asthma prevalence in the eight ISAAC centres in North-East Brazil. Methods: Estimates on occurrence, severity and medical diagnoses of asthma in the previous 12 months were compared using environmental and socioeconomic indicators. Associations were assessed using simple linear regression and Pearson correlation coefficient. Results: There was no difference in asthma prevalence between centres. Active asthma prevalence increased with increasing water privation, and this would explain 62 % of the observed prevalence. Median temperature increase was inversely related to active asthma (r = 0.81; p < 0.05). There was a positive association between latitude and active asthma prevalence (r = 0.82; p < 0.005), a negative association between severe asthma and yearly medium temperature (r = -0.89; p < 0.05), and a positive association with latitude (r = 0.78; p < 0.05) (AU)

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Production of two novel laccase isoforms by a thermotolerant strain of Pycnoporus sanguineus isolated from an oil-polluted tropical habitat

A thermotolerant and halotolerant strain of Pycnoporus sanguineus was isolated from an oil-polluted site in a tropical area located in Veracruz, Mexico. This strain was able to grow at 47 degrees C and in culture medium containing 500 mM NaCl. The strain was also tolerant to the presence of 30,000 ppm of crude Maya oil. A 68-kDa protein purified from submerged cultures exhibited laccase activity towards 2,2’-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS), guaiacol, syringaldazine, and o-dianisidine, for which it presented the highest affinity (Km = 43 microM). Two-dimensional gel electrophoresis analysis showed that, unusual for laccases, the enzyme has two active isoforms, with isoelectric points of 7.00 and 7.08. The purified enzyme showed high thermostability, retaining 40% of its original activity after 3 h at 60 degrees C. This property seems to correlate with a long «shelf-life», given that at 40 degrees C enzyme activity was only gradually lost over a 5-day period incubation. Both the fungus and its laccase are likely to have high potential for biotechnological applications (AU)

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Enfermedad cerebrovascular en los trópicos / Cerebrovascular disease in the tropics

Objetivo. Revisar las manifestaciones clínicas, diagnóstico y tratamiento de entidades responsables del desarrollo de enfermedad cerebrovascular (ECV) en regiones tropicales. Desarrollo. Entre las enfermedades tropicales que se asocian con ECV destacan: la anemia de células falciformes, la arteritis de Takayasu, la cisticercosis, la endocarditis infecciosa, la enfermedad de Chagas, las fiebres hemorrágicas víricas, la gnatostomiasis, la leptospirosis, las mordeduras de serpiente, el paludismo cerebral, la trombosis venosa puerperal y la tuberculosis. Dichas entidades pueden producir infartos o hemorragias cerebrales y, en la mayoría de los casos, estas complicaciones se relacionan con daño vascular secundario a angeítis o se presentan como parte de una coagulopatía diseminada con sangrado en otros órganos. En algunos casos, la gravedad del compromiso neurológico no permite identificar un síndrome ictal específico y las complicaciones cerebrovasculares solamente son reconocidas mediante estudios de neuroimagen o en la autopsia. Conclusiones. Existe un grupo de enfermedades, infecciosas o no, capaces de producir infartos o hemorragias cerebrales en los trópicos. Su reconocimiento oportuno permite iniciar tratamiento específico destinado a reducir la magnitud del daño cerebral y a evitar ictus recurrentes (AU)

El síndrome de CADASIL:un modelo de desconexión córtico-subcortical / The CADASIL syndrome: a model of subcortical-cortical disconnection

Introducción. El síndrome conocido como CADASIL (arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía) da lugar a diversos signos y síntomas neurológicos (trastornos de la marcha, crisis epilépticas, parálisis pseudobulbar, migrañas, etc.), así como a disfunciones neuropsicológicas (deterioro cognitivo y ejecutivo, trastornos emocionales y, a menudo, demencia). Este síndrome es un buen modelo de afectación de la sustancia blanca cerebral y de potenciales síndromes de desconexión. Caso clínico. En el presente trabajo se estudia de manera detallada el perfil neuropsicológico de una mujer de 47 años afectada de CADASIL. Los resultados muestran un déficit cognitivo y ejecutivo moderado, que se corresponde predominantemente con una disfunción temporo-fronto-subcortical, pero no con demencia. Conclusión. Este cuadro constituye un ejemplo ilustrativo de los efectos neuropsicológicos de la desconexión parcial de la corteza prefrontal del tálamo y de los ganglios basales (AU)

Valoración diagnóstica del paciente con síndrome febril tras viaje a los trópicos / Diagnostic assessment of the patient with fever after travelling to tropical areas

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Prevalencia de la esclerosis múltiple en Colombia / Prevalence of multiple sclerosis in Colombia

Introducción. La esclerosis múltiple (EM) es la enfermedad desmielinizante más común del sistema nervioso. Se caracteriza por numerosas áreas desmielinizantes o placas de desmielinización que se encuentran dispersas en el sistema nervioso. Se ha demostrado que la EM es menos frecuente en las regiones tropicales que en aquellas localizadas en el subtrópico, En Latinoamérica, particularmente, existen algunos estudios que evidencian dicho fenómeno.Sin embargo, en Colombia no se han realizado estudios de prevalencia de EM. Objetivo. Determinar la prevalencia de la esclerosis múltiple en cinco provincias colombianas (Antioquia, Caldas, Santander, Risaralda y Bolívar). Pacientes y métodos. Se utilizó el método de captura-recaptura de dos fuentes para estimar el número de casos de EM definida según los criterios de Poser et al, durante el período comprendido entre julio de 1995 y junio de 2000. Resultados. La prevalencia (casos de EM por 100.000 habitantes) varió entre 1,48 en Antioquia (IC95 por ciento 1,12; 1,78) a 4,98 en Risaralda (IC95 por ciento 3,52; 6,43). El 72 por ciento de los individuos identificados eran mujeres. Las regiones incluidas en este estudio comprenden al 25 por ciento de la población de Colombia. Conclusiones. La prevalencia de EM estimada es baja y está de acuerdo a lo esperado para las áreas tropicales. Los individuos con EM de estas regiones pueden ser muy útiles para el estudio de otros factores involucrados en la etiología de la EM (genético). El método de captura- recaptura es una excelente herramienta para la realización de estudios de prevalencia porque consume poco tiempo y es muy barato (AU)

Estudio radiológico de las alteraciones cervicales en el síndrome de down. Nuevos hallazgos mediante tomografía computarizada y reconstrucciones tridimensionales / A radiological study of the cervical alterations in down's syndrome. New findings on computerized tomography and three dimensional reconstructions

Objetivo. Estudiamos gran parte de la población con síndrome de Down de nuestra área sanitaria para establecer la incidencia y variedad de alteraciones de la columna cervical y esclarecer las pautas de diagnóstico preventivo aconsejables en relación con la inestabilidad atloaxoidea, patología frecuente en estos enfermos. Pacientes y métodos. Primera fase: estudio radiológico simple de columna cervical en proyección lateral neutra y flexión a 188 pacientes, medición de las distancias atlodontoideas. Segunda fase: estudio de tomografía computarizada (TC) y reconstrucciones tridimensionales a 25 pacientes (13,3 por ciento) elegidos al azar. Los cortes axiales desde la porción superior de C3 hasta el occipital fueron de 3 mm de grosor con 3 mm de intervalo y algoritmo de reconstrucción estándar. Resultados. Las incidencias de inestabilidad atloaxoidea con distancia atlodontoidea 5 mm no han sido superponibles a las series publicadas, incidencia menor (4,2 por ciento), sin diferencias entre las medidas en flexión y lateral neutra. Hubo una mayor incidencia de malformaciones que otros autores, entre ellas un caso de os odontoideum de rara aparición, así como constante asimetría de los cóndilos occipitales (100 por ciento) en los pacientes de la serie de TC y, consecuentemente, basculación del atlas (96 por ciento) y odontoides descentrada (84 por ciento).Conclusiones. El estudio reveló un deficiente y asimétrico desarrollo del hueso occipital, que condiciona diferente altura en los cóndilos occipitales y provoca una mal posición del cervicocráneo. Para estudiar el grado de malposición y las anomalías congénitas, aconsejamos sustituir el estudio radiológico simple por la TC con reconstrucciones tridimensionales (AU)