Effect of obesity on bronchial hyperreactivity among Latino children.

BACKGROUND: The association between obesity and bronchial hyperreactivity (BHR) in children has not been fully demonstrated in cross-sectional or longitudinal studies, and no study has specifically addressed Latino children. METHODS: A cross-sectional study of 450 children (10-18 years) from public schools was conducted in Mexico city. Among this group, 260 met the study criteria (no chronic respiratory illnesses, including asthma and rhinitis; no acute respiratory infections; and no tobacco-exposure or endocrine or body dysmorphic disorders), and 229 performed reproducible pulmonary function and methacholine challenge tests and were fully analyzed. RESULTS: According to BMI percentiles, 40 were normal weight, 116 were obese, and 73 morbidly obese. Children in the morbidly obese group had significantly higher % FVC than those in the normal-weight group, and obese children had higher % PEF those in the morbidly obese and normal-weight groups. In the BHR methacholine challenge test, baseline FEV1 values among obese children were significantly lower than in the morbidly obese group. Using adjusted percentages for FEV1 , values were significantly lower among obese compared to morbidly obese children at metacholine concentrations of 0.25, 1, and 4 mg/ml. The proportion of positive BHR (PC20 ≤ 16 mg/ml) was higher in these two groups compared to normal-weight children (28.4%, 17.8%, and 12.5%, respectively), although differences were not significant. CONCLUSION: Our findings show that obesity by itself is not a sufficient condition to alter airway responsiveness to methacholine in a group of adolescents.

Calidad de vida del cuidador del niño asmático

A pesar del mejor entendimiento de la fisiopatología del asma, del hecho de contar con más y mejores fármacos (como anti-inflamatorios potentes y agonistas beta dos de acción prolongada) los síntomas y la presencia de la enfermedad puede ser persistentes, así como la exacerbaciones que llegan a comprometer la integridad del paciente y hacen necesario valorar el impacto de la enfermedad sobre la vida del paciente y sus cuidadores. Esto ha llevado a incluir en su evaluación general, cuestionarios de calidad de vida. El objetivo de nuestro estudio fue aplicar un cuestionario de calidad de vida a la persona encargada del cuidado de niños asmáticos en dos grupos de pacientes los cuales recibieron diferentes esquemas terapéuticos: uno con un esteroide inhalado (EI) y el otro con el EI más un broncodilatador de acción prolongada (BAP), para valorar los cambios percibidos en los cuestionarios y compararlos de acuerdo al tratamiento. Material y métodos: se realizó un estudio clínico controlado experimental y comparativo, aplicando un cuestionario a la persona encargada del cuidado del niño asmático. Este cuestionario fue elaborado, validado y autorizado su uso por la doctora Efizabeth Juniper y se le conoce como el PACQLQ. Los pacientes y sus cuidadores se distribuyeron al azar en dos grupos: grupo A tratados inicialmente con EI (Beclometasona) más BAP (Salmeterol) por un periodo de seis semanas posterior a lo cual permanecieron dos semanas sin manejo y continuaron las siguientes seis semanas con EI solo. En tanto el grupo B inició con EI solo y después de dos semanas de lavado continuo seis semanas con EI más BAP. A los cuidadores se les realizó el cuestionario al iniciar el tratamiento y en las semanas dos, cuatro y seis. Resultados: se incluyeron a 30 pacientes con sus cuidadores. Se encontró una mejoría en la calidad de vida de los cuidadores de acuerdo al cuestionario en los dos grupos al compararlos con el basal, mientras que los del grupo que recibieron EI mas BAP fue mayor este cambio siendo estadísticamente significativo. Conclusiones: nuestro estudio primero que se realiza en nuestro medio, demuestra que al realizar una intervención en el tratamiento del asma (usar EI o BAP) condiciona una mejoría significativa en la valoración del cuestionario PACQLQ desde las primeras semanas de tratamiento y que los que recibieron terapia de EI más BAP al inicio del tratamiento la mejoría fue mayor. Estos resultados coinciden con lo publicado hasta la fecha. Por lo anterior recomendamos el uso de cuestionario de calidad de vida desde el inicio del tratamiento de los pacientes como parte de su evaluación integral.

Despite better understanding of the pathophysiology of asthma, the application of better drugs (potent anti-inflammatory medications and beta2 adrenergics with long-lasting effects), some symptoms persist and the illness itself, at the same time with exacerbation, may compromise the integrity of the patient. This calls for an evaluation of the impact of the ailment in different aspects of daily life of patients and of his/her caregivers. To address these situations, quality-of-life questionnaires for patients and caregivers were designed. With this study, our objective was to make up a quality-of-life questionnaire to be filled out by caregivers of asthmatic children treated with one of two therapeutic schemes: with inhaled steroids (EI), or the EI plus prolonged action bronchodilator (BAP). Materials and methods: controlled, experimental, and comparative clinical trial polling asthmatic child caregivers, applying a questionnaire designed by Elizabeth Juniper (PACQLQ). Patients and caregivers were randomized in two groups: group A was treated with IE (Beclomethasone) plus BAP (Salmeterol) during a 6-week period, followed by a 2-week wash-out period followed by a 6-week period with only IE. Group B were treated only with EI followed by a 2-week period of wash-out and a six-week period with IE plus BAP. Caregivers filled in the questionnaires at the beginning, and at second, fourth, and sixth-weeks of treatment. Results: we included 30 patients and their caregivers who were randomized in two groups. Values in every group showed significant improvement in quality of life, as compared to basal values. Values between groups showed greater improvement in groups who received El plus BAP at the beginning. Conclusions: our study shows that administering treatment for asthma improves significantly the caregiver's appreciation of quality of life with respect to the PACQLQ questionnaire. The group that received El therapy plus BAP at the beginning showed greater improvement. These results coincide with those published to date. We recommend the use of questionnaires at the beginning of the treatment as part of the integral evaluation of every patient with asthma.

[Eosinophilic proctocolitis induced by foods. Report of a case]. / Proctocolitis eosinofílica inducida por alimentos. Reporte de un caso.

The food-induced eosinophilic proctocolitis is a major cause of blood-tinged stools and appears in the first two months of life. The infant is generally described as well, but the clinical features and laboratory results are often nonspecific. We present an early infant with fresh blood stools at 50 days. The colonoscopy and biopsy of the rectum and lower sigmoid revealed lymphoid nodular hyperplasia of the submucose and eosinophil infiltration (40 to 50 per high power field) of the lamina propria and intraepithelial. Elimination of the offending protein from the diet, through the use of an extensively hydrolyzed casein-based formula and soy, lead to clinical resolution of bleeding at 48 hours. We made a review of the case.