[Prevalence of intolerance to salicylates in patients with nasal polyposis]. / Prevalencia de intolerancia a salicilatos en pacientes con poliposis nasosinusal.

BACKGROUND: Salicylates intolerance is related to alteration in the metabolism of arachidonic acid leading to increased leukotrienes. The condition may be manifested with respiratory, skin or systemic symptoms or associated with sinonasal polyposis. Salicylates are present in anti-inflammatory drugs, cosmetics products and food. OBJECTIVE: To determine the prevalence of salicylates intolerance in patients with sinonasal polyposis presenting to Clinical Immunology and Allergy and Otolaryngology Service, CMN 20 Noviembre, Mexico City. MATERIAL AND METHOD: An observational, descriptive, cross sectional study included patients with sinonasal polyposis. The sample size was 49 patients, and variables were compared using STATISTICA 8.0. RESULTS: The prevalence of sinonasal polyposis was 4% of the study group, predominantly in females; only 24% of the population had an ideal weight, the salicylates intolerance prevalence was 53%, and the Samter triad was 31%. CONCLUSIONS: Sinonasal polyposis has an inflammatory disease pattern. Its pathophysiology is not yet fully established and in this study was related to obesity and persistent sinusitis. The most feared complication recurrence is associated with salicylates intolerance. The study found a slight increase of recurrence in the group of intolerance, with no statistically significant difference, possibly related to the sample size.

Antecedentes: la intolerancia a salicilatos se relaciona con la alteración en el metabolismo del ácido araquidónico, desencadenando incremento de cisteinil leucotrienos; puede manifestarse con síntomas respiratorios, cutáneos, sistémicos o asociado con poliposis nasosinusal. Los salicilatos están contenidos en antiinflamatorios, productos cosméticos y alimentos. Objetivo: determinar la prevalencia de la intolerancia a salicilatos en pacientes con poliposis nasosinusal que acuden al Servicio de Inmunología Clínica y Alergia y al servicio de Otorrinolaringología del Centro Médico Nacional 20 Noviembre, ISSSTE. Material y método: estudio observacional, descriptivo, transversal, en el que se incluyeron pacientes con poliposis nasosinusal. El tamaño de la muestra fue de 49 pacientes, las variables se compararon utilizando STATISTICA 8.0. Resultados: la prevalencia de poliposis nasosinusal fue de 4%, fue mayor en el género femenino; sólo 24% de la población se encontraba en un peso ideal, la prevalencia de intolerancia a salicilatos fue de 53%, la prevalencia de la tríada de Samter fue de 31%. Conclusiones: la poliposis nasosinusal es una enfermedad con patrón inflamatorio, su fisiopatología aún no se establece totalmente; en este estudio se encontró relacionada con obesidad y con la persistencia de sinusitis. La complicación más temida es la recurrencia, se ha relacionado con intolerancia a salicilatos; en este estudio se encontró leve incremento de la recurrencia en el grupo de intolerancia, sin diferencia estadísticamente significativa, posiblemente relacionado con el tamaño de la población.

[Pulmonary age-chronological age relation as indicator of improvement and severity of patients with bronchial asthma]. / Relación edad pulmonar-edad cronológica como indicador de mejoría y gravedad de los pacientes con asma bronquial.

BACKGROUND: Spirometry is a very useful clinical test to evaluate pulmonary function in asthmatic patients. However, pulmonary function could be affected by the sex, time of clinical evolution, lung age (LA) and chronological age (CA). OBJECTIVE: To evaluate LA/CA as index of clinical improvement or severity in asthmatic patients. MATERIAL AND METHOD: A prospective study was done where asthma severity was evaluated according to GINA classification. Spirometry was performed at the beginning of this study, at 46, 96, 192 days and after 10 months. Statistical analysis was performed using t test, two-way ANOVA test, correlation and multiple regression models as well as ROC curves were also performed, a p<0.05 was considered significant. RESULTS: Seventy asthmatic patients were included (22 male and 48 female), mean CA was 35-years; mean LA was 48-years with a LA/CA index=1.4, time of clinical evolution was 13 years. A LA/CA index=1 (range 0.5 to 0.9) was observed in asymptomatic patients. LA/CA index over 1 were related with airway inflammation, and a LA/CA index higher than 2 correlated with GINA step 3. Interestingly when we analyzed CA and LA, we observed in female group a higher than 10 years difference between CA and LA (GINA step 2 and 3); while in male we observed (GINA step 1, step 2 and step 3). LA/CA index less than or equal to 1 was considered normal. CONCLUSIONS: LA/CA index could be used as clinical indicator of clinical improvement or severity in asthma patients in both, male and female, with excellent correlation of pulmonary function and age.

Antecedentes: la espirometría es una prueba clínica que se utiliza para evaluar la función pulmonar en asmáticos. La función pulmonar puede estar afectada por el género, tiempo de evolución clínica, edad pulmonar y edad cronológica. Objetivo: evaluar la relación edad pulmonar-edad cronológica (EP/EC) como indicador de gravedad en pacientes asmáticos. Material y método: estudio prospectivo en el que se evaluó la gravedad del asma mediante la clasificación GINA. La espirometría se realizó al inicio del estudio y a los días 46, 96 y 192, durante 10 meses de seguimiento. Se usaron la prueba t Student, ANOVA de dos vías, modelos de correlación y regresión múltiple y curvas ROC; un valor p<0.05 se consideró significativo. Resultados: se incluyeron 70 pacientes asmáticos (22 hombres y 48 mujeres); la media de la edad cronológica (EC) fue de 35 años, la media de la edad pulmonar (EP) fue de 48 años, con valor del indicador EP-EC=1.4 y la evolución clínica de la enfermedad fue de 13 años. El valor del indicador EP-EC=1 (intervalo de 0.5 a 0.9) se observó en pacientes asintomáticos. El indicador EP-EC mayor a 1 se relacionó con obstrucción de la vía aérea y el indicador EP-EC mayor a 2 se correlacionó con grado 3 de GINA. El análisis de la edad cronológica y pulmonar en las mujeres demostró diferencia de más de 10 años entre ambas edades (GINA grados 2 y 3); mientras que en los hombres se observaron (GINA grados 1, 2 y 3). El valor del indicador EP-EC menor o igual que 1 se consideró normal. Conclusiones: la relación edad pulmonar-edad cronológica puede usarse como indicador clínico de la gravedad y mejoría clínica de pacientes asmáticos, con buena correlación entre la función pulmonar y la edad cronológica.

[Effect of low-intensity pulsed ultrasound on regeneration of joint cartilage in patients with second and third degree osteoarthritis of the knee]. / Efecto del ultrasonido terapéutico pulsátil de baja intensidad sobre la regeneración del cartílago articular en pacientes con gonartrosis de segundo y tercer grado.

OBJECTIVE: To determine if the application of low intensity pulsed ultrasound (LIPUS) therapy has a positive effect over the cartilage repair, functional status and reduction of pain in patients with grade 2 or 3 osteoarthrosis of the knee. DESIGN: This trial was an observational, before and after study without a control group, in which 10 patients (eleven knees) were studied. We applied LIPUS therapy with an intensity of 0.3W/cm(2), duty cycle of 50%, giving a total of 36J/cm(2) per session during 36 sessions (three months). The clinical measures were obtained before the first session and at the end of the 36th session, and were: cartilage thickness by the analysis of magnetic resonance images (MRI) measured by two rheumatologists and a radiology specialist, pain by a visual analog scale (1-10cm) and function/severity by the Lequesne index. We used the non parametric tests of Wilcoxon for comparing medians and the Spearmans rho for the correlation of the inter observer cartilage thickness measurements defining a p value of<0.05 as significant. RESULTS: We observed an effect on pain (VAS mean before 7.09+-2.54 mean after 4.18+-2.22 p 0.005) and on the function/severity index (Lequesne mean before 10.55+-5.42 mean after 5+-4.45 p 0.008). There was poor consistency regarding the cartilage thickness measures by resonance imaging between the three observers (2 rheumatologists and 1 radiologist) so we were not able to define the presence or absence of effect on cartilage thickness augmentation. CONCLUSIONS: LIPUS has a benefic effect over pain and functionality/severity in patients with Kellgren and Lawrence grade 2 and 3 osteoarthritis of the knee. Unfortunately in this study we did not count with a reliable measure method to conclude on its effect over cartilage thickness measured by MRI.

[Allergic asthma and interleukins 2, 4, 5, 6 and 12 and gamma interferon levels]. / Asma alérgica y concentraciones de interleucinas 2, 4, 5, 6 y 12 e interferón gamma.

BACKGROUND: Asthma is an inflammatory chronic illness, in which mastocyt cells, basophils, T lymphocytes, eosinophils and cytokines play a role. Its association with the production of TH2 cytokines is not well known, but it is considered an aberrant immune response, yielding the activation and recruitment of a number of effector cells (mastocyts/eosinophils) and the appearance of clinical symptoms. OBJECTIVE: To determine the serum values of the interleukins 2, 4, 5, 6 and 12 and gamma interferon in relation to the severity degree of asthma and the time of immunotherapy in patients with stable chronic allergic bronchial asthma. MATERIAL AND METHODS: Clinical records of allergic asthmatic patients from the external consultation at Servicio de Alergia e Immunología Clínica were reviewed in a period of 12 months (1st January 2002 to 1st January 2003) and those of healthy volunteers, forming three groups: Group 1, allergic asthmatics with immunotherapy less than 24 months; Group 2, allergic asthmatics with more than 24 months of immunotherapy, and Group 3, healthy volunteers (control group). Previous informed consent, a serum sample was taken of all subjects. RESULTS: Ninety-two subjects were included: 41 (45%) allergic asthmatics and 51 (55%) healthy volunteers. Significant differences were found in interleukins 2, 4, 5, 6 and 12 levels between healthy volunteers and asthmatics without relating the immunotherapy time. In the total group gamma interferon levels were not found. A relation of interleukins Th2 levels with the severity degree of asthma was not found. Differences of serum interleukins Th1 and Th2 in allergic patients related to immunotherapy time were not significant; even though, irrespective of immunotherapy time, IgG levels were always high. CONCLUSIONS: Patients with allergic asthma have a predominance of serum interleukins Th2 and, despite of the immunotherapy, in the maintaining phase, these continue high, which may be due to an immune system dysregulation maybe including other factors. Immunotherapy continues being one of the most useful specific treatments in allergic diseases, demonstrated by its satisfactory clinical response, reduced drugs' use and modification in severity and evolution of the disease.

[Presence of anti-Helicobacter pylori, antithyroid, and high-affinity IgE receptor antibodies in patients with chronic urticaria]. / Presencia de anticuerpos anti-Helicobacter pylori, antitiroideos y antirreceptor de alta afinidad de la inmunoglobulina E en pacientes con urticaria crónica.

BACKGROUND: Chronic urticaria is characterized by erythematous wheals during more than 6 weeks. In 47% of the patients it is associated to Helicobacter pylori infection; in 50%, to antibodies (Abs) against the high affinity receptor of the IgE, and in 12 to 20% to antithyroid's antibodies (antithyroglobuline, mychrosomals) and, from these, 25% have alterations of the thyroid function. OBJECTIVE: To determine the presence of the anti-Helicobacter pylori and anttihyroids antibodies and the high affinity anti-receptor of the IgE in healthy subjects and patients with chronic urticaria. MATERIAL AND METHODS: Eighty subjects were included: 40 healthy subjects and 40 patients whit diagnosis of chronic urticaria. In all of them a blood sample was extracted to the determination of the antibodies and skin test applications with autologous serum to determine the antibody of the high affinity anti-receptor of IgE. For the analysis of the results descriptive statistics was used (central tendency measures, frequencies, means, averages and percentages), as well as multiple correlations and inferential analyses. RESULTS: Anti-Helicobacter pylori, antithyroid (antithyroglobulin, microsomal) antibodies and the skin test with autologous serum (antibody of the high affinity anti-receptor of IgE) were negative in the healthy group (mean age: 41 years, 36 women, 90%). Of the 40 patients with chronic urticaria (mean age: 42 years, 36 women, 90%), the frequency of the antibody of high affinity anti-receptor of the IgE was: 5 patients with negative skin test (12.5%), 1 (2.5%)+, 7 (17.5%)++, 9 (22.5%)+++, 18 (45%)++++. The anti-Helicobacter pylori antibodies were positive in 30 (75%) patients and negative in 10 (25%). The antithyroid's antibodies were as follows: antithyroglobulin: 4 (10%) positive, microsomal: 4 (10%) positive. The concomitant diseases found were: hypothyroidism (3, 7.5%) mixed rhinitis (2.5%) and autoimmunity 2 (5%). CONCLUSION: The test skin with autologous serum to determine the IgG antibody against the high affinity receptor of IgE is a simple and low-cost procedure leading to determine the cause of the idiopathic chronic urticaria in a high percentage of patients. As reported in literature, the Helicobacter pylori infection documented by the detection of the IgM antibodies against Helicobacter pylori is frequent in patients with chronic urticaria, which is important due to it could be implied in the diagnosis and treatment.

Efecto del ultrasonido terapéutico pulsátil de baja intensidad sobre la regeneración del cartílago articular en pacientes con gonartrosis de segundo y tercer grado / Effect of low-intensity pulsed ultrasound on regeneration of joint cartilage in patients with second and third degree osteoarthritis of the knee

Objetivo Indagar si la aplicación del ultrasonido terapéutico pulsátil de baja intensidad (USTPBI) produce cambios favorables en la regeneración del cartílago articular, así como beneficios clínicos en pacientes que tienen gonartrosis grado 2 o 3 según la clasificación de Kellgren y Lawrence. Diseño Éste es un estudio observacional, tipo antes y después, sin grupo control, en el que se estudiaron 10 pacientes (11 rodillas) con gonartrosis grados 2 y 3 (según la clasificación de Kellgren y Lawrence), a los que se les aplicó ultrasonido terapéutico a una intensidad de 0,3W/cm2 pulsátil al 50%, que otorgó un total de energía de 36J/cm2 por sesión durante 36 sesiones. Las mediciones se realizaron previas al inicio del tratamiento y posteriores al término de éste (3 meses después), y consistieron en: grosor del cartílago articular mediante el análisis de imágenes tomadas por resonancia magnética (RM) por 2 reumatólogos y un experto radiólogo; dolor mediante escala visual analógica (de uno a 10cm), y el índice de gravedad de Lequesne. Se utilizaron pruebas estadísticas no paramétricas de Wilcoxon y pruebas de correlación de Spearman, y se definió un valor de p<0,05 como estadísticamente significativo. Resultados Se observó una disminución en la intensidad de dolor (basal media de 7,09±2,54; final media de 4,18±2,22; p=0,005) y una mejoría en cuanto a la funcionalidad (basal media de 10,55±5,42; final media de 5±4,45; p=0,008) después del tratamiento con USTPBI. Con respecto al grosor medido en la RM, no se obtuvieron mediciones consistentes entre los observadores, por lo que se concluyó que el método de medición no fue reproducible, lo que hizo difícil definir si hubo un incremento o no en el grosor del cartílago articular. Conclusiones El USTPBI tiene un efecto benéfico sobre la disminución del dolor y la mejoría de la funcionalidad. Desafortunadamente, en este estudio no se cuenta con un método de medición reproducible para arrojar una conclusión válida en cuanto al efecto del USTPBI sobre el grosor del cartílago articular (AU)

Objective To determine if the application of low intensity pulsed ultrasound (LIPUS) therapy has a positive effect over the cartilage repair, functional status and reduction of pain in patients with grade 2 or 3 osteoarthrosis of the knee. DesignT his trial was an observational, before and after study without a control group, in which 10 patients (eleven knees) were studied. We applied LIPUS therapy with an intensity of 0.3W/cm2, duty cycle of 50%, giving a total of 36J/cm2 per session during 36 sessions (three months). The clinical measures were obtained before the first session and at the end of the 36th session, and were: cartilage thickness by the analysis of magnetic resonance images (MRI) measured by two rheumatologists and a radiology specialist, pain by a visual analog scale (1–10cm) and function/severity by the Lequesne index. We used the non parametric tests of Wilcoxon for comparing medians and the Spearmans rho for the correlation of the inter observer cartilage thickness measurements defining a p value of<0.05 as significant. Results We observed an effect on pain (VAS mean before 7.09+−2.54 mean after 4.18+−2.22 p 0.005) and on the function/severity index (Lequesne mean before 10.55+−5.42 mean after 5+−4.45 p 0.008). There was poor consistency regarding the cartilage thickness measures by resonance imaging between the three observers (2 rheumatologists and 1 radiologist) so we were not able to define the presence or absence of effect on cartilage thickness augmentation. Conclusions LIPUS has a benefic effect over pain and functionality/severity in patients with Kellgren and Lawrence grade 2 and 3 osteoarthritis of the knee. Unfortunately in this study we did not count with a reliable measure method to conclude on its effect over cartilage thickness measured by MRI (AU)

Detección de factor reumatoide por nefelometría en pacientes de un centro hospitalario en México / Determination of rheumatoid factor by nephelometry in a mexican medical center

Se estudió la presencia de factor reumatoide por nefelometría en 6.264 muestras consecutivas de suero, provenientes de pacientes captados de una población hospitalaria de 1988 a 1990. El 52 por ciento de estos pacientes presentaron FR positivo, en comparación con el 1,4 por ciento en el grupo control. Se obtuvieron resultados negativos en 48 por ciento de los sueros captados en población hospitalaria, en comparación al 98 por ciento de muestras negativas en una población control (p<0,000001), captada en una clínica de atención de primer nivel. Ambos grupos mostraron características demográficas y socioeconómicas similares y los resultados no dependieron del número de pacientes estudiados, cuando se divieron a los resultados en negativos (<30Ul/ml), intermedios (30-110 Ul/ml) y altos (>30 Ul/ml), se encontró una frecuencia similar de los sueros positivos (20-27 por ciento), especialmente cuando se evaluaron los límites intermedios. Estos niveles variaron muy poco en los diferentes períodos del estudio. Los resultados de factor reumatoide pueden mostrar gran variación de acuerdo a la edad, sexo, antecedentes inmunogenéticos, o antecedentes patológicos en diferentes poblaciones. Los pacientes de población hospitalaria, muestran una alta incidencia de padecimientos infecciosos e inflamatorios crónicos que pueden cursar con pruebas positivas para factor reumatoide, y esto puede explicar su alta frecuencia en comparación con el grupo control. Falta definir la participación de ésta y otras variables en estudios posteriores