Usefulness and limitations of sequential serum tryptase for the diagnosis of anaphylaxis in 102 patients.

BACKGROUND: The diagnosis of anaphylaxis is based on clinical history since no reliable biological marker is currently available to confirm the diagnosis. OBJECTIVE: It was the aim of this study to determine sequential serum tryptase concentrations during anaphylaxis and to evaluate its potential as a diagnostic marker. METHODS: We performed a prospective study including patients with acute anaphylaxis (according to the National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network criteria) attending the emergency department. Demographic characteristics, anaphylactic triggers, specific risk factors, clinical characteristics and management of anaphylaxis were recorded. Serum tryptase was measured at 1-2 h (T1), 4-6 h (T2) and 12-24 h (T3) following onset of the episode and at basal conditions (TB). RESULTS: A total of 102 patients were included (63 females, mean age 47.4 ± 19.1 years). Tryptase concentration at T1 (19.3 ± 15.4 µg/l) was significantly higher than at T2, T3 and TB (all <11.4 µg/l; p < 0.0001). Importantly, tryptase was not raised in 36.3% of cases; furthermore, in 60.6% of these patients, no changes were observed in tryptase levels comparing T1 and TB (ΔT1-TB = 0). Tryptase was more frequently elevated in more severe anaphylaxis (p < 0.0001) and positively correlated with the grades of severity (p < 0.001, r = 0.49). Anaphylaxis was more severe and tryptase concentration higher when the causative agent was a drug compared to food, both at T1 (p = 0.045) and at TB (p = 0.019). Age and coronary risk factors were associated with more severe anaphylaxis (p = 0.001). CONCLUSION: Tryptase is a biomarker related to the severity of anaphylaxis. However, since its concentration remains unaltered in a considerable number of patients during acute anaphylaxis, there is a need for more reliable diagnostic biological tests.

Spirometric maneuvers and inhaled salbutamol do not affect exhaled nitric oxide measurements among patients with allergic asthma.

BACKGROUND: Exhaled nitric oxide (ENO) is used as a marker of airway inflammation. Factors such as spirometric maneuvers (SPM), ß(2)-agonists, or tobacco smoking have been postulated to affect ENO measurements. Guidelines on measurement techniques have been published based on expert opinions. Nevertheless, there is no strong clinical evidence of many aspects because they have not been supported by research data. OBJECTIVES: The aim of this study was to evaluate the influence of performing a spirometry or receiving inhaled salbutamol on ENO readings. METHODS: One hundred forty-five adults and 62 children with allergic asthma were included with a mean age of 36 ± 13 years for adults and 13 ± 2 years for children. A control group comprised 30 healthy adults and 30 children with a mean age of 37 ± 14 years and 13 ± 2 years, respectively. ENO measurements were performed with a NIOX-MINO® electrochemical device. In 179 patients ENO was measured before and after performing SPM and in 88 patients before and 15 min after SPM plus 2 puffs of salbutamol (100 µg/puff). RESULTS: There were no significant differences in mean ENO levels before and after SPM or before and after SPM plus 2 puffs of inhaled salbutamol in adults or children (asthmatic or healthy). CONCLUSIONS: Levels of ENO are not significantly affected by SPM or salbutamol inhalation.

Frozen fruit skin prick test for the diagnosis of fruit allergy.

BACKGROUND: Diagnosis of fruit sensitisation by skin prick test (SPT) is fast and easy to perform. Nevertheless, some fruit is not available throughout the year. Freezing aliquots of these fresh fruits to be defrosted would be a good solution to perform SPT at any time. OBJECTIVE: To compare the reproducibility of SPT with Rosaceae and Cucurbitaceae frozen fruit with fresh and commercial fruit extracts. METHODS: SPT with the following fruit were performed: apricot, cherry, strawberry, nectarine, Japanese medlar, peach, (peel and pulp), yellow and red plum, melon and watermelon. We compared fresh fruit, commercial extract and fruit which had been frozen at -18 degrees C. Results were read by planimetry (Inmunotek prick-film) after 15 minutes. RESULTS: The study group comprised 48 patients (9 males, 39 females) with a mean age of 31, 6 +/- 2.0 years. Concordance of positive and negative results was extremely high and significant in all cases. Correlation between frozen fruit and commercial extract, frozen fruit and fresh and commercial extract and fresh fruit was statistically significant in all cases except for strawberry. CONCLUSIONS: The use of frozen fruit is a valid method, as the performance of the SPT is similar to that of fresh fruit. This enables diagnostic procedures with seasonal fruit at any time of the year.

Allergic diseases in the elderly.

Demographic distribution of the population is progressively changing with the proportion of elderly persons increasing in most societies. This entails that there is a need to evaluate the impact of common diseases, such as asthma and other allergic conditions, in this age segment. Frailty, comorbidities and polymedication are some of the factors that condition management in geriatric patients. The objective of this review is to highlight the characteristics of allergic diseases in older age groups, from the influence of immunosenescence, to particular clinical implications and management issues, such as drug interactions or age-related side effects.

Asma alérgica / Allergic asthma

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Los trastornos de la personalidad en adictos a la heroína y la seroconversión al VIH, una asociación relevante / No disponible

Introducción. En los últimos años ha aumentado considerablemente la preocupación sobre el diagnóstico y tratamiento de los pacientes con abuso de drogas, trastornos de la personalidad y seroconversión a VIH (virus de la inmunodefi ciencia humana). Objetivo del estudio es profundizar en la pluripatología que estos pacientes presentan, y comprender qué factores pueden ser determinantes en el desarrollo de su patología. Pacientes y método. Estudio descriptivo y transversal. Se ha relacionado la comorbilidad psiquiátrica con las variables: determinación del VIH, vía de administración y abuso o polidrogodependencia a otras drogas. Y también la comorbilidad de la positividad del VIH con las variables: diagnóstico psiquiátrico de la patología asociada, vía de administración y abuso o polidrogodependencia a otras drogas. Resultados. Se ha incluido 349 pacientes del Hospital Santa Maria de Lleida. Un 29,5% (n= 103) de la muestra presenta un trastorno antisocial de la personalidad y un 6,6% (n= 23) un trastorno límite de la personalidad. Se observó como el grupo con trastornoantisocial de la personalidad presentaba una mayor proporción de VIH positivos 49,5%, (n= 46) que cualquier de los otros dos grupos. Estas diferencias han resultado estadísticamente signifi cativas, de manera que los pacientes afectados por trastorno antisocial de la personalidad presentaban un riesgo 2,3 veces superior a tener positividad al VIH que los pacientes sin comorbilidad asociada. Conclusiones. La psicopatología está signifi cativamente asociada con niveles más altos de conductas de riesgo relacionados con el VIH en pacientes drogodependientes (AU)

Background. In recent years the concern regarding diagnosis and treatment of patients suffering from drug abuse, personality disorders and seroconversion to HIV (human immunodefi ciency virus) has increased considerably. Objective. The aim of the study is to examine the pluripathology these patients present and to comprehend which factors are decisive in the development of their pathology.Patients and method: Descriptive cross study. Psychiatric comorbidity has been related to the variables of HIV determination, administration method as well as abuse or codependence on other drugs. Likewise, the comorbidity of HIV positivity was associated with the variables of psychiatric diagnosis of associated pathology, administration method as well as abuse or co-dependence on other drugs. Results: 349 patients of Santa Maria de Lleida Hospital were included. 29.5% (n=103) of the sample present an anti-social personality disorder and 6.6% (n=23) a borderline personality disorder. The group with anti-social personality disorder had a higher percentage of HIV positives 49.5% (n=46) than either of the other two groups. These differences are statistically signifi cant, whereby patients affected with an anti-social personality disorder had a 2.3 times higher risk of being HIV positive than patients without associated comorbidity. Conclusions: Psychopathology is signifi cantly associated with higher levels of risk behaviours related to HIV in drug-addicted patients (AU)

Alteraciones morfológicas en la enfermedad por quemaduras: experiencias en 156 autopsias / Morphological alterations in burn disease: experiences in 156 autopsies

La enfermedad por quemaduras, presente en tiempo de guerra o en tiempo de paz, constituye un reto a enfrentar en función de recuperar una vida. Se realizó un estudio de las autopsias de los fallecidos por enfermedad por quemaduras que se encuentran en la base de datos del Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto", con el propósito de determinar las alteraciones morfológicas principales que se manifiestan en estos. Se revisaron las variables de los grupos de edades, sexo, estadía hospitalaria, causas de muerte, presencia de infección y daño múltiple de órganos. Más de las tres/cuarta partes de los casos se encontraban entre los 15 y 54 años de edad, con un discreto predominio en el porcentaje del sexo femenino. La estadía osciló entre 0 y 60 días, con un valor medio de 10,61 días. Las quemaduras dermohipodérmicas según la extensión de la superficie corporal quemada se comportó con mayor frecuencia por encima del 60 % en más de la mitad de los casos estudiados. Las causas directas de muerte se manifestaron de modo característico, se afectó al pulmón como órgano diana en más de la mitad de los fallecidos. La sepsis se destacó entre las causas de muerte. En los fallecidos estudiados, la infección y el daño múltiple de órganos se presentaron en el 69,9 y 67,3 % respectivamente. Entre las enfermedades más diagnosticadas, se destacaron las relacionadas con el daño múltiple de órganos. La experiencia alcanzada por el colectivo en estudios preclínicos, sustentan la necesidad de realizar una labor terapéutica precoz, para impedir desencadenar la respuesta inflamatoria sistémica que provoca morfológicamente el daño múltiple de órganos.

Burn disease in war or peace time is a challenge to recover life. A necropsy study of the patients who died of burn diseases registered in the database of "Luis Díaz Soto" Higher Military Medicine Institute was conducted to determine their main morphological alterations. The following variables were studied: age, sex, hospital stay, causes of death, presence of infection and multiple organ damage. More than the three fourth parts of the cases were aged 15-54, with a discrete predominance of females. Hospital stay fluctuates between 0 and 60 days with a mean value of 10.61 days. The dermohypodermic burns according to the extent of the burned body surface behaves frequently above 60 % in more than half of the studied cases. The direct causes of death manifested in a characteristic way. The lung was affected as a target organ in more than half of the dead. Sepsis stood out among the death causes. In the studied deceased, infection and multiple organ damage were present in 69.9 and 67.3 %, respectively. Among the most diagnosed diseases are those related to multiple organ damage. The experience gained by the group as regards preclinic studies, supports the need of carrying out an early therapeutical work to prevent the triggering of a systemic inflammatory response morphologically caused by multiple organ damage.

Aneurisma micótico de aorta abdominal infrarrenal por Coxiella burnetii / Mycotic aneurysm of infrarenal abdominal aorta due to Coxiella bunetii

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Tratamiento de las quemaduras de espesor parcial con quitina en polvo / Treatment of partial thickness burns with powdered chitin

Se realizó un ensayo clínico controlado para evaluar la eficacia de la aplicación local de quitina en polvo al 100 %, obtenida por el método de extracción elaborado por la doctora Irma García, en 118 pacientes afectados de quemaduras dérmicas A y AB hasta el 2 % de superficie corporal, tratados ambulatoriamente en los servicios de caumatología de los hospitales "Dr. Luis Díaz Soto" y "William Soler". El grupo de ensayo estuvo constituido por 45 adultos y 21 niños y el grupo control, tratado con crema de sulfadiazina de plata al 1 %, por 31 adultos y 21 niños. Se comprobó la eficacia de la quitina al 100 % y se obtuvo un tiempo de cicatrización clínica significativamente inferior al del grupo control en las lesiones dérmicas A y AB en los niños (3,8 y 4,3 días menos respectivamente) y en las dérmicas AB en los pacientes adultos (4,1 días menos).

A controlled clinical trial was carried out to assess the effectiveness of the local application of 100 % powdered chitin, obtained by the extraction method, realized by Dr. Irma García in 118 patients affected with A and AB dermal burns up to 2 % of the body surface, ambulatorily treated at the burns services of "Dr. Luis Díaz Soto" and "William Soler" hospitals. Fourty five adults and 21 children integrated the assay group, and the control group, treated with 1 % silver sulfadiazine, was integrated by 31 adults and 21 children. An efficacy of 100 % chitin was confirmed, and a significantly inferior clinical healing time was obtained, related to that of the control group in A and AB dermal lesions in children (3,8 and 4,3 days less, respectively) and in AB dermal lesions in adult patients (4,1 days less).