Student performance in year 1 undergraduate medical education during traditional, emergency online, online and HyFlex teaching strategy: A single center study / Health Sciences Journal

Background@#The global pandemic caused by COVID-19, the subsequent improvement in health situation caused by anti- COVID-19 vaccination and the developments in digital technology prompted changes in undergraduate medical education as to content delivery and assessment. This study determined the difference in the performance of first year medical students in traditional face-to face, online and Hyflex teaching strategy.@*Methods@#A non-concurrent cohort study was done to determine the performance of students in three annual subjects in Year 1 undergraduate medical education for school years 2018 to 2023. One-way ANOVA at p=0.001 determined significance of differences of variables.@*Results@#There was no difference in the profile of students as to their sex, pre-medicine course and scores in the National Medical Admission Test (NMAT). The performance in the written examinations in Anatomy and Physiology showed significant difference (p=0.001) when the conduct of examinations was shifted online on an emergency basis. There was no difference (p=0.001) in performance in the laboratory conference sessions in Physiology, as compared to the focused group discussion sessions in Biochemistry and practical examinations in Anatomy.@*Conclusion@#Significant difference in the performance of first year medical students was observed only during the emergency shift to online examinations, otherwise the performance was similar in traditional face-to face, online and Hyflex teaching strategy.

Prevalence of extended-spectrum ß-lactamase-producing Escherichia coll and Klebsiella pneumoniae isolates in outpatients with urinary tract infection in a Cuban municipality / Prevalência de aislamientos de Escherichia coli y Klebsiella pneumoniae productoras de ß-lactamasas de espectro extendido en pacientes ambulatorios de un municipio de Cuba con infección del tracto urinario

Abstract Introduction: Community- acquired urinary tract infections (CA-UTI) caused by extended-spectrum ß-lactamases (ESBL) -producing Enterobacteriaceae are a growing phenomenon worldwide. Objective: To determine the prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates obtained from urine samples of outpatients with CA-UTI in a Cuban municipality, as well as the antibiotic resistance profiles associated with the ESBL phenotype. Materials and methods: Retrospective descriptive study. A total of 304 isolates of E. coli and 34 of K. pneumoniae obtained from urine cultures of patients with CA-UTI treated between January 1, 2019, and December 31, 2020, at the Hospital Clínico-Quirúrgico Docente Aleida Fernández Chardiet, in the municipality of Güines, Mayabeque province, Cuba, were analyzed. A bivariate analysis (chi-square test) was performed to determine differences in antibiotic resistance rates between ESBL-producing and non-producing bacteria. Results: 16.77% (51/304) and 17.64% (6/34) of E. coli and K. pneumoniae isolates were classified as ESBL-producing bacteria. In the case of ESBL-producing E. coli isolates, ESBL+ciprofloxacin was the most frequent antibiotic resistance pattern (22/51; 43.13%), followed by ESBL+ciprofloxacin and amikacin (14/51; 27.45%). Moreover, 41.17% (21/51) were multidrug-resistant. In the case of ESBL-producing K. pneumoniae, ESBL+ciprofloxacin, amikacin and nitrofurantoin was the predominant antimicrobial resistance pattern (2/6; 33.33%), and 50 % (3/6) were multidrug resistant. Conclusions: The results reported confirm the presence of ESLB-producing E. coli and K. pneumoniae, with a high prevalence of multidrug resistance in patients with CA-UTI in the municipality of Güines, Cuba.

Resumen Introducción. Las infecciones del tracto urinario (ITU) adquiridas en la comunidad y causadas por enterobacterias productoras de ß-lactamasas de espectro extendido (BLEE) son un fenómeno creciente a nivel mundial. Objetivo. Determinar en un municipio de Cuba la prevalencia de aislamientos de Escherichia coli y Klebsiella pneumoniae productoras de BLEE obtenidos de muestras de orina de pacientes ambulatorios con ITU adquirida en la comunidad, así como los perfiles de resistencia a antibióticos asociados al fenotipo BLEE. Materiales y métodos. Estudio descriptivo retrospectivo. Se analizaron 304 aislamientos de E. coli y 34 de K. pneumoniae obtenidos de urocultivos de pacientes con ITU adquirida en la comunidad atendidos entre enero 1 de 2019 y diciembre 31 de 2020 en el Hospital Clínico-Quirúrgico Docente Aleida Fernández Chardiet del municipio de Güines, provincia Mayabeque, Cuba. Se realizó un análisis bivariado (prueba chi-cuadra-do) para determinar diferencias en las tasas de resistencia antibiótica entre las bacterias productoras de BLEE y las no productoras. Resultados. El 16.77% (51/304) y el 17.64 % (6/34) de los aislamientos de E. coli y K. pneumoniae se clasificaron como bacterias productoras de BLEE, respectivamente. En el caso de los aislados de E. coli productoras de BLEE, BLEE+ciprofloxacina fue el patrón de resistencia más frecuente (22/51; 43.13%), seguido por BLEE+-ciprofloxacino y amikacina (14/51; 27.45%). Además, 41.17% (21/51) fueron multirresistentes. En el caso de K. pneumoniae productoras de BLEE, predominó el patrón de resistencia BLEE+ciprofloxacino, amikacina y nitrofurantoina (2/6; 33.33%), y 50% (3/6) fueron multirresistentes. Conclusiones. Los resultados confirman la presencia de E. coli y K. pneumoniae productoras de BLEE, con una alta prevalencia de multirresistencia en pacientes con ITU adquirida en la comunidad en el municipio de Güines.

Variación de la susceptibilidad a antimicrobianos en aislados clínicos de Klebsiella pneumoniae y Escherichia coli de pacientes hospitalizados / Variation of antimicrobial susceptibility in clinical isolates of Klebsiella pneumoniae and Escherichia coli in inpatients

Introducción: La presencia de enterobacterias multirresistentes en los hospitales es cada vez más frecuente. Objetivos: Describir la variación de la susceptibilidad a los antimicrobianos en aislados de Klebsiella pneumoniae y Escherichia coli e identificar la frecuencia de aislados multirresistentes. Métodos: Estudio descriptivo retrospectivo realizado entre el 1 de enero de 2018 y 31 de diciembre de 2021. Se estudió la susceptibilidad a los antimicrobianos por el método de difusión de discos Bauer-Kirby a 220 aislados (111 de K. pneumoniae y 109 de E. coli) obtenidos de muestras clínicas (sangre, lesiones de piel, catéteres vasculares, secreciones traqueobronquiales y de herida quirúrgica) de pacientes hospitalizados en el Hospital Clínico-Quirúrgico Docente Aleida Fernández Chardiet, provincia Mayabeque, Cuba. Resultados: Durante los 4 años de estudio, en los aislados de K. pneumoniae la resistencia mostró tendencia a crecer en el tiempo para todos los antimicrobianos probados, excepto para amoxicilina/ácido clavulánico con tendencia a decrecer de -3,34. La diferencia porcentual de la resistencia del año 2021 con respecto al 2018 fue mayor para meropenem, cloranfenicol y amikacina (108,3 %, 70,2 % y 70,2 %, respectivamente). Aun así, los datos mostraron significación estadística para los antibióticos cefepima, aztreonam y meropenem (p ≤ 0,05). En cuanto a los aislados de E. coli, la resistencia mostró tendencia a decrecer en ocho de los antimicrobianos investigados, pero el cloranfenicol y amikacina evidenciaron una tendencia al incremento de 3,65 y 4,83, respectivamente. La diferencia porcentual entre los años extremos del estudio en nueve antimicrobianos mostró valores inferiores al 50,0 %. Los datos evidenciaron significación estadística (p ≤ 0,05) para cefotaxima y ampicilina/sulbactam. Conclusiones: Hubo variación en la susceptibilidad a los antimicrobianos en los aislados de K. pneumoniae y E. coli durante los 4 años del estudio. Además, se observó una alta prevalencia de aislados multirresistentes.

Introduction: The presence of multidrug resistant enterobacteria in hospitals is increasingly frequent. Objectives: To describe the variation of the antimicrobial susceptibility pattern of Klebsiella pneumoniae and Escherichia coli isolates obtained from clinical samples of patients who were hospitalized and to identify the frequency of multidrug resistant isolates. Methods: A retrospective and descriptive study was performed between January 1, 2018 and December 31, 2021. The antimicrobial susceptibility was analyzed using the Bauer- Kirby disc diffusion method of 220 isolates (111 K. pneumoniae and 109 E. coli) obtained from clinical samples (blood, skin lesions, vascular catheters and tracheobronchial and surgical wound secretions) of patients hospitalized at the Hospital teaching surgical - clinic Aleida Fernández Chardiet, located in the province of Mayabeque, Cuba. Results: In the K. pneumoniae isolates during the four years of the study, resistance showed a tendency to increase over time, for all antibiotic tested, except for amoxicillin / ácid clavulánic, which showed a tendency to decrease from 3.34. The percentage difference of the resistance between the year 2021 in relation to 2018 were greater for meropenem, chloramphenicol and amikacin (108.3%, 70,2% y 70.2% respectively). Even so, the data provided evidence that showed statistical significance for the antibiotics cefepime, aztreonam y meropenem (p ≤ 0,05). Regarding the E. coli isolates, resistance showed a tendency to decrease over the course of the four years of the study in eight of the investigated antibiotics. chloramphenicol and amikacin showed an increasing trend of 3.65 y 4.83 respectively. The percentage difference between the extreme years of the study in nine antimicrobials showed values lower than 50.0%. The data provide elements to suggest the presence of statistical significance (p ≤ 0.05) for cefotaxim y ampicilin/sulbactam. Finally, 83.87% of K. pneumoniae isolates and 80.73% of E. coli isolates were multidrug resistant. Conclusions: There was variation in the susceptibility to antibiotic in the K. pneumoniae and E. coli isolates during the four years of the study. In addition, a high prevalence of multiresistant isolates was observed.

COVID-19 vaccination: The greater Manila experience 2021 / The Health Sciences Journal

INTRODUCTION@#Almost half of adult Filipinos were unwilling to receive the COVID-19 vaccination in early 2021. This study aimed to describe the COVID-19 vaccination experience in the Greater Manila Area. @*METHODS@#An analytical cross-sectional study design was done where Filipinos aged 18-60 years old residing in the Greater Manila Area answered an online survey. Fisher’s exact test was used to compute p-values for the association between participants’ willingness or refusal to get vaccinated and their sociodemographic and clinical characteristics.@*RESULTS@#Among 1,248 respondents, 97.92% were willing to get vaccinated against COVID-19. The majority who refused strongly agreed that the vaccine could cause serious side effects (46.2%). Being a college graduate (OR = 3.03, p = 0.006) and high income (OR = 5.06, p = 0.003) had a statistically significant positive association with willingness to get vaccinated.@*CONCLUSION@#There are more individuals willing to get vaccinated and there is a statistically significant association between educational attainment and monthly income with vaccine willingness or refusal.

Acceptability of telemedicine among patients undergoing prenatal and postnatal care in the setting of the COVID-19 pandemic / Philippine Journal of Obstetrics and Gynecology

Background@#While COVID‑19 spreads rapidly around the world, innovative means to provide continuing prenatal care are being developed to monitor maternal and fetal health while minimizing disease transmission. Telemedicine is one platform by which patients are provided the necessary prenatal and postpartum care safely as the pandemic rages@*Aims and Objectives@#To evaluate the acceptability of telemedicine in the delivery of prenatal and postnatal care in the setting of the COVID‑19 pandemic@*Materials and Methods@#A cross‑sectional study was conducted in a tertiary hospital in Manila. A structured Likert scale‑based survey consisting of a model measuring telemedicine perception was utilized. This was a predeveloped model by Lin in 2017.[1] Descriptive statistical analysis and Chi‑square tests were done to evaluate the data@*Results@#A total of 193 pregnant and postpartum patients participated in the study. Majority of the respondents were between 25 and 34 years old, living within Metro Manila, and normal obstetric patients who were previously seen at the outpatient department. Most of the participants considered telemedicine to be cost‑effective, reliable, easy to use, and useful@*Conclusion@#We conclude that telemedicine is an acceptable means of providing prenatal and postnatal care among pregnant patients because it allowed the necessary interaction between patient and doctor and these “users” kept on using the system. There was no association between telemedicine perceptions and patient age, place of residence, type of patient encounter, disease, and treatment. In the setting of the COVID‑19 pandemic, telemedicine is an acceptable means of providing prenatal and postnatal care regardless of patient characteristics

Impacto de la hipertensión arterial esencial y la cardiopatía isquémica en víctimas de muerte cardíaca súbita / Impact of essential blood hypertension and ischemic heart diseases in sudden cardiac death victims

Objetivo: Determinar la asociación que existe entre la hipertensión arterial esencial y la cardiopatía isquémica en la muerte cardíaca súbita. Métodos: Estudio observacional analítico de tipo casos y controles no pareados. Se analizaron 600 casos de muertes naturales cardíacas diagnosticados en el hospital Julio Trigo López en el período 2007-2011. Del total, 200 fallecieron por causa cardíaca súbita y 400, por causa cardíaca no súbita; contaron con estudios anatomopatológicos. Resultados: Se demostró tanto en el análisis univariado como multivariado que la hipertensión arterial y la cardiopatía isquémica tienen una fuerza de asociación positiva como factor de riesgo para la muerte cardíaca súbita. Se comprobó que las lesiones ateroscleróticas se presentaron de forma significativa en los fallecidos por muerte cardíaca súbita con estos factores de riesgo, por lo que se estableció con ello una relación de causalidad evidente. Se definió que los estudios con base anatomopatológica cuentan con un margen de seguridad mayor al evaluar una entidad tan polémica como la muerte cardíaca súbita. Conclusiones: La hipertensión arterial y la cardiopatía isquémica constituyen factores de riesgo independientes para la muerte cardíaca súbita, ambos elementos tienen una relación marcada y directa con la presencia de lesiones ateroscleróticas en el árbol vascular coronario como evidencia del papel de la aterosclerosis en la etiopatogenia del fenómeno(AU)

Objective: To determine the relationship between essential blood hypertension and ischemic heart disease in sudden cardiac death. Methods: Non-paired case-control observational analytical study of 600 natural cardiac death cases which were diagnosed at Julio Trigo Lopez hospital in the period of 2007 to 2011. In this group, 200 died from sudden cardiac death and 400 from non-sudden cardiac death; anatomic and pathological studies were performed. Results: The univariate and multivariate analyses proved that blood hypertension and ischemic heart disease were positively associated as risk factors for sudden cardiac death. It was conformed that atherosclerotic lesions were significantly present in sudden cardiac death victims together with these risk factors, so an evident causality relationship was set. It was defined that anatomic.pathological studies exhibited higher level of reliability as to evaluation of a very controversial issue such as sudden cardiac death. Conclusions: Blood hypertension and ischemic heart disease are independent risk factors for sudden cardiac death; both elements have direct marked relation with the presence of atherosclerotic lesions in the coronary vascular tree as evidence of the role of atherosclerosis in the etiopathogeny of the disease(AU)

Resultados del Grupo de Investigación en Muerte Súbita, 20 años después de su creación / The Research Group on Sudden Death and its results after 20 years

La muerte súbita representa en la actualidad uno de los principales desafíos para los sistemas sanitarios a nivel mundial dada su elevada incidencia, dramatismo en su presentación y años de vida que se pierden prematuramente como consecuencia de esta entidad. OBJETIVO: describir los antecedentes de la creación hace 20 años del Grupo de Investigación en Muerte Súbita en Cuba y mostrar sus resultados más significativos. MÉTODO: se realizó una revisión documental de los primeros 20 años de trabajo de investigación científica del Grupo de Investigación en Muerte Súbita en Cuba (1995-2014). RESULTADOS: se estudiaron 24 758 muertes naturales a las cuales se les aplicó un algoritmo diagnóstico para documentar 1 953 eventos de muerte súbita cardiovascular, que representaron el 7,8 por ciento de la mortalidad global registrada. El 98,1 por ciento de la casuística investigada correspondió a 14 municipios de la provincia La Habana. El 2 por ciento restante incluyó 26 municipios de 11 provincias del país. Los estudios han demostrado un incremento en la probabilidad para este evento en pacientes con hipertensión arterial, obesidad, diabetes mellitus, cardiopatía isquémica, necrosis miocárdica previa, tabaquismo, engrosamiento ventricular izquierdo y alteración del perfil lipídico. CONCLUSIONES: la creación del Grupo de Investigación en Muerte Súbita ha permitido, en los últimos 20 años, el diseño y ejecución de investigaciones científicas encaminadas a la caracterización epidemiológica de este problema de salud en Cuba, elementos útiles para trazar estrategias de intervención que permitan lograr una disminución sensible en la incidencia e impacto económico, familiar y social de esta entidad(AU)

Sudden death presently represents one of the main challenges for the health care systems worldwide due to high incidence, dramatic presentation and life years prematurely lost as a result of this event. OBJECTIVE: to describe the background of the creation of the research group on sudden death in Cuba twenty years ago, and to show its most significant results. METHODs: a documentary review of the first 20 years of scientific research work performed by the Research Group on Sudden Death in Cuba (1995-2014). RESULTS: twenty four thousand eight hundred and seventy six deaths of natural causes were studied and applied a diagnostic algorithm to document 1 953 events of sudden cardiovascular death accounting for 7.8 percent of recorded global mortality. In the studied casuistry, 98.1 percent went to 14 municipalities from 11 provinces. The studies showed increased probabilities for this event in patients suffering blood hypertension, obesity, diabetes mellitus, ischemia, previous myocardial necrosis, smoking, left ventricle thickening, and lipid profile impairment. CONCLUSIONS: the creation of the Research Group on Sudden Death allowed in the last twenty years designing and performing scientific research studies aimed at the epidemiological characterization of this health problem in Cuba and those are useful elements to draw up intervention strategies to significantly reduce the incidence and the economic, family and social impact of this event(AU)

Infarto miocárdico crónico como factor de riesgo de muerte súbita cardíaca / Chronic myocardial infarction as a risk factor for sudden cardiac death

INTRODUCCIÓN: el infarto miocárdico crónico constituye un factor de riesgo independiente para la muerte súbita cardiovascular. OBJETIVO: identificar la presencia de infarto miocárdico crónico en fallecidos de muerte súbita cardiovascular en un estudio poblacional. MÉTODO: se diseñó un estudio observacional, descriptivo y de corte transversal de los casos diagnosticados de forma consecutiva en 11 años, en el hospital "Julio Trigo López" en La Habana, Cuba. RESULTADOS: el infarto miocárdico crónico estuvo presente en el 24,7 % del universo analizado, con predominio en hombres (64,7 %), en edades de 60-74 años (41,3 %). La asistolia fue la arritmia documentada con mayor frecuencia en el medio extra hospitalario (51,6 %). El diagnóstico de un trombo coronario fresco y/o infarto agudo del miocardio representó la principal causa de muerte (63,5 %). CONCLUSIONES: en los pacientes con infarto miocárdico crónico, la muerte súbita constituye la causa más frecuente de muerte. Este factor de riesgo incrementa, por sí sólo, la probabilidad de ocurrencia del evento en los primeros 18 meses de ocurrida la necrosis miocárdica aguda. En la estratificación de riesgo del paciente post-infarto se hace necesaria la búsqueda de inestabilidad eléctrica, isquemia residual y disfunción ventricular izquierda como predictores para este tipo de evento.

INTRODUCTION: chronic myocardial infarction is an independent risk factor for sudden cardiovascular death. OBJECTIVE: identify the presence of chronic myocardial infarction in sudden cardiovascular death victims included in a population study. METHOD: a cross-sectional observational descriptive study was conducted of cases diagnosed consecutively in a period of 11 years at Julio Trigo López hospital in Havana, Cuba. RESULTS: chronic myocardial infarction was present in 24.7% of the study universe, with a predominance of men (64.7%) and the 60-74 age group (41.3%). Asystole was documented as the most common arrhythmia occurring in out-of-hospital conditions (51.6%). The main causes of death (63.5%) were a freshly diagnosed coronary thrombus and/or acute myocardial infarction. CONCLUSIONS: sudden death is the most common cause of death among patients with chronic myocardial infarction. This risk factor of itself increases the probability of occurrence of the event during the 18 months following the appearance of acute myocardial necrosis. Stratification of risk in post-infarction patients should include the search for electrical instability, residual ischemia and ventricular dysfunction as predictors of this type of event.

Perfil de riesgo vascular aterosclerótico del fallecido por muerte cardíaca súbita / Atherosclerotic vascular risk profile in patients who died of sudden cardiac death

Objetivo: determinar el perfil de riesgo vascular aterosclerótico en los fallecidos por muerte cardíaca súbita atendidos en el Hospital Julio Trigo López en el período 2007-2011. Métodos: estudio observacional, analítico, de casos y controles no pareados. Resultados: algunos factores de riesgo vasculares ateroscleróticos se expresaron de forma significativa en el grupo de fallecidos por causas cardíacas súbitas (hipertensión arterial, tabaquismo, obesidad, cardiopatía isquémica, hipertrofia ventricular izquierda, alcoholismo). Se corroboró que la existencia de 3 o más factores eleva exponencialmente el riesgo de muerte cardíaca súbita sobre la mortalidad cardiovascular total. Se halló presencia significativa de lesiones ateroscleróticas coronarias en ambos grupos, que determinaron la aparición de trombosis coronaria y/o infarto agudo del miocardio, con predominio en las muertes súbitas. Conclusiones: no existieron factores de riesgo específicos para la muerte cardíaca súbita. Algunos de estos mostraron un incremento en la probabilidad para este tipo de evento. La búsqueda de un perfil de riesgo en fallecidos de muerte cardíaca súbita debe ir orientada al diseño de investigaciones donde se incluyan las estadísticas vitales de mortalidad global y no por causas específicas (cardiovasculares)

Objective: to determine the atherosclerotic vascular risk profile in patients who died of sudden cardiac death, treated in Julio Trigo López Hospital during the period 2007- 2011. Methods: an observational, analytical, and non-matched case-control study was conducted. Results: some atherosclerotic vascular risk factors were expressed significantly in the group of patients who died of sudden cardiac deaths (hypertension, smoking, obesity, ischemic heart disease, left ventricular hypertrophy, alcoholism). It was confirmed that the existence of 3 or more factors exponentially increases the risk of sudden cardiac death on total cardiovascular mortality. A significant presence of coronary atherosclerotic lesions was found in both groups, which determined the onset of coronary thrombosis and/or acute myocardial infarction that predominated in sudden deaths. Conclusions: there were no specific risk factors for sudden cardiac death. Some of them showed an increased probability for this type of event. The search for a risk profile for sudden cardiac death should be oriented to the research design which would include vital statistics of global mortality and not the specific causes (cardiovascular)

Educación Superior y desarrollo económico y social en Cuba: a propósito de la "Tercera Misión / Higher Education and socio-economic development in Cuba: high rewards of a risky high-tech strategy

En este documento se muestra mediante un estudio de caso cómo la universidad cubana se involucra de modo directo con el desarrollo económico y social del país. Esta exposición se relaciona con el debate internacional sobre la "Tercera Misión" de la universidad, a partir de la peculiar experiencia cubana.

This paper presents case studies on how Cuban universities have increasingly become directly involved with the economic and social development of the country. The paper shows how Cuban universities, from the late 1980s and early 1990s, started reorientation and organization of their scientific research, becoming more directly and intensely involved in the economic and social development of the country. In this connection, special reference is made to the case of a research group at the University of Havana: the Laboratory of Synthetic Antigens. This group developed the first synthetic vaccine for human use approved in the world. In the article, public policies involved in this success as well as different obstacles are discussed. These obstacles demonstrate the difficulties and challenges that universities face when carrying out research and innovation activities related to economic and social development.

Childhood asthma and its relationship with tonsillar tissue.

The aim of this study was to evaluate the prevalence of asthma among 4-17 years old school children and to determine the relationship between frequent tonsillitis, tonsillar hypertrophy and asthma-related symptoms. A total of 2,000 school children, aged 4-17 years, in Denizli were surveyed using the ISAAC questionnaire; the size of the tonsils was evaluated by physical examination. A total of 1,784 questionnaires were completed giving an overall response rate of 89.2%. The prevalence of lifetime wheezing, 12-month wheezing and lifetime doctor-diagnosed asthma were 16.4%, 6.2% and 1.7%, respectively. The prevalence of frequent tonsillitis and tonsillar hypertrophy were 19.9% and 3.4%, respectively. Tonsillar hypertrophy was positively correlated with a history of frequent tonsillitis. Frequent tonsillitis and tonsillar hypertrophy could be evaluated as risk factors for asthma due to their significant association with asthma-related symptoms.

Evaluation of the nasal provocation test for its necessity in the diagnosis of nasal allergy to house dust mite.

The aim of this study was to evaluate rhinomanometric responses to nasal allergen provocation in children with allergic rhinitis sensitized to house dust mite. We studied 51 children, aged 6-16 years (mean: 11.5 +/- 2.6 years), with clinical symptoms of perennial allergic rhinitis without asthma and 20 non-atopic healthy controls in the same age range (mean: 11.8 +/- 3.8 years). All of the patients had positive skin prick test (SPT) results and serum specific IgE above 0.70 kU/l to Dermatophagoides pteronyssinus (Dp). Nasal provocation testing (NPT) was performed with increasing concentrations of Dp extracts and the nasal response was evaluated by active anterior rhinomanometry. A 100% increase of resistance in one or both nasal cavities was considered positive. There was a statistically significant difference of baseline nasal resistance (total, right and left sides) between the control and the patient groups (p < 0.001). A positive response to house dust mite allergens was recorded in 47/51 (92.2%) patients by rhinomanometry. The NPT presented no significant correlation with age, weight, height, SPT diameter, serum total and specific IgE levels to Dp and baseline nasal airway resistance values. This study suggests that a nasal provocation test with allergen is unnecessary in children with positive skin prick test and serum IgE specific to house dust mite. The rhinomanometric response to the allergen provocation does not correlate with the diameter of the skin prick test and the level of serum specific IgE.

Critério de obesidade central em população brasileira: impacto sobre a síndrome metabólica / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome / Criteria for central obesity in a Brazilian population: impact on metabolic syndrome

OBJETIVO: Identificar e propor os melhores pontos de corte da circunferência da cintura (CCp) para diagnosticar obesidade central numa população brasileira; compará-los àqueles recomendados pelo ATPIII (CC-ATPIII) e estimar diferenças nas prevalências da síndrome metabólica (SM) usando os dois critérios. MÉTODOS: Estudo transversal, realizado em subgrupo populacional de 1.439 adultos, Salvador, Brasil. Foram construídas curvas ROC da circunferência da cintura (CC) para identificar diabete melito (DM) e obesidade. Valores >60 por cento da sensibilidade e da especificidade da curva ROC e mais próximos entre si foram usados para definir o CCp. A prevalência da SM foi estimada pelos CCp e pelos CC-ATPIII. RESULTADOS: As 829 mulheres compuseram 57,7 por cento da amostra. Os CCp selecionados foram 84 cm para mulheres e 88 cm para homens. Esses pontos detectaram DM com sensibilidade de 68,7 por cento e 70 por cento, respectivamente, e especificidade de 66,2 por cento e 68,3 por cento. Para obesidade, a sensibilidade e a especificidade foram 79,8 por cento e 77,6 por cento nas mulheres, e 64,3 por cento e 71,6 por cento nos homens. Pelos CC-ATPIII, 88 cm (mulheres) e 102 para (homens), as sensibilidades foram de 53,3 por cento e 26,5 por cento, para diagnosticar DM. Para obesidade, a sensibilidade foi 66,5 por cento (mulheres) e 28,6 por cento (homens). A prevalência da SM, pelos CCp foi 23,7 por cento, IC 95 por cento (21,6 - 25,9) e pelos CC-ATPIII de 19,0 por cento, IC 95 por cento (17,1- 20,9), 1,2 vezes maior pelo CCP. CONCLUSÃO: As CC-ATPIII foram inapropriados e subestimam a prevalência da SM nessa população, particularmente entre os homens. Sugerimos que os pontos de corte da CC de >84 cm nas mulheres e > 88 cm nos homens sejam testados em outras populações brasileiras.

OBJECTIVE: To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. METHODS: Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60 percent and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. RESULTS: Eight hundred and twenty nine women comprised 57.7 percent of the sample. The WCp selected were 84cm for women and 88cm for men. These cut-off points detected DM with a 68.7 percent and 70 percent sensitivity, and a 66.2 percent and 68.3 percent specificity, respectively. For obesity, sensitivity and specificity were 79.8 percent and 77.6 percent in women and 64.3 percent and 71.6 percent in men, respectively. Using WC-ATPIII, 88cm (for women) and 102cm (for men), the sensitivity was 53.3 percent and 26.5 percent, respectively, to diagnose DM. For obesity, sensitivity was 66.5 percent (for women) and 28.6 percent (for men). The prevalence of MS using WCp was 23.7 percent, 95 percentCI (21.6 - 25.9), whereas using WC-ATPIII it was 19.0 percent, 95 percentCI (17.1- 20.9), 1.2 times higher using WCp. CONCLUSION: WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84cm for women and > 88cm for men should be tested in other Brazilian populations.

Asthma knowledge level of primary schoolteachers in Istanbul, Turkey.

The purpose of this study was to elucidate the asthma knowledge level of primary school teachers in Istanbul, and factors associated with this subject. Seven hundred and ninety-two teachers from 73 randomly selected primary schools in Istanbul were included in this study. Although Istanbul primary school teachers generally have a satisfactory knowledge on asthma, they lack knowledge on triggers of asthma attacks and on the management of the disease. The knowledge level of the teachers was related to gender but was not related to age, education level, length of tenure, location of primary school and county. We think that an asthma education program is needed for Turkish teachers to increase their understanding about what asthma is, its impact and how to meet the needs of a child with asthma to achieve improved wellbeing and school attendance.

Thoracic three-dimensional spiral CT findings of an infant with spondylothoracic dysostosis.

Spondylocostal dysostoses are a group of rare inherited disease with a heterogeneous disorder of vertebral segmentation defects and rib anomalies, which lead to respiratory problems predicting the clinical outcome. Spiral CT with three-dimensional (3D) imaging provides exact measurement of the bony rib cage. We report a case of an infant with spondylothoracic dysostosis, a phenotype of spondylocostal dysostoses, and 3D spiral CT findings of his rib cage since it may contribute to the surgical planning.

Skin sensitization to common allergens in Turkish wheezy children less than 3 years of age.

Infants and small children with asthma are not commonly skin tested, as allergy is not considered to be a major cause of infantile asthma. The aim of this study was to determine the frequency of skin test positivity to various allergens in wheezy children less than 3 years of age. We evaluated 161 patients with infantile asthma (median age 20 months) and 100 healthy controls (median age 18 months). Infantile asthma was defined as three or more episodes of wheezing in a child less than 3 years of age, whose symptoms improved on treatment with beta-agonist and anti-inflammatory agents. All children were skin tested to house dust mites (HDM), pollens, molds, and cow milk extracts using prick technique. One hundred and eighteen (73.3%) children In the patient group tested positive to HDM, 84 (52.1%) to pollens, 37 (22.9%) to molds, and 16 (10%) to cow milk. Sensitization rates to HDM were significantly higher in the patient group than In the healthy controls. Sensitization rates to pollens were not statistically different between the two groups. There was no association between family history of atopy and frequency of sensitization to allergens in the wheezy and control groups. We concluded that skin sensitization to allergens was common In wheezy infants. The prevalence of sensitization to indoor allergens was higher than to outdoor or food allergens.