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INTRODUCTION: People with Down syndrome (DS) have high respiratory morbidity, evaluating their respiratory health with standardized, objective tests is desirable. Thus, the objective of this study was to evaluate the technical quality of Pulmonary Function Tests (PFTs) to determine which ones are most suitable for this population. METHODS: Participants included children, teenagers and adults with DS, 5 years of age or older (n=302). The technical quality of the impulse oscillometry system (IOS), forced spirometry, lung-diffusing capacity for carbon monoxide (DLCO), and 6-min walk test (6MWT) were analyzed by age group. Capnography and pulse oximetry were included in the study. Technical quality was determined on the basis of current international PFTs standards. RESULTS: Fifty-one percent of participants were males. A total of 184 participants (71%) who completed the IOS fulfilled the quality criteria, while 210 (70%) completed the 6MWT. Performance on forced spirometry and DLCO was poor. All pulse oximetries and 96% percent heart rates obtained had good quality, but exhaled carbon dioxide (PetCO2) and respiratory rate (RR) showed deficient repeatability. CONCLUSIONS: IOS appears to be the most reliable instrument for evaluating lung mechanics in individuals with DS.
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Síndrome de Down/fisiopatología , Pulmón/fisiopatología , Pruebas de Función Respiratoria/normas , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
RATIONALE: Single-breath diffusing capacity of the lung for carbon monoxide (DlCOsb) values are used to evaluate gas exchange; however, the quality of maneuvers performed by children has not been evaluated, and reference values for young people living at moderate altitudes are not well established. OBJECTIVES: Our objectives were 1) to determine whether DlCOsb maneuvers performed by a pediatric population would meet 2017 European Respiratory Society/American Thoracic Society (ERS/ATS) quality control standards; and 2) to report normal DlCOsb values for Mexican/Latino children and adolescents living at moderate altitudes. METHODS: This study involved healthy young people 4-20 years of age from the metropolitan area of Mexico City (2,240 m above sea level) who were recruited in schools from July 2014 to August 2017. DlCOsb testing was performed according to the 2005 ATS/ERS standards, and the quality control of each maneuver was analyzed according to the 2017 ERS/ATS standards. We constructed models for DlCOsb with linear and quadratic terms for weight, height, and age as independent variables using shrinkage statistics, variance inflation factors, the Akaike information criterion, and R2 to compare the results of different models. RESULTS: Results were obtained for 420 individuals (53% boys) with a mean age of 11.7 ± 4.5 standard deviation (SD) years; 47% of maneuvers from children age 4-6 years were grade A (13% grade B), and 90% of those in children older than 13 years were grade A or B. Forty-six percent of the subjects had a DlCOsb repeatability of <1 ml/min/mm Hg. The mean DlCOsb was higher for boys than for girls (32.4 ± 13.6 [SD] vs. 24.1 ± 7.5 ml/min/mm Hg, respectively). The reference equation for boys was DlCOsb = exp(1.63469 + [0.03251 × age] + [0.00846 × height] + [0.00304 × weight]), R2 = 0.87; for girls, the best equation was DlCOsb = exp(1.56516 + [0.0193 × age] + [0.00893 × height] + [0.00273 × weight]), R2 = 0.75. The single-breath transfer coefficient of the lung for carbon monoxide remained constant with age and height, with a lower limit of normal of 6.5 ml/min/mm Hg/L in boys and 5.4 ml/min/mm Hg/L in girls. Measured DlCOsb was higher than predicted by other authors (P < 0.001 by paired t test). CONCLUSIONS: Individuals 4-20 years of age can complete high-quality DlCOsb tests. Children and adolescents living at 2,240 m have higher DlCOsb values than those living at sea level. Reference equations for DlCOsb obtained at sea level are poor predictors of the values measured at moderate altitude.
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Altitud , Monóxido de Carbono/metabolismo , Pulmón/fisiología , Capacidad de Difusión Pulmonar , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Voluntarios Sanos , Humanos , Masculino , México , Control de Calidad , Valores de Referencia , Análisis de Regresión , Adulto JovenRESUMEN
PURPOSE: In lung cancer patients, radiation therapy modifies lung architecture, resulting in functional deterioration, which worsens symptoms and reduces quality of life. METHODS AND MATERIALS: A multicenter, prospective, longitudinal study was conducted in a cohort of patients with locally advanced and oligometastatic non-small cell lung cancer treated with concurrent chemoradiation therapy (CCRT). A wide array of pulmonary function tests (forced spirometry, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity, fraction of exhaled nitric oxide, arterial blood gases, and 6-minute walk test) were used to evaluate lung function at baseline; after radiation therapy; and at 6, 12, 24, and 48 weeks after CCRT. Relative changes in test results (percentages) were estimated at the aforementioned intervals and compared with baseline results. RESULTS: Thirty-seven patients completed the follow-up and were included in the analysis. After CCRT, patients showed a maximum decline in lung volumes as follows: (1) 31% in forced expiratory volume in the first second after 24 weeks (P = .008), (2) 9.6% in forced vital capacity after 48 weeks (P = .04), and (3) 15.1% in total lung capacity after 48 weeks (P = .0015). Similarly, at 12 weeks after CCRT, patients showed a 21.8% decrease in carbon monoxide diffusing capacity (P = .002). Increases were found in total airway resistance (respiratory system resistance at 5 Hz), frequency dependence of resistance (change in respiratory system resistance at 5 Hz-respiratory system resistance at 20 Hz, P = .012), and reactance (P = .0003 for respiratory system reactance at 5 Hz and P = .001 for reactance area), which together indicate small-airway dysfunction. CONCLUSIONS: The longitudinal evaluation of lung function through pulmonary function tests detects CCRT-induced damage before the appearance of clinical symptoms associated with CCRT lung toxicity.
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Carcinoma de Pulmón de Células no Pequeñas/fisiopatología , Carcinoma de Pulmón de Células no Pequeñas/terapia , Quimioradioterapia/métodos , Neoplasias Pulmonares/fisiopatología , Neoplasias Pulmonares/terapia , Pulmón/efectos de la radiación , Anciano , Resistencia de las Vías Respiratorias , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/fisiopatología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Oscilometría , Paclitaxel/administración & dosificación , Pletismografía Total , Estudios Prospectivos , Pruebas de Función Respiratoria , Capacidad Vital , Prueba de PasoRESUMEN
In Chagas disease the clinical, acute and chronic manifestations are the result of the interaction between the parasite and the host factors. The balance between inflammatory and anti-inflammatory immune responses is essential for the increase or resolution of the manifestations in individuals infected with T. cruzi. To identify if children with chronic Chagas disease and heart injury is related with non-regulated Th1, Th2 and Th17 responses. We included 31 children with T. cruzi confirmed chronic infection from endemic areas of Mexico. Subsequently, they were separated according to their ECHO and ECG results into three groups according to the severity of cardiac involvement. Circulating Th1, Th2 and Th17 cytokine profiles were performed by Luminex assays and the results were analyzed by bivariate and multivariable analysis. Patients were classified in asymptomatic chronic (group 1, N=12); individuals with IRBBB in ECG and incipient lesions in ECHO (Group 2, N=8) and Patients with severe chronic symptomatic disease (Group 3, N=11). The analysis of immune mediators revealed that patients with severe cardiac manifestations had significant higher levels (p <0.05) of Th17 related cytokines including IL-17 and IL-6 as well as IFN-γ and IL-2. Also patients with severe cardiomyopathy exhibit increased levels of IL-13 (p <0.05) after multivariate analysis. High levels of Th17 related cytokines including IL-17, IFN-γ, IL-6 and IL-2 and pro-fibrotic factors such as IL-13 could be associated to the severity of cardiac involvement in children with chronic T. cruzi infection. These cytokines could be useful as indicators for the early identification of cardiac damage associated to the T. cruzi infection.
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Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/patología , Citocinas/sangre , Enfermedades Endémicas , Trypanosoma cruzi/inmunología , Animales , Biomarcadores/sangre , Enfermedad de Chagas/sangre , Enfermedad de Chagas/parasitología , Niño , Femenino , Humanos , Masculino , México/epidemiologíaRESUMEN
BACKGROUND: The impulse oscillometry system (IOS) measures the impedance (Z) of the respiratory system, but proper interpretation of its results requires adequate reference values. The objectives of this work were: (1) to validate the reference equations for the IOS published previously by our group and (2) to compare the adjustment of new available reference equations for the IOS from different countries in a sample of healthy children. METHODS: Subjects were healthy 4-15-y-old children from the metropolitan area of Mexico City, who performed an IOS test. The functional IOS parameters obtained were compared with the predicted values from 12 reference equations determined in studies of different ethnic groups. The validation methods applied were: analysis of the differences between measured and predicted values for each reference equation; correlation and concordance coefficients; adjustment by Z-score values; percentage of predicted value; and the percentage of patients below the lower limit of normality or above the upper limit of normality. RESULTS: Of the 224 participants, 117 (52.3%) were girls, and the mean age was 8.6 ± 2.3 y. The equations that showed the best adjustment for the different parameters were those from the studies by Nowowiejska et al (2008) and Gochicoa et al (2015). The equations proposed by Frei et al (2005), Hellinckx et al (1998), Kalhoff et al (2011), Klug and Bisgaard (1998), de Assumpção et al (2016), and Dencker et al (2006) overestimated the airway resistance of the children in our sample, whereas the equation of Amra et al (2008) underestimated it. In the analysis of the lower and upper limits of normality, Gochicoa et al equation was the closest, since 5% of subjects were below or above percentiles 5 and 95, respectively. The study found that, in general, all of the equations showed greater error at the extremes of the age distribution. CONCLUSIONS: Because of the robust adjustment of the present study reference equations for the IOS, it can be recommended for both clinical and research purposes in our population. The differential adjustment of other equations underlines the need to obtain local reference values.
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Pulmón/fisiología , Oscilometría/estadística & datos numéricos , Pletismografía de Impedancia/estadística & datos numéricos , Adolescente , Resistencia de las Vías Respiratorias/fisiología , Niño , Preescolar , Femenino , Voluntarios Sanos , Humanos , Masculino , México , Oscilometría/normas , Pletismografía de Impedancia/normas , Estándares de Referencia , Valores de Referencia , Reproducibilidad de los Resultados , Pruebas de Función Respiratoria/métodosRESUMEN
INTRODUCTION: Diabetes mellitus (DM), a very common disease in Mexico, is a well-known risk factor for tuberculosis (TB). However, it is not known by which extent DM predisposes to adverse events (AE) to anti-TB drugs and/or to worse outcomes in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). The main objective of this study was to describe the outcomes of TB treatment, the impact of DM and the prevalence of AE in a cohort of patients with MDR-/XDR pulmonary TB treated at the national TB referral centre in Mexico City. RESULTS: Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (12.2%) and 6 (6.7%) with XDR-TB, including 49 (54.4%) with DM, and 3 with Human Immunodeficiency Virus (HIV) co-infection (3.3%). In 98% of patients, diagnosis was made by culture and drug susceptibility testing, while in a single case the diagnosis was made by a molecular test. The presence of DM was associated with an increased risk of serious drug-related AEs, such as nephrotoxicity (Odds Ratio [OR]=6.5; 95% Confidence Interval [95% CI]: 1.9-21.8) and hypothyroidism (OR=8.8; 95% CI: 1.8-54.2), but not for a worse outcome. CONCLUSIONS: Our data suggest that DM does not impact second-line TB treatment outcomes, but patients with DM have a higher risk of developing serious AEs to drug-resistant TB treatment, such as nephrotoxicity and hypothyroidism.
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Antituberculosos/efectos adversos , Diabetes Mellitus Tipo 2/complicaciones , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/etiología , Comorbilidad , Susceptibilidad a Enfermedades , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Tuberculosis Extensivamente Resistente a Drogas/epidemiología , Femenino , Infecciones por VIH/epidemiología , Pérdida Auditiva/inducido químicamente , Pérdida Auditiva/epidemiología , Humanos , Hipertensión/epidemiología , Hipotiroidismo/inducido químicamente , Hipotiroidismo/epidemiología , Enfermedades Renales/inducido químicamente , Enfermedades Renales/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Periodontal disease is a chronic inflammatory gingival process that has been associated with the severity of respiratory diseases. In Mexico a prevalence of 78% was found in population with social security and > 60 years old. The aim of this study is to establish the association between periodontal disease and respiratory diseases according to the inpatient days. MATERIAL AND METHODS: A cross-sectional study was conducted from January to December 2011. We included hospitalized patients, ≥ 18 years of age, without sedation or intubated. A dentist classified patients into two groups according to the severity of the periodontal disease: mild-to-moderate and severe. We estimated medians of inpatient days by disease and severity. Negative binomial models were adjusted to estimate incidence rate ratios and predicted inpatient days. RESULTS: 3,059 patients were enrolled. The median of observed and predicted inpatient days was higher in the group of severe periodontal disease (p < 0.05). Patients with chronic obstructive pulmonary disease, tuberculosis, and influenza had the highest incidence rates ratios of periodontal disease (p < 0.05). CONCLUSIONS: The severity of periodontal disease is positively -associated with inpatient days of patients with respiratory diseases.
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Tiempo de Internación/estadística & datos numéricos , Enfermedades Periodontales/complicaciones , Trastornos Respiratorios/complicaciones , Trastornos Respiratorios/epidemiología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/epidemiologíaRESUMEN
BACKGROUND: Environmental tobacco smoke affects the current and future health of children. OBJECTIVE: To determine whether schoolchildren aged 8-17 years old residing at an altitude of 2,240 m and exposed to tobacco smoke at home presented a reduction in the growth of pulmonary function and a greater problem of respiratory symptoms and infections compared with non-exposed children. MATERIALS AND METHODS: We followed, with questionnaires and spirometry, 1,632 boys and 1,555 girls from Mexico City and its metropolitan area (the Metropolitan Study to Evaluate the Chronic Effects of Pollution in School-age Children [EMPECE]) every six months for six years. The impact of passive smoking was estimated by mixed-effects models and Generalized Linear and Latent Mixed Models (GLLAMM), stratifying by gender and adjusting for age, height, weight, and ozone levels. RESULTS: Passive smoking (reported by one-half of participants) was associated with reduced spirometric lung function (log transformed or as Z-scores) and a higher frequency of self-reported respiratory symptoms and respiratory infections. Levels of forced expiratory volume in 1 second and forced vital capacity in individuals exposed to passive smoking were 6.8 and 14.1 ml, respectively, below those of non-exposed children, and these values decreased with increasing number of smokers at home and higher ozone levels. CONCLUSIONS: Passive smoking in children is a significant risk factor for respiratory disease and reduced lung function growth, which are additive with levels of air pollution, asthma, and the presence of respiratory symptoms.
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Pulmón/fisiopatología , Enfermedades Respiratorias/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Contaminación por Humo de Tabaco/efectos adversos , Adolescente , Niño , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , México/epidemiología , Modelos Estadísticos , Pruebas de Función Respiratoria , Enfermedades Respiratorias/etiología , Infecciones del Sistema Respiratorio/etiología , Factores de Riesgo , Espirometría , Encuestas y Cuestionarios , Capacidad VitalRESUMEN
BACKGROUND: Severe periodontal disease is a chronic inflammatory gingival process associated with systemic diseases. OBJECTIVE: To determine the prevalence of severe periodontal disease and its association with respiratory diseases among hospitalized patients at the Institute of Respiratory Diseases "Ismael Cosio Villegas" (INER) in 2011. MATERIAL AND METHODS: A cross-sectional study was developed. The severe periodontal disease was diagnosed by the Department of Stomatology. The International Classification of Diseases 10th revision was used. A multinomial logistic was fit to estimate relative-risk. RESULTS: Three thousand and fifty-nine patients were included; 772/3,059 (25.2%) had severe periodontal disease. After controlling for age, sex, inpatient days, death, and socioeconomic status, the infectious respiratory diseases that were significantly associated with severe periodontal disease were: HIV/AIDS (RR: 10.6; 95% CI: 9.1-23.3; p < 0.0001); pneumonia (RR: 2.6; 95% CI: 2.2-5.7; p < 0.0001); pulmonary tuberculosis and its sequels (RR: 2.1; 95% CI: 1.6-4.9; p < 0.0001); and lung abscess (RR: 2.6; 95% CI: 1.6-7.8; p = 0.002). Lung cancer and pleural diseases were also significantly associated with severe periodontal disease. CONCLUSIONS: High prevalence of severe periodontal disease was observed in the different respiratory diseases. Severe periodontal disease was associated with both infectious and non-infectious respiratory diseases. It is important to study an oral health intervention.
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Enfermedades Periodontales/complicaciones , Enfermedades Periodontales/epidemiología , Trastornos Respiratorios/complicaciones , Estudios Transversales , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Centros de Atención TerciariaRESUMEN
INTRODUCTION: Our aim was to estimate the longitudinal effect of Socioeconomic status (SES) on lung function growth of Mexican children and adolescents. MATERIALS AND METHODS: A cohort of Mexican children in third grade of primary school was followed with spirometry twice a year for 6 years through secondary school. Multilevel mixed-effects lineal models were fitted for the spirometric variables of 2,641 respiratory-healthy Mexican children. Monthly family income (in 2002 U.S. dollars [USD]) and parents' years completed at school were used as proxies of SES. RESULTS: Individuals with higher SES tended to have greater height for age, and smaller sitting height/standing height and crude lung function. For each 1-year increase of parents' schooling, Forced expiratory volume in 1 sec (FEV1) and Forced vital capacity (FVC) increased 8.5 (0.4%) and 10.6 mL (0.4%), respectively (p <0.05) when models were adjusted for gender. Impact of education on lung function was reduced drastically or abolished on adjusting by anthropometric variables and ozone. CONCLUSIONS: Higher parental schooling and higher monthly family income were associated with higher lung function in healthy Mexican children, with the majority of the effect likely due to the increase in height-for-age.
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Voluntarios Sanos , Pulmón/fisiología , Clase Social , Niño , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Pulmón/fisiopatología , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/fisiopatología , Masculino , México/epidemiología , Respiración , EspirometríaRESUMEN
BACKGROUND: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in primary care can be improved by a more efficient screening strategy. AIMS: To evaluate a three-step method of screening for COPD consisting of an initial short questionnaire followed by measurement of forced expiratory volume in 1s/forced expiratory volume in 6s (FEV1/FEV6) using an inexpensive pocket spirometer in those with high risk, and diagnostic quality spirometry in those with a low FEV1/FEV6. METHODS: We analysed two related Mexico City cross-sectional samples. The 2003 Mexico City PLATINO survey (n=542) was used to develop a short questionnaire to determine the risk of COPD and a 2010 survey (n=737) additionally used a pocket spirometer. The discriminatory power of the two instruments was assessed with receiver operator characteristic (ROC) curves using three COPD definitions. RESULTS: The developed COPD scale included two variables from a simple questionnaire and, in ROC analysis, an area under the curve (AUC) between 0.64 and 0.77 was found to detect COPD. The pocket spirometer had an AUC between 0.85 and 0.88 to detect COPD. Using the COPD scale as a first screening step excluded 35-48% of the total population from further testing at the cost of not detecting 8-18% of those with COPD. Using the pocket spirometer and sending those with a FEV1/FEV6<0.80 for diagnostic quality spirometry is very efficient, and substantially improved the positive predictive value at the cost of not detecting one-third of COPD cases. CONCLUSIONS: A three-step screening strategy for COPD substantially reduces the need for spirometry testing when only a COPD scale is used for screening.
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Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Espirometría/instrumentación , Espirometría/métodos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Our aim was to compare the longitudinal lung function growth of Mexican children and adolescents with the collated spirometric reference proposed for international use and with that of Mexican-Americans from the National Health State Examination Survey III (NHANES) III study. MATERIALS AND METHODS: A cohort of Mexican children in third year of primary school was followed with spirometry twice a year through secondary school. Multilevel mixed-effects lineal models separated by gender were fit for the spirometric variables of 2,641 respiratory-healthy Mexican children expressed as Z-scores of tested reference equations. Impact of adjustment by sitting height on differences with Mexican-American children was observed in a subsample of 1,987 children. RESULTS: At same gender, age, and height, Mexican children had increasingly higher forced expiratory volume in 1 s (FEV1) and Forced vital capacity (FVC) than the children from the collated reference study (mean Z-score, 0.68 for FEV1 and 0.51 for FVC) and than Mexican-American children (Z-score, 0.23 for FEV1 and 0.21 for FVC) respectively. Differences with Mexican-Americans were not reduced by adjusting by sitting height. CONCLUSIONS: For reasons that remain unclear, the gender-, age-, and height-adjusted lung function of children from Mexico City is higher than that reported by several international studies.
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Internacionalidad , Pruebas de Función Respiratoria/estadística & datos numéricos , Adolescente , Niño , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , México , Ápice del Flujo Espiratorio , Análisis de Regresión , EspirometríaRESUMEN
OBJECTIVES: We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40 years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL). METHODS: Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela). Data from 4533 individuals were analyzed using a single questionnaire entitled, PLATINO, which was designed to collect data on self-reported sleep symptoms. Spirometry also was performed in accordance with international standards. All statistical analyses took the study design into consideration with adjustments for each city. RESULTS: The prevalence of subjects who reported sleeping <7h was 38.4%, ≥ 7 to <9h was 51.4%, and ≥ 9h was 10.2%. In the multivariate analysis, individuals with shorter sleep duration had higher frequencies of insomnia, increased forced expiratory volume in one second in liters and percentage/forced vital capacity in liters (FEV1/FVC) of predicted ratios, and a higher presence of coughing and phlegm. The main risk factor associated with longer duration of sleep was the number of comorbidities. CONCLUSIONS: Self-reported sleep duration discriminated among groups that differed in sleep-related symptoms, respiratory symptoms, QoL and comorbid conditions.
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Percepción , Calidad de Vida , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Sueño , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Estudios Transversales , Diabetes Mellitus/epidemiología , Femenino , Volumen Espiratorio Forzado , Gastritis/epidemiología , Humanos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Factores de Riesgo , Autoinforme , Capacidad VitalRESUMEN
OBJECTIVE: To determine the effect of altitude of residence on influenza A (H1N1). MATERIALS AND METHODS: We analyzed 207 135 officially notified of influenza-like illness (ILI) cases, 23 048 hospitalizations and 573 deaths during the first months of the novel pandemic influenza A H1N1 virus, to examine if residents of high altitude had more frequently these adverse outcomes. RESULTS: Adjusted rates for hospitalization and hospital mortality rates increased with altitude, probably due to hypoxemia.
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Altitud , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Pandemias , Neumonía Viral/epidemiología , Adolescente , Adulto , Niño , Humanos , México/epidemiología , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To determine the effect of altitude of residence on influenza A (H1N1). MATERIALS AND METHODS: We analyzed 207 135 officially notified of influenza-like illness (ILI) cases, 23 048 hospitalizations and 573 deaths during the first months of the novel pandemic influenza A H1N1 virus, to examine if residents of high altitude had more frequently these adverse outcomes. RESULTS: Adjusted rates for hospitalization and hospital mortality rates increased with altitude, probably due to hypoxemia.
OBJETIVO: Determinar el efecto de la altitud del lugar de residencia sobre la epidemia de influenza A (H1N1). MATERIAL Y MÉTODOS: Se analizaron 207 135 casos notificados a la Secretaría de Salud, 23 048 hospitalizaciones y 573 muertes por enfermedad similar a la influenza (ILI, por sus siglas en inglés) durante los primeros meses de la pandemia del nuevo virus de la influenza A H1N1 durante 2009, para examinar si los residentes de zonas más altas presentaron tasas más altas de hospitalización y muerte. RESULTADOS: Las tasas ajustadas de hospitalización y mortalidad hospitalaria se incrementaron con la altitud probablemente por la presencia de hipoxemia.
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Adolescente , Adulto , Niño , Humanos , Persona de Mediana Edad , Adulto Joven , Altitud , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Pandemias , Neumonía Viral/epidemiología , México/epidemiologíaRESUMEN
OBJETIVOS: Determinar la prevalencia de asma y la asociación entre características sociodemográficas, espirométricas, síntomas respiratorios, calidad de vida y sueño en adultos >40 años. MATERIAL Y MÉTODOS: Este informe es parte del estudio PLATINO (Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar), llevado a cabo en la Ciudad de México y área metropolitana en 2003. Se utilizaron modelos de regresión logística ajustados por el diseño del estudio, donde asma fue la variable dependiente y las independientes síntomas respiratorios y características sociodemográficas y clínicas, entre otras. RESULTADOS: La prevalencia de asma diagnosticada por médico fue de 3.3% en hombres y 6.2% en mujeres. La función pulmonar disminuyó en asmáticos. En el análisis multivariado, después de ajustar por confusores potenciales, los asmáticos mostraron un mayor riesgo de ronquido más somnolencia excesiva diurna [RM=3.2 (IC95%1.4-7.4), p=0.008], y mayor frecuencia de inasistencias laborales por problemas respiratorios [RM=5.1 (IC95% 2.5-10.4), p<0.0001]. CONCLUSIONES: La prevalencia de asma fue de 5%. Los asmáticos mostraron menor calidad de vida y función pulmonar.
OBJECTIVES: To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults > 40 years. MATERIALS AND METHODS: This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others. RESULTS: The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p<0.0001]. CONCLUSIONS: The prevalence of asthma was 5%. Asthmatics showed lower quality of life and lung function.
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Asma/epidemiología , Asma/fisiopatología , Asma/psicología , Estudios Transversales , México/epidemiología , Prevalencia , Calidad de Vida , Pruebas de Función Respiratoria , Trastornos Intrínsecos del Sueño/epidemiología , Factores Socioeconómicos , Población Urbana/estadística & datos numéricosRESUMEN
OBJECTIVES: To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults > 40 years. MATERIALS AND METHODS: This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others. RESULTS: The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p<0.0001]. CONCLUSIONS: The prevalence of asthma was 5%. Asthmatics showed lower quality of life and lung function.
Asunto(s)
Asma/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Asma/fisiopatología , Asma/psicología , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Pruebas de Función Respiratoria , Trastornos Intrínsecos del Sueño/epidemiología , Factores Socioeconómicos , Población Urbana/estadística & datos numéricosRESUMEN
OBJECTIVE: Comparison of routine hospital indicators (consults at the Emergency Room (ER) and hospital admissions) during the 2009 pandemic of the influenza AH1N1 virus at the national referral hospital for respiratory diseases in Mexico City. MATERIAL AND METHODS: The outbreak was from April to mid-May 2009 and two control periods were used:2009 (before and after the outbreak),and during April-May from 2007 and 2008. RESULTS: During the outbreak total consultation at the ER increased six times compared with the 2007-2008 control period and 11 times compared with the 2009 control period. Pneumonia- or influenza-related ER consultations increased 23.2 and 15.3%, respectively. The rate of nosocomial infection during the outbreak was 13.6 and that of nosocomial pneumonia was 6 per/100 hospital discharges, a two-fold and three-fold increase compared to the control periods respectively. CONCLUSIONS: During the outbreak,mean severity of admitted patients increased,with a rise in in-hospital mortality and nosocomial infections rate, including nosocomial pneumonia.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Servicio de Urgencia en Hospital/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Admisión del Paciente/estadística & datos numéricos , Humanos , México/epidemiología , Estudios Retrospectivos , Salud UrbanaRESUMEN
Idiopathic pulmonary fibrosis (IPF) is a lethal lung disorder of unknown etiology. The disease is likely the result of complex interactions between genetic and environmental factors. Evidence suggests that certain environmental factors, such as cigarette smoking and metal dust exposures, or comorbidities like gastroesophageal reflux, and type 2 diabetes mellitus (DM2) may increase risk to develop IPF. Substantial uncertainty remains, however, regarding these and other putative risk factors for IPF. In this study we performed a case-control analysis including 100 patients with IPF and 263 controls matched for age sex and place of residence. We used a structured questionnaire to identify potential risk factors for IPF, including environmental and occupational exposures as well as the relevance of family history of pulmonary fibrosis. The multivariate analysis revealed that family history of pulmonary fibrosis [OR = 6.1, CI95% 2.3-15.9; p < 0.0001] was strongly associated with increased risk of IPF. Actually, 20% of the cases reported a parent or sibling with pulmonary fibrosis. Gastroesophageal reflux [OR = 2.9, CI: 1.3-6.6; p = 0.007], former cigarette smoking [OR = 2.5, CI: 1.4-4.6, p = 0.003], and past or current occupational exposure to dusts, smokes, gases or chemicals [OR = 2.8, CI: 1.5-5.5; p = 0.002] were also associated with the disease. Despite being a significant risk factor on univariate analysis DM2 was not significant in multivariate analysis. These findings indicate that family history of pulmonary fibrosis is a strong risk factor for IPF. Also, we confirmed that occupational exposures, gastroesophageal reflux and former smoking increase the risk for this disease.
Asunto(s)
Fibrosis Pulmonar Idiopática/etiología , Metales/efectos adversos , Exposición Profesional/efectos adversos , Fibrosis Pulmonar/complicaciones , Fumar/efectos adversos , Anciano , Estudios de Casos y Controles , Comorbilidad , Polvo , Femenino , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/epidemiología , Humanos , Fibrosis Pulmonar Idiopática/epidemiología , Fibrosis Pulmonar Idiopática/fisiopatología , Masculino , Análisis Multivariante , Fibrosis Pulmonar/epidemiología , Fibrosis Pulmonar/fisiopatología , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Comparison of routine hospital indicators (consults at the Emergency Room (ER) and hospital admissions) during the 2009 pandemic of the influenza AH1N1 virus at the national referral hospital for respiratory diseases in Mexico City. MATERIAL AND METHODS: The outbreak was from April to mid-May 2009 and two control periods were used:2009 (before and after the outbreak),and during April-May from 2007 and 2008. RESULTS: During the outbreak total consultation at the ER increased six times compared with the 2007-2008 control period and 11 times compared with the 2009 control period. Pneumonia- or influenza-related ER consultations increased 23.2 and 15.3 percent, respectively. The rate of nosocomial infection during the outbreak was 13.6 and that of nosocomial pneumonia was 6 per/100 hospital discharges, a two-fold and three-fold increase compared to the control periods respectively. CONCLUSIONS: During the outbreak,mean severity of admitted patients increased,with a rise in in-hospital mortality and nosocomial infections rate, including nosocomial pneumonia.
OBJETIVO: Comparación de indicadores hospitalarios de rutina (consultas de urgencia, admisiones hospitalarias etc.) durante la pandemia de influenzaAH1N1 2009 en un hospital de referencia para enfermedades respiratorias de la Ciudad de México. MATERIAL Y MÉTODOS: El brote se consideró de abril a la mitad de mayo de 2009 y se comparó con dos periodos control: el de 2009 (antes y después del brote), y durante abril y mayo de 2007 y 2008. RESULTADOS: Durante el brote las consultas de urgencia crecieron seis veces comparadas con el periodo control 2007-2008 y 11 veces contra el periodo control de 2009. Las consultas por neumonía o influenza incrementaron 23.2 y 15.3 por ciento comparadas contra los periodos control, respectivamente. La tasa de infección nosocomial durante el brote fue de 13.6 y la de neumonía nosocomial de 6.0 por 100 egresos hospitalarios, el doble y el triple de la documentada en los periodos control respectivamente. CONCLUSIONES: Durante el brote, la gravedad promedio de los pacientes hospitalizados se incrementó, desencadenando un aumento en la mortalidad hospitalaria y en la tasa de infecciones nosocomiales, incluyendo la de neumonía nosocomial.