Doxycycline suppresses Chlamydia pneumoniae-mediated increases in ongoing immunoglobulin E and interleukin-4 responses by peripheral blood mononuclear cells of patients with allergic asthma.

OBJECTIVES: Chlamydia pneumoniae, an obligate intracellular bacterium, has been associated with asthma and the induction of immunoglobulin E (IgE) responses. Whereas tetracyclines have anti-chlamydial activity, their effect on human IgE responses to C. pneumoniae has not been studied. METHODS: Peripheral blood mononuclear cells (PBMCs) from serum IgE+ allergic asthmatic subjects (n = 11) and healthy controls (n = 12) were infected with C. pneumoniae and cultured for 12 days with or without doxycycline (0.01-1.0 mg/L). IgE, interferon (IFN)-γ and interleukin (IL)-4 levels in supernatants were determined on days 1-12 post-infection, and C. pneumoniae DNA copy numbers in PBMC culture were measured on day 2 (quantitative PCR). RESULTS: C. pneumoniae-infected PBMCs from allergic asthmatic individuals had increased levels of IgE in supernatants compared with uninfected PBMCs (520% on day 10 post-infection, P = 0.008). IgE levels in PBMC cultures from controls were undetectable (<0.3 ng/mL). Increases in C. pneumoniae-induced IgE in asthmatics correlated with those of C. pneumoniae-induced IL-4 (r = 0.98; P < 0.001), but not with IFN-γ. The addition of doxycycline (1.0 mg/L) to the culture strongly suppressed the production of IgE (>70%, P = 0.04) and IL-4 (75%, P = 0.018), but not IFN-γ. The suppressive effect on IL-4 production remained significant even at concentrations of doxycycline that were subinhibitory (0.01 mg/L) for C. pneumoniae. In both asthmatic participants and controls, no significant effect of doxycycline on DNA copy numbers of C. pneumoniae was observed. CONCLUSIONS: Doxycycline suppressed the C. pneumoniae-induced production of IgE and IL-4, but not IFN-γ, in PBMCs from IgE+ allergic asthmatic subjects. These findings resulted from the immunomodulatory anti-allergic properties of tetracyclines.

Evaluación del cumplimiento de los atributos de la atención primaria y grado de satisfacción de los usuarios de un establecimiento de primer nivel de atención / Attributes of primary care and patient satisfaction degree on a primary care facility

La Atención Primaria de Salud es la estrategia adoptada por EsSalud (Seguridad Social del Perú) para lograr sus objetivos institucionales. Objetivo: Evaluar el cumplimiento de la estrategia de atención primaria y el grado de satisfacción de los usuarios en un establecimiento de salud de primer nivel. Material y Métodos: Se realizó un estudio descriptivo transversal en un establecimiento de salud de primer nivel. Se aplicaron 2 encuestas a 240 usuarios escogidos al azar. Se midió el grado de satisfacción con respecto a la estructura, los procesos y los resultados del establecimiento, y el cumplimiento de tres atributos de la atención primaria: primer contacto, integralidad y continuidad. Resultados: El 61,7% de los usuarios mostró satisfacción media y 23,3% satisfacción alta. Los usuarios estaban satisfechos o muy satisfechos en 5 parámetros: accesibilidad geográfica (99,8%), infraestructura (66,6%), horarios de atención (61%), resolución de problemas (52,5%) y exámenes auxiliares (51,3%). El 47% mostró satisfacción media con la atención recibida. El grado más bajo de satisfacción se encontró con los tiempos de espera para atenciones programadas (29,1%) y de emergencia (7,5%). En cuanto a los atributos de la Atención Primaria, los atributos de continuidad (55%) y de primer contacto (55,8%) mostraron un cumplimiento medio y el de integralidad fue percibido de bajo cumplimiento (51,7%). Conclusiones: El grado de satisfacción con el establecimiento y el cumplimiento de los atributos de la atención primaria fueron percibidos en grado medio.

Primary health care strategy has been adopted by Health Social Security from Peru (EsSalud) to achieve its corporate goals. Objective: To assess the compliance of the primary health care strategy and the user satisfaction degree in an EsSalud primary care center. Material and Methods: A cross-sectional descriptive study design was conducted. Two surveys were applied to 240 randomly selected users. User satisfaction degree was measured considering the structure, processes and outcomes of the center. We measured the compliance of three attributes of primary care: accessibility, comprehensiveness and continuity. Results: 61.7% of users showed medium general satisfaction and 23.3% high general satisfaction. The users were satisfied or very satisfied with 5 parameters: geographical accessibility(99.8%), infrastructure (66.6%), hours care (61%), problem solving (52.5%) and diagnostic tests (51.3%). 47% of users showed medium satisfaction with care received in the center. The lowest degree of satisfaction was found with the waiting times for outpatient clinic care (29.1%) and emergency care (7.5%). About Primary care Attributes, accessibility (55.8%) and continuity (55%) showed a medium compliance, comprehensiveness was perceived as a low compliance (51.7%). Conclusions: The satisfaction degree with the center and the compliance of the primary care attributes were medium.