[Usefulness of the coccidioidin skin test in patients with type diabetes mellitus in an endemic zone]. / Utilidad de la prueba cutánea a la coccidioidina en personas con diabetes mellitus tipo 2 en una zona endémica.

OBJECTIVE: There are few studies available about skin response to mycotic antigens in diabetes mellitus subjects, therefore, the possible difference of skin reactivity to coccidioidin in subjects with and without diabetes mellitus was analyzed. MATERIAL AND METHODS: The prevalence of skin reactivity to coccidioidin in a population sample of 1651 subjects in a coccidioidomycosis endemic zone was estimated using a transversal design. Subjects with diabetes mellitus were identified and the diagnosis was validated by clinical and laboratory criteria. In order to determine the reactivity association level with the diabetes mellitus history, data was compared with the population sample, through logistic regression analysis adjusted by age, sex and residence geographical area. Odds ratio (OR) and 95% confidence intervals were obtained. RESULTS: In the population study, there were 665 coccidioidin positive subjects (40.28% rate). Seventy six cases with diabetes mellitus were identified, 23 were positive to the test (30.26% rate) with an odds ratio of 0.63 for this group (95% CI 0.37-1.07). The OR decrease to 0.52 (95% CI 0.31-0.88, p = 0.014) with the adjusted logistic regression analysis. CONCLUSION: Coccidioidin reactivity was lower in the diabetes mellitus cases than in general population. It is necessary to be cautious with the coccidioidin test interpretation in people with DM 2.

Correlation between respiratory function tests and evolution time in asthmatic patients.

A transversal and prospective study was performed to demonstrate a relationship between the evolution time of asthma episodes and alterations observed in the respiratory function tests (RFT) during asymptomatic periods. Asthmatic patients (n = 80) of both sexes, were studied, we investigated the evolution time of the asthmatic episodes and performed RFTs in the patients during their asymptomatic periods. Respiratory patterns were classified as normal, obstructive, or mixed (obstructive-restrictive), and a Spearman correlation test was performed. Twenty nine patients were male and fifty one female. All were between 5 and 49 years of age. Of the total number of patients, 13.7% fell into a normal pattern, 57.5% into an obstructive pattern and 28.7% in a mixed pattern. In the groups showing the shortest evolution time, the obstructive pattern was more common (75% of patients with less than 5 years of evolution time and 53.8% with an evolution time between five and ten years). The mixed pattern was more common in patients with more years suffering asthma (16.6% in the group of patients having 5 or less years of evolution and 50% in the group with more than 20 years). We found a Spearman value of 0.7, and we can conclude that there is more pulmonary damage associated to a longer evolution period of bronchial asthma.

[Asthma and the environment in the Lagunera district]. / Asma y medio ambiente en la Comarca Lagunera.

AIMS: The characteristics and real dimension of the environmental problems are frequently unknown. These results in a poor knowledge about health impact and deficient planning of the measures required for their protection. Asthma is a prior health problem at Comarca Lagunera. OBJECTIVE: The analysis of environment characteristics that could affect its presentation is the objective of this paper. MATERIAL AND METHOD: We took information form several official bureaus and regional records. It identified that the coexistence of some factors, like regional weather characteristics, with extreme temperature and frequent dust storm, growing deforest, dominant flora and acute and chronic contamination by particulates material, mainly at urban areas, could explain the epidemiological profile of the disease in this urban area so an interdisciplinary participation is required for solving this problem. RESULTS: In the Comarca Lagunera, several factors coexist which precipitate symptoms in asthmatic subjects: climatological features which favor the inflammatory process and increase susceptibility to respiratory tract infections which can set off asthmatic crises. CONCLUSION: The epidemiological behavior os asthma in this regions may be associated with its climatological characteristics.

[Degree of skin hypersensitivity as possible indicator of severity of asthma in the atopic subject]. / El grado de hipersensibilidad cutánea como posible indicador de severidad del asma en el sujeto atópico.

AIMS: Many factors have been involved in the determination of bronchial asthma severity, among which are: Family history, atopic condition and environmental factors. OBJECTIVE: To evaluate if the degree of skin test reactivity is an useful indicator of bronchial asthma severity in atopic subjects. MATERIAL AND METHODS: In a prospective design, 140 patients with allergic bronchial asthma were included. The degree of skin reactivity was measured by intradermal reaction to 54 common allergens, it was classified in four groups according to the positive test percentage. The patients were followed during one year, and the frequency of symptoms and exacerbations, tolerance to exercise, nocturnal asthma, frequency and type of required medication were registered. The pulmonary function was evaluated by espirometry and plethysmography every 6 months. Asthma severity was classified according to the GINA criteria (Global Initiative for Asthma) and drugs requirements. The results were analyzed with descriptive statistics and Spearman correlation, stratification by age groups was carried out. RESULTS: Mean age was 25.57 +/- 12.12 years, 59% were female patients. Intermittent asthma was present in 42% of the subjects, mild persistent asthma in 31%, moderate persistent asthma in 18% and severe persistent asthma in 9%. The degree of skin test reactivity was < 25% in 26 patients, 25-50% in 60 patients, 51-75% in 36 and > 75% in 15. There was not correlation between skin test reactivity and asthma severity in the total population. In the stratified analysis there was significant correlation in the group of 5-15 years (p < 0.05) but with a low predictable value. CONCLUSIONS: The skin test reactivity degree was not an useful indicator of the asthma severity in this study.

Prevalence of skin reactivity to coccidioidin and associated risks factors in subjects living in a northern city of Mexico.

BACKGROUND: Coccidioidomycosis is a reemerging fungal disease seen mainly in the states located at the Mexican-U.S. border. The finding of advanced cases of the disease are now more frequent. METHODS: A cross-sectional study was conducted to determine the prevalence of skin reactivity to coccidioidin in the city of Torreón, Coahuila, Mexico, located in the northern region of the country. A multifactorial association of environmental, social, and health conditions was analyzed. A total of 1,653 coccidioidin skin tests was applied in male and female subjects older than 8 years of age. RESULTS: The overall rate of positive reactivity in this city was 40.2%, with a 95% confidence interval of 37.8-42.5. This was related to time/life exposure risk and to the habitat of unpaved streets. No statistically significant difference regarding gender, socioeconomic level, and working activities was found. The highest reactivity was observed in subjects between 30 and 65 years of age. CONCLUSIONS: Positive results were related to exposure risk and habitat, principally in the southeast region of the city. These results were applied both to residents and outsiders with no differences between the groups. Of the total, 87.5% were considered high-risk subjects. It is recommended that future surveys be carried out in other northern cities of Mexico to obtain more useful data concerning the extent of the infection and mainly to establish preventive measures, such as appropriate reforestation and urbanization procedures.

Is the histamine skin test inhibited by prednisone?

BACKGROUND: A clinical trial was carried out to determine whether therapeutic doses of prednisone could inhibit the response to the histamine skin test. METHODS: Forty-five male and female asthmatic and allergic patients participated in the study, their ages ranged from 6-14 years old (16 girls and 29 boys). The clinical trial was random, double-blind, and placebo-controlled. METHODS: Three treatment groups were formed and patients were assigned randomly to them. Groups A and B received prednisone at 0.5 and 1 mg/kg/day, respectively, whereas group C received a placebo (p.o.). All treatments lasted for 10 days. The histamine test was applied on the first, fifth and tenth days of treatment, and the size of the wheal and the extension of the flare were evaluated 5 min after the application of the test. The statistical tool used was ANOVA, since the study sought to see the difference among the treatment groups, after including 45 patients in three groups of 15 patients each. RESULTS: No significant statistical difference was observed among the groups using an ANOVA test. CONCLUSIONS: It was concluded that the response to the histamine test was not modified by a 10-day treatment with prednisone at doses of 0.5 mg/kg/day and 1 mg/kg/day.

[Cutaneous hypersensitivity in patients with bronchial asthma in La Comarca Lagunera]. / Hipersensibilidad cutánea en pacientes con asma bronquial de La Comarca Lagunera.

A cross-sectional study was done to determine the frequency of cutaneous sensibility to aeroallergens and variations related to residence area. In a period of time from June 1994 to June 1995, we analyzed 101 patients residents in the Comarca Lagunera diagnosed as having allergic bronchial asthma. The patients were highly sensitive to pollen grains: Cynodon Dactylon (70%), Chenopodium (69%), Rusian Thistle (63%), Rye Grass (61%), Zea Maiz and Prosopis (57%). The sensitivity to molds was less: Candida (22%), Helmintosporium (18%) and Cephalosporium (16%). House Dust was positive in 55% and Dermatophagoides in 35%. Cotton hypersensitivity was poor (7%). There were not differences in cutaneous reactivity related with residence area.