Recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca en población pediátrica colombiana - Posición de expertos / Expert recommendations for diagnosis and treatment of cow's milk protein allergy in the Colombian pediatric population

Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.

Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.

Simulación Mediante Elemento Finito de Sistemas Intramedulares Telescópicos para Rehabilitación de Pacientes con Osteogénesis Imperfecta / Simulation by Finite Element Method of Intramedullary Telescopic Systems for Rehabilitation of Patients with Osteogenesis Imperfecta

Resumen En el trabajo se plantea el análisis de diferentes geometrías para un dispositivo intramedular, las cuales ayudan a reducir y evitar la migración, deformación y rotura del implante en tejido óseo afectado con Osteogénesis Imperfecta (OI). Se realizaron diseños en CAD de diferentes prototipos, donde se analizan las propiedades mecánicas en el alma del dispositivo, así como en las roscas distal y proximal de los implantes macho y hembra. Asimismo, se obtuvieron modelos 3D de huesos de un infante afectado con OI para realizar simulaciones mediante elemento finito de la interacción entre el hueso y el dispositivo intramedular. Los resultados muestran que los prototipos propuestos disminuyen la deformación del dispositivo, así como el aumento en la rigidez de la relación hueso-prótesis. Asimismo, las roscas generaron un menor esfuerzo en la unión con el hueso, lo que prevé un menor daño al tejido óseo. El trabajo se limitó al análisis numérico del rediseño de implantes telescópicos intramedulares para afectados con OI. Concluyendo que la geometría semicircular 3/4 de caña, otorga un óptimo resultado en las pruebas realizadas, al tiempo que las roscas ACME proveen una mejor sujeción en las epífisis distal y proximal de los huesos largos.

Abstract In this work we propose the analysis of different geometries for an intramedullary device, which help to reduce and avoid the migration, deformation and rupture of the implant in bone tissue affected with Osteogenesis Imperfecta (OI). Designs of different prototypes were made in CAD, where the mechanical properties in the device's soul are analyzed, as well as in the distal and proximal threads of the male and female implants. Likewise, 3D bone models of an affected infant with OI were obtained to perform finite element simulations of the interaction between the bone and the intramedullary device. The results show that the prototypes proposed decrease the strain of the device, as well as the increase in the stiffnes of the bone-prosthesis relationship. Also, the threads generated less stress in the union with the bone, which provides less damage to the bone tissue. The work was limited to the numerical analysis of the redesign of intramedullary telescopic implants for patients with OI. Concluding that the semicircular geometry 3/4 of cane, gives an optimal result in the tests carried out, while the ACME threads provide a better subjection in the distal and proximal epiphyses of the long bones.

IgE-Mediated Sensitization to Galactose-α-1,3- Galactose (α-Gal) in Urticaria and Anaphylaxis in Spain: Geographical Variations and Risk Factors.

BACKGROUND: The objectives of this study were to investigate the prevalence of sIgE to galactose-α-1,3-galactose (α-gal) in individuals with acute urticaria or anaphylaxis from different geographical areas of Spain and to evaluate the relevance of demographics and lifestyle as risk factors for this immune response. METHODS: Participants were recruited from allergy departments at 14 Spanish hospitals. Patients aged 18 years or older presenting with urticaria or anaphylaxis were enrolled into one of 2 arms: cases and controls. An interviewer-administered questionnaire collecting demographic data, lifestyle habits, and the presence of cofactors was obtained from each participant. sIgE to α-gal and total IgE were determined using ImmunoCAP. sIgE levels ≥0.35 kU/L were considered a positive result. RESULTS: The study population comprised 160 cases and 126 controls. The median age was 44 years. The overall prevalence of a positive result of sIgE to α-gal was 15.7%; this was higher in cases (26.3%) than in controls (2.4%). The sIgE anti-α-gal positivity rate ranged from 37.68% (rural) to 15.38% (semiurban), and 7.85% (urban). The rates of positivity were 46.32%, (Northern), 0.72% (Center), and 0% (Mediterranean). A positive result for sIgE to α-gal was associated with a history of tick bites, participation in outdoor activities, pet ownership, and ingestion of mammalian meats or innards before the onset of symptoms. Only alcohol consumption could be implicated as a cofactor. CONCLUSION: Sensitization to α-gal in patients with urticaria or anaphylaxis differs considerably between the 3 geographical areas studied and is related to tick bites.

IgE-mediated sensitization to galactose-alfa-1.3-galactose (alfa-Gal) in urticaria and anaphylaxis in Spain: geographical variations and risk factors

BACKGROUND: The objectives of this study were to investigate the prevalence of sIgE to galactose-alfa-1,3-galactose (alfa-gal) in individuals with acute urticaria or anaphylaxis from different geographical areas of Spain and to evaluate the relevance of demographics and lifestyle as risk factors for this immune response. METHODS: Participants were recruited from allergy departments at 14 Spanish hospitals. Patients aged 18 years or older presenting with urticaria or anaphylaxis were enrolled into one of 2 arms: cases and controls. An interviewer-administered questionnaire collecting demographic data, lifestyle habits, and the presence of cofactors was obtained from each participant. sIgE to alfa-gal and total IgE were determined using ImmunoCAP. sIgE levels ≥0.35 kU/L were considered a positive result. RESULTS: The study population comprised 160 cases and 126 controls. The median age was 44 years. The overall prevalence of a positive result of sIgE to alfa-gal was 15.7%; this was higher in cases (26.3%) than in controls (2.4%). The sIgE anti-alfa-gal positivity rate ranged from 37.68% (rural) to 15.38% (semiurban), and 7.85% (urban). The rates of positivity were 46.32%, (Northern), 0.72% (Center), and 0% (Mediterranean). A positive result for sIgE to alfa-gal was associated with a history of tick bites, participation in outdoor activities, pet ownership, and ingestion of mammalian meats or innards before the onset of symptoms. Only alcohol consumption could be implicated as a cofactor. CONCLUSION: Sensitization to alfa-gal in patients with urticaria or anaphylaxis differs considerably between the 3 geographical areas studied and is related to tick bites

ANTECEDENTES: Investigar la prevalencia de IgE específica a galactosa-alfa-1,3-galactosa (alfa-gal) en sujetos con urticaria aguda o anafilaxia de diferentes zonas geográficas de España y evaluar la relevancia de factores demográficos y de estilo de vida como factores de riesgo para esta respuesta inmunológica. MÉTODOS: Pacientes de 18 años o mayores con urticaria o anafilaxia fueron reclutados en los Departamentos de Alergia de 14 hospitales españoles e incluidos en uno de dos grupos; casos o controles. Se recogieron datos demográficos, de estilo de vida y la presencia de cofactores. La IgE total e IgE especifica a alfa-gal se determinaron mediante ImmunoCAP. Niveles de IgE específica ≥0,35 kU/L fueron considerados como positivos. RESULTADOS: Se reclutaron 160 casos y 126 controles. La mediana de edad fue 44 años. La prevalencia global de positividad de IgE específica a alfa-gal fue 15,7%; siendo mayor en casos (26,3%) que en controles (2,4%) y oscilando entre 37,68% (rural) a 15,38% (semiurbano) y 7,85% (urbano). Las frecuencias de positividad fueron 46,32%, (Norte), 0,72% (Centro), y 0% (Mediterráneo). La positividad de IgE específica a alfa-gal se asoció a haber experimentado picadura de garrapata, participación en actividades de exterior, tenencia de mascotas e ingestion de carne de mamíferos o visceras previo al inicio de los síntomas. Solo el consumo de alcohol podía ser implicado como cofactor. CONCLUSIÓN: La sensibilización a alfa-gal en pacientes con urticaria o anafilaxia difiere considerablemente entre las tres zonas estudiadas y está relacionada con picadura de garrapata

Effects of cysteamine during in vitro maturation on viability and meiotic competence of vitrified buffalo oocytes.

The aims of the present study were to assess the effects of cysteamine as an anti-oxidant on the rate of in vitro maturation (IVM) of buffalo oocytes (experiment 1), and their viability and nuclear status following vitrification (experiment 2). Immature oocytes with compact cumulus cells obtained from the ovaries of slaughtered animals were harvested and then cultured in the maturation medium with no cysteamine (control) or 50 µM cysteamine (treated). Oocytes were vitrified in vitrification solution 1 (VS1): 1.5 M ethylene glycol (EG) + 1.5 M dimethyl sulfoxide (DMSO) for 45 s (step one). After this initial exposure, oocytes were transferred to VS2: 3 M EG + 3 M DMSO in a holding medium for 25 s (step two). After warming, oocytes were evaluated morphologically and then cultured for a further 2 h in the cysteamine-supplemented or control maturation media. The oocytes were evaluated morphologically, stained with trypan blue for viability evaluation. The maturation rate of oocytes was higher (P<0.05) for IVM media with cysteamine compared with controls. There was no significant difference in morphology, survivability and maturation rate between the two vitrification groups (cysteamine-treated and untreated groups) but the morphology, survivability and percentages of metaphase-II oocytes in both groups of vitrified oocytes were lower compared with their respective controls. In conclusion, the addition of cysteamine to the maturation medium improved nuclear maturation of buffalo oocytes but had no positive effect on their cryoresistance during vitrification.

Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution

Purpose: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. Methods/patients: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. Results: The most frequent subtype was diffuse large B cell (31.2 %), followed by follicular lymphoma (18.9 %). The predominant pattern was mixed (nodular-interstitial) (9.2 %). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7 %). There was discordance in 51 cases (14.3 %): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. Conclusions: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive (AU)

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Bone marrow trephine biopsy involvement by lymphoma: pattern of involvement and concordance with flow cytometry, in 10 years from a single institution.

PURPOSE: To evaluate the features of bone marrow (BM) biopsy involvement by lymphoma, pattern of infiltration, morphological analysis and flow cytometry were reviewed at all lymphoma patients over a period of 10 years. METHODS/PATIENTS: 413 cases were included in the study if BM biopsy slides were available. Only 356 patients had both BM trephine biopsy and flow cytometry. RESULTS: The most frequent subtype was diffuse large B cell (31.2%), followed by follicular lymphoma (18.9%). The predominant pattern was mixed (nodular-interstitial) (9.2%). Morphological marrow infiltration was found in 138 cases, and flow cytometry identified 117 cases with BM involvement. A concordance between the two methods was detected in 305 cases (85.7%). There was discordance in 51 cases (14.3%): morphology positive/FC negative in 33 cases and morphology negative/FC positive in 18. CONCLUSIONS: Flow cytometry is slightly more useful in detecting involvement when the BM is affected, but this finding is not conclusive.

Effect of Relaxin on Fertility Parameters of Frozen-Thawed Buffalo (Bubalus bubalis) Sperm.

The aim of this work was to evaluate the effect of relaxin on fertility parameters of buffalo frozen/thawed sperm. Sperm were incubated in the absence of capacitating agents (negative control), with a known capacitating agent such as heparin (positive control) and with 50 and 100 ng/ml relaxin for 2 and 4 h. Sperm viability, motility, capacitation and the effect of relaxin on the fertilizing ability after heterologous IVF were evaluated. Although viability was not affected, relaxin increased (p < 0.05) sperm motility compared to the negative and positive controls both after 2 h (60.0 ± 2.0, 60.0 ± 3.1, 68.3 ± 1.7 and 69.4 ± 2.7, respectively, in negative control, positive control, 50 and 100 ng/ml relaxin) and 4 h (55.0 ± 2.5, 53.3 ± 3.0, 62.2 ± 3.0 and 65.0 ± 3.2, respectively, in negative control, positive control, 50 and 100 ng/ml relaxin) incubation. When sperm were incubated with both 100 ng/ml relaxin and heparin, a decrease (p < 0.01) of pattern A, that is low capacitation level, was observed compared to the negative control both after 2 h (54.4, 34.3 and 36.4%, respectively, in negative control, positive control and 100 ng/ml relaxin) and 4 h (51.9, 35.0 and 34.3%, respectively, in negative control, positive control and 100 ng/ml relaxin). Moreover, an increase (p < 0.01) of pattern EA, that is high capacitation level, was recorded with 100 ng/ml relaxin and heparin compared to the negative control both after 2 h (44.1, 59.3 and 57.7%, respectively, in negative control, positive control and 100 ng/ml relaxin) and after 4 h (43.0, 54.4 and 56.0%, respectively, in negative control, positive control and 100 ng/ml relaxin). Finally, relaxin increased (p < 0.01) cleavage rate compared to the negative control (57.1 ± 4.4, 72.5 ± 6.0, 71.4 ± 5.5 and 73.6 ± 2.9, respectively, in negative control, positive control, 50 and 100 ng/ml relaxin). In conclusion, relaxin has a beneficial effect on motility, capacitation and fertilizing ability of frozen-thawed buffalo sperm.

Motionless system to measure relative angular emission intensity of decaying or modulated light emitting diodes.

In this paper, a measurement system is presented which enables fast and accurate determination of the relative angular emission intensity of light emitting devices, taking into account their specific features such as low light output, narrow spectral distribution, high spatial luminous intensity ratios, and small dimensions. Application of logarithmic sensors allows for fast measurement of relative emission by simple analog circuitry, while locating 18 of them on a fixed ring around the emitter allows a motionless measurement system. As a result, the proposed system can determine the relative angular emission in less than 100 ms with a resolution of 5° for symmetric emitters.

Interrelationship between milk constituents, serum oestradiol and vaginal mucus indicators of oestrus in Egyptian buffaloes.

The intensity of heat signs in buffaloes is generally low and the incidence of suboestrus varied from 15 to 73% (Buffalopedia). The objective of this study was to investigate the feasibility of monitoring the changes in some milk constituents, oestradiol levels and electrical conductivity of vaginal mucus during peri-oestrous period in prediction of the timing of oestrus in buffaloes. Twenty-one Egyptian buffaloes aged 3-9 year, 1st-6th lactations, were examined by oestrous detector and ultrasonographically for monitoring the ovarian and uterine activity for 7 days around the time of standing oestrus. Sodium, potassium, chloride and lactose were assayed in aqueous phase of milk; besides, oestradiol was estimated in serum. Current results declared highly significant acute changes in milk constituents at the time of oestrus characterized by peaking of chloride and sodium levels and lowering of potassium and lactose values. The alternation in milk composition when arranged in decreasing order of magnitude, sodium was the highest (77.78 ± 0.69%), followed by chloride (61.60 ± 1.52%) and potassium (-58.14 ± 10.89%). Concomitantly, milk lactose decreased by 26.07 ± 7.97% compared to baseline levels. Synchronously, vaginal electrical resistance (VER) showed a significant (p < 0.01) decrease, but serum oestradiol 17ß levels surged (59.93 ± 7.29 pg/ml) on day of oestrus. Serum oestradiol level was negatively correlated with VER (r = -0.577), potassium (r = -0.661), positively correlated with chloride (r = 0.707) and sodium (r = 0.579) and not correlated with lactose levels. These results for the first time suggested that the changes in constituents of milk during peri-oestrous period may be used as a practical non-invasive indicator for oestrous detection and prediction of ovulation in Egyptian buffaloes.

Loss of TCR-beta F1 and/or EZRIN expression is associated with unfavorable prognosis in nodal peripheral T-cell lymphomas.

Nodal peripheral T-cell lymphoma (nodal PTCL) has an unfavorable prognosis, and specific pathogenic alterations have not been fully identified. The biological and clinical relevance of the expression of CD30/T-cell receptor (TCR) genes is a topic under active investigation. One-hundred and ninety-three consecutive nodal PTCLs (89 angioimmunoblastic T-cell lymphomas (AITL) and 104 PTCL-unspecified (PTCL-not otherwise specified (NOS)) cases) were analyzed for the immunohistochemical expression of 19 molecules, involving TCR/CD30 pathways and the associations with standard prognostic indices. Mutually exclusive expression was found between CD3 and TCR-beta F1 with CD30 expression. Taking all PTCL cases together, logistic regression identified a biological score (BS) including TCR molecules (TCR-beta F1 and EZRIN) that separates two subgroups of patients with a median survival of 34.57 and 5.20 months (P<0.001). Multivariate analysis identified BS and the prognostic index for PTCL (PIT) score as independent prognostic factors. This BS maintained its significance in multivariate analysis only for the PTCL-NOS subgroup of tumors. In AITL cases, only a high level of ki67 expression was related to prognosis. A BS including molecules involved in the TCR signaling pathway proved to be an independent prognostic factor of poor outcome in a multivariate analysis, specifically in PTCL-NOS patients. Nevertheless, validation in an independent series of homogeneously treated PTCL patients is required to confirm these data.

Air pollutant characterization in Tula industrial corridor, Central Mexico, during the MILAGRO study.

Pollutant emissions and their contribution to local and regional air quality at the industrial area of Tula were studied during a four-week period as part of the MILAGRO initiative. A recurrent shallow stable layer was observed in the morning favoring air pollutants accumulation in the lower 100 m atmospheric layer. In the afternoon the mixing layer height reached 3000 m, along with a featuring low level jet which was responsible of transporting air pollutants at regional scales. Average PM10 at Jasso (JAS) and Tepeji (TEP) was 75.1 and 36.8 µ g/m(3), respectively while average PM2.5 was 31.0 and 25.7 µ g/m(3). JAS was highly impacted by local limestone dust, while TEP was a receptor of major sources of combustion emissions with 70% of the PM10 constituted by PM2.5. Average hourly aerosol light absorption was 22 Mm(-1), while aerosol scattering (76 Mm(-1)) was higher compared to a rural site but much lower than at Mexico City. δ(13)C values in the epiphyte Tillandsia recurvata show that the emission plume directly affects the SW sector of Mezquital Valley and is then constrained by a mountain range preventing its dispersion. Air pollutants may exacerbate acute and chronic adverse health effects in this region.

Origin of the low-energy emission band in epitaxially grown para-sexiphenyl nanocrystallites.

A comparative study of steady-state and time-resolved photoluminescence of para-sexiphenyl (PSP) films grown by organic molecular beam epitaxy (OMBE) and hot wall epitaxy (HWE) under comparable conditions is presented. Using different template substrates [mica(001) and KCl(001) surfaces] as well as different OMBE growth conditions has enabled us to vary greatly the morphology of the PSP crystallites while keeping their chemical structure virtually untouched. We prove that the broad redshifted emission band has a structure-related origin rather than being due to monomolecular oxidative defects. We conclude that the growth conditions and type of template substrate impacts substantially on the film morphology (measured by atomic force microscopy) and emission properties of the PSP films. The relative intensity of the defect emission band observed in the delayed spectra was found to correlate with the structural quality of PSP crystallites. In particular, the defect emission has been found to be drastically suppressed when (i) a KCl template substrate was used instead of mica in HWE-grown films, and (ii) in the OMBE-grown films dominated by growth mounds composed of upright standing molecules as opposed to the films consisting of crystallites formed by molecules lying parallel to the substrate.

Efecto del celecoxib en la colitis inducida en ratas / Effect of the colecoxib in the the colitis induced in rats

Debido a las controversias sobre los inhibidores selectivos de la ciclooxigenasa 2 (COX-2) sobre la inflamación intestinal, decidimos estudiar el Celecoxib, un inhibidor de COX-2 sobre la evolución de la inflamación experimental del colon de rata. Se utilizaron tres grupos de 12 ratas cada uno (ratas machos Sprague-Dawley). Al grupo control se les administró por vía intrarectal 2 ml de agua, al grupo inflamado 1 ml de ácido acético al 10 por ciento más 1 ml de agua, y al grupo medicado 1 ml de ácido acético y 1 ml de Celecoxib (10 mg/Kg-p). Se registró el peso durante 3 días, al cabo de ese tiempo se sacrificaron y se evaluó el colon macro y microscópicamente. El tratamiento con colecoxib ocasiona una significativa disminución de las lesiones macroscópicas. El grupo control no presentó edema, ulceración o erosión. Se encontró 33 por ciento de edema en el grupo medicado contra 93 por ciento en el grupo inflamado (p<0.0005); 22 por ciento de erosión en el grupo medicado contra 65 por ciento en el grupo inflamado (p<0.03) y 12 por ciento de ulceración en el grupo medicado contra el 44 por ciento en el grupo inflamado (p<0.047). La severidad de las lesiones microscópicas fueron significativamente menores en el grupo medicado con regeneración de la mucosa en el 50 por ciento y regenración parcial en 50 por ciento restante. En el grupo inflamado hubo pérdida del 90 por ciento de la mucosa y el grupo control sin alteraciones. La perdida de peso fue de 6g en el inflamado. El Celecoxib mejora notablemente el cuadro de inflamación en el colon de las ratas, mediante la inhibición de la Cox-2 y disminución de la interleucina 1 (IL-1)

Estudio observacional en el área 10: manejo de la hipercolesterolemia en ancianos diabéticos / Cross-sectional study in Area 10: hypercholesterolemia management in elderly population with diabetes

OBJETIVO: Describir el nivel de cumplimiento de los criterios del adecuado manejo de la hipercolesterolemia en la población anciana con dislipemia y diabetes, realizado por los médicos de Atención Primaria. POBLACION Y MÉTODOS: Estudio observacional transversal con 38 médicos de Atención Primaria (Área 10 INSALUD Madrid), y 272 pacientes >= 65 años con hipercolesterolemia y diabetes. Se evaluó el nivel de cumplimiento de las recomendaciones del National Cholesterol Education Program (NCEP). RESULTADOS: El 94,12 por ciento [90,44; 96,49 (IC 95 por ciento)] de los sujetos de estudio tenían dos o más factores de riesgo cardiovasculares, y el 27,21 por ciento [22,09; 32,98 (IC 95 por ciento)], padecían cardiopatía isquémica u otra enfermedad vascular arteriosclerótica. El tratamiento de la hipercolesterolemia con dieta exclusivamente, se realizó en el 66,54 por ciento [60,55; 72,06 (IC 95 por ciento)] de los pacientes. El tratamiento farmacológico con estatinas se realizó en el 19,49 por ciento [15,05; 24,80 (IC 95 por ciento)] de las ocasiones, con fibratos en el 11,76 por ciento [8,30; 16,34 (IC 95 por ciento)], y con resinas en el 2,21 por ciento [0,90; 4,97 (IC 95 por ciento)]. El nivel de cumplimiento de los criterios de adecuado manejo de la hipercolesterolemia en sujetos de estudio fue del 41,91 por ciento [36,02; 48,03 (IC 95 por ciento)]. CONCLUSION: La hipercolesterolemia en la población anciana con diabetes no es tratada adecuadamente en el 58,09 por ciento [51,97; 63,98 (IC 95 por ciento)] de las ocasiones. Se hace necesario investigar las razones que influyen en el inadecuado manejo de la dislipemia en esta población (AU)

Estudio observacional del manejo de la hipercolesterolemia en ancianos entre 65 y 75 años / Cross-sectional study: dyslipidaemia management in population between 65 and 75 years old

Fundamento : dada la variabilidad del manejo de la hipercolesterolemia en el anciano por los Médicos de Atención Primaria (MAPs), se precisa una evaluación inicial.Objetivo : describir el manejo de la hipercolesterolemia en ancianos entre 65 y 75 años por los médicos de familia.Diseño: estudio observacional transversal.Material y método: de 16 Equipos de Atención Primaria (EAPs) del Área 10 INSALUD, con 125 MAPs, se eligieron a 4 EAPs (25 por ciento) con 38 MAPs, mediante muestreo bietápico por conglomerados, y de los 841 pacientes elegibles, se seleccionaron 551 pacientes mediante muestreo aleatorio simple. Se analizó la existencia de factores de riesgo cardiovasculares (FRCIs), cardiopatía isquémica o enfermedad vascular arterioesclerótica (CI/EV A ) , perfil lipídico, y la adecuación del manejo de la hipercolesterolemia a las recomendaciones del National Cholesterol Education Program (NCEP I I ) Resultados: utilizando la prueba Chi cuadrado, se detectó que el 71,87 por ciento (IC95 por ciento: 67,88; 75,55) de los pacientes tenían 2 FRCIs además de hipercolesterolemia, o CI/EVA. Se trató la hipercolesterolemia con dieta exclusivamente en el 64,25 por ciento (IC95 por ciento: 60,07; 68,23), con estatinas un 20,87 por ciento (IC95 por ciento: 17,60; 24,56), con fibratos un 12,16 por ciento (IC95 por ciento: 9,61; 15,25), y con resinas un 2,36 por ciento (IC95 por ciento: 1,32; 4,11). La hipercolesterolemia se manejaba correctamente en el 47,91 por ciento (IC95 por ciento: 43,68; 52,71), disminuía al 41,05 por ciento (IC95 por ciento: 35,33; 47,02) cuando el paciente tenía 2 FRCIs, y al 36,94 por ciento (IC95 por ciento: 28,12; 46,67) cuando padecía C I / E VA Conclusiones : el manejo de la hipercolesterolemia de la población entre 65 y 75 años no se adecua a la NCEP II en el 52,09 por ciento, empeorando al 59,95 por ciento si el paciente tiene 2 FRCIs, y al 63,06 por ciento si padece CI/EVA. Es necesario investigar las razones que influyen en este problema (AU)

[Continuing medical education about the use of antilipemic agents in elderly patients aged 65-75 years]. / Formación médica continuada sobre el uso de hipolipemiantes en ancianos de 65-75 años.

OBJECTIVE: The objective is evaluating the efficacy of the educative intervention to primary care physicians, about the accurate dyslipidaemia management in population between 65 and 75 years old with hypercholesterolemia. DESIGN: Simple-blind random clinical trial. SETTING: Area 10 primary care (National Institute of Health of Spain). STUDY SUBJECTS: . Thirty eight primary care physicians of Area 10. Seven hundred and five patients between 65 and 75 years old with dyslipidaemia. INTERVENTIONS: Clinical session to physicians about the dyslipidaemia management, reinforced with the shipment of the accurate management criteria and bibliographic information. Physicians were followed up for one year. RESULTS: The therapeutic management varied (p = 0.03) in the experimental group after educative intervention. The dietetic therapeutic increased 6.56 percent (p = 0.21), the therapeutic with HMG-CoA-reductase inhibitors increased 4.16 percent (p = 0.36), and the therapeutic with fibric-acid derivates decreased 4.22 percent (p = 0.24). The criteria fulfillment rate of accurate dyslipidaemia management did not vary (p = 1.0) in the control group (44.3 percent) and there was hardly any variation (from 49.4 percent to 49.1) in the experimental group (p = 0.96). The fulfillment rate decreased 7,56 percent (p = 0.25) when dyslipidaemia managed with only diet. The fulfillment improved 17,17 percent (p = 0.14) if dyslipidaemia managed with fibric-acid derivates, and it improved 17,58 percent (p = 0.06) if was managed with HMG-CoA-reductase inhibitors. CONCLUSIONS: The educative session to primary care physicians reinforced with the shipment of the received information, is not likely to relieve the criteria fulfillment rate of accurate management of population between 65 and 75 years old with hypercholesterolemia.

Formación médica continuada sobre el uso de hipolipemiantes en ancianos de 65-75 años / Continued medical education about the dislipaemia management in population between 65 to 75 years old

Objetivo. Evaluar la eficacia de la intervención educativa en médicos de atención primaria (MAP) sobre el manejo de la dislipemia en pacientes de 65-75 años con hipercolesterolemia. Diseño. Ensayo clínico aleatorio, simple ciego. Ámbito del estudio. Atención primaria Área 10 INSALUD Madrid. Sujetos de estudio. MAP (38) del Área 10. Pacientes de 65-75 años con hipercolesterolemia (705).Intervención. Sesión clínica a médicos de atención primaria sobre el adecuado manejo de las dislipemias de una hora de duración, reforzado con el envío personalizado de los criterios de uso de hipolipemiantes con referencias bibliográficas. El seguimiento de los médicos se realizó durante un año. Resultados. El manejo hipolipemiante varió (p = 0,03) tras la intervención educativa. En el grupo experimental, el tratamiento dietético aumentó un 6,56 por ciento (p = 0,21), las estatinas se incrementaron un 4,16 por ciento (p = 0,36) y los fibratos disminuyeron un 4,22 por ciento (p = 0,24). El cumplimiento de los criterios de adecuado manejo de las dislipemias no varió (p = 1,0) en el grupo control (44,3 por ciento), ni tampoco (p = 0,96) en el grupo experimental (49,4 por ciento frente a 49,1 por ciento). El cumplimiento en el grupo de intervención disminuyó un 7,56 por ciento (p = 0,25) cuando las dislipemias se trataban sólo con dieta, mejoró un 17,17 por ciento (p = 0,14) si se usaban fibratos y un 17,58 por ciento (p = 0,06) si se utilizaban estatinas. Conclusión. No parece probable que la sesión didáctica a MAP, reforzada con el envío posterior de la información ofrecida, mejore el cumplimiento de los criterios de adecuado manejo de la dislipemia sobre la población de 65-75 años con hipercolesterolemia (AU)

Developmental study of immunocompetent cells in the bronchus-associated lymphoid tissue (BALT) from Wistar rats.

The aim of the present report was to study in growing Wistar rats the development of immunocompetent cells in the bronchus-associated lymphoid tissue (BALT). We found at day 4 postpartum, a high number of TCRgamma/delta+ T cells and very few CD8alpha+, CD8beta+, CD5+, TCRalpha/beta+ T cells in BALT. The latter cells and CD4+ T cells increase with age. Even though T cells expressing TCRgamma/delta outnumber those expressing TCRalpha/beta early in development, until 45 days of age, alpha/beta+ predominate over gamma/delta+ T cells only in adult rats (60 days of age). Moreover, a predominance of suppressor/cytotoxic T cells over T-helper cells was found in 60 days old rats. Surprisingly, more CD8alpha+ than CD8beta+ T cells in BALT are observed. The number of IgA+ B and CD4+ T cells found in the BALT increases with age. The early appearance - 4 days of age - of all T-cell phenotypes in BALT especially of gamma/delta+ T cells may imply a benefit to respond to inhaled antigen soon after birth.

Particulate Air Pollution in Mexico City: A Collaborative Research Project.

PM10, PM25, precursor gas, and upper-air meteorological measurements were taken in Mexico City, Mexico, from February 23 to March 22, 1997, to understand concentrations and chemical compositions of the city's particulate matter (PM). Average 24-hr PM10 concentrations over the period of study at the core sites in the city were 75 H g/m3. The 24-hr standard of 150 µ g/m3 was exceeded for seven samples taken during the study period; the maximum 24-hr concentration measured was 542 µ g/m3. Nearly half of the PM10 was composed of fugitive dust from roadways, construction, and bare land. About 50% of the PM10 consisted of PM2.5, with higher percentages during the morning hours. Organic and black carbon constituted up to half of the PM2.5. PM concentrations were highest during the early morning and after sunset, when the mixed layers were shallow. Meteorological measurements taken during the field campaign show that on most days air was transported out of the Mexico City basin during the afternoon with little day-to-day carryover.