Lung function, asthma paradox, atopy, and risk factors in Mexican spirometry-diagnosed asthmatic patients.

Despite long-term studies, still not much is known about the asthma triggering factors and its sometimes controversial results. Probably one of the major problems of controversy is the lack of specific and accurate diagnosis of this disease. The aim of this study was to assess lung function, atopy, and environmental factors in spirometry-diagnosed asthmatic patients. Time series of daily counts of hospital emergency admissions were constructed for known asthmatic subjects. Spirometry, chest radiograph, arterial gasometry, skin tests, environmental SO2 levels, and climatic parameters were evaluated. Family asthma history was observed in a high proportion of asthmatic patients and it correlated marginally with severity of asthma. A seasonal trend in asthma frequency was recorded and it was more common in the urban area and in those living in the margins of the city. The most frequent asthma type recorded was the severe persistent asthma. More than 50% of subjects had subresponse to bronchodilator; asthma paradox was recorded in 10.8%. Positive skin tests were observed in 36.9% and SO2 levels did not correlate with asthma attacks. Paradox asthma or tolerance may be developed by asthmatic subjects during chronic treatment with short-acting 92-agonists. To avoid side effects and to decrease the morbidity and mortality associated with the usage of antiasthma medications, it is essential to identify quickly those subjects that respond abnormally to the short-acting P2-agonist.

Utilidad de la prueba cutánea a la coccidioidina en personas con diabetes mellitus tipo 2 en una zona endémica / Clinical useful of coccidioidin skin test in subjects with type 2 diabetes mellitus in an endemic area

Objetivo: Existen pocos estudios que evaluen la respuesta cutánea a antígenos micóticos en personas con diabetes, por lo que analizamos la posible diferencia de la reactividad cutánea a la coccidioidina en sujetos con y sin diabetes mellitus. Material y metodo: Mediante un diseño transversal se estimó la prevalencia de la reactividad cutánea a coccidioidina en una muestra poblacional de 1651 sujetos en una zona endémica de coccidioidomicosis. Se identificaron los portadores de diabetes mellitus, validándose el diagnóstico por criterios clínicos y de laboratorio. Para determinar el grado de asociación de la reactividad con el antecedente de diabetes mellitus se contrastaron los datos crudos y mediante regresión logística ajustada por edad, sexo y zona geográfica de residencia. Se obtuvo razón de momios (RM) e intervalos de confianza al 95 por ciento. Resultados: En el estudio poblacional hubo 665 positivos a la coccidioidina (tasa 40.28 por ciento). Se identificaron 76 casos con diabetes mellitus, 23 positivos a la prueba (tasa 30.26 por ciento), con una RM para este grupo de 0.63 (IC 95 por ciento 0.37-1.07), disminuyendo a 0.52 (IC95 por ciento 0.31 - 0.88, p=0.014) al analizar mediante regresión logística ajustada por variables confusoras. Conclusion: La reactividad a la coccidioidina fue significativamente menor en los casos con diabetes mellitus que en la población general. Se sugiere interpretar con cautela la respuesta de esta prueba en personas con DM tipo 2.

Prevalance 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 percent, with a 95 percent 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. Conslusions. Positive results were related to exposure risk and habitat, principally in the sputheast region of the city. These results were applied both to residents and outsiders with no differences between the groups. Of the total, 87.5 percent 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

Tratamiento quirúrgico del timoma invasor con síndrome de vena cava superior: informe de tres casos / Surgical treatment of invasive thymoma with superior vena cava syndrome: a report of three cases

Se estudiaron tres pacientes con timoma invasor y síndrome de vena cava superior Todos los enfermos tuvieron afección clínica grave en el sistema nervioso central o en el aparato respiratorio, obstrucción vascular de tipo II o III de Stanford. En todos los pacientes se realizó resección del tumor y derivación de la vena cava, mediante un injerto desde la vena innominada izquierda hasta la orejuela derecha. En dos pacientes se utilizó vena safena en espiral que se reforzó con bandas de PTFE y anillos de alambre quirúrgico, en el restante se usó politetrafluoro-etileno. En todos los pacientes se obtuvo mejoría clínica inmediata y todos los injertos estuvieron permeables al mes de la cirugía y han durado un promedio de 10 meses

Coccidioidomicosis pulmonar y pleural de difícil diagnóstico. Informe de tres casos / Coccidioidal pneumoniae and pleural coccidioidomycosis, a difficult diagnostic. Three cases report

Se estudiaron tres pacientes con coccidioidomicosis; dos de ellos tuvieron una forma neumónica aguda que resultó ser idéntica clínica y dariológicamente a una neumonía bacteriana, el otro enfermo tuvo una pleuritis crónica granulomatosa muy parcida a la tuberculosa. En todos los pacientes el diagnóstico inicial fue erróneo y sólo pudo establecerse el de coccidioidomicosis cuando se practicaron los estudios necesarios para demostrar el hongo en el lavado broncoalveolar o en la biopsia pleural. Todos los pacientes respondieron favorablemente al tratamiento con anfotericina B, 3 g dosis total, y fluconazol, 400 mg diarios, durante un año