[Asthma prevalence in adolescents. Relation to sex and active smoking]. / Prevalencia de asma en adolescentes. Relación con el sexo y el tabaquismo activo.

BACKGROUND: Asthma prevalence in adolescents appears to be increasing and determinants are not well established. OBJECTIVE: To determine the association between sex and active smoking with asthma prevalence in adolescents. PARTICIPANTS AND METHOD: In this cross-sectional study 6,922 students, ages 12 to 18 years, residents in an area of northeastern Mexico, were included. We developed a questionnaire based on The International Study of Asthma and Allergies in Childhood (ISAAC) and on The European Community Respiratory Health Survey (ECRHS). The association between sex and active smoking with asthma prevalence was determined using a logistic regression model. RESULTS: Of the total population, 46.3% were males, 7.3% suffered from asthma and 17.3% were cigarette smokers. We found that sex (OR = 0.55; CI 95%: 0.48-0.63) and active smoking (adjusted OR = 1.12; CI 95%: 0.89-1.42) were not associated with asthma prevalence. Females (OR = 1.44; CI 95%: 1.13-1.84) and active smoking (adjusted OR = 1.38; CI 95%: 1.15-1.67) were associated with prevalence of wheezing in the last 12 months, and with prevalence of dry cough at night (OR = 1.53; CI 95%: 1.34-1.76). CONCLUSIONS: Teenager males and active smoking were not associated with asthma prevalence. Females had an association with wheezing in the last 12 months and dry cough at night.

[Asthma classification]. / Clasificación del asma.

Asthma, as chronic inflammatory disease, shows variations in clinical manifestations and the degree of airflow obstruction, so its severity may change over time in the same patient. The Global Initiative for Asthma (GINA) established a practical system of classification, considering clinical and functional aspects as frequency of diurnal and nocturnal respiratory symptoms and lung function, their combination allows for classifying asthma severity as intermittent and persistent ( mild, moderate and severe). Recently, it has been proposed to classify the asthma according to degree of control: controlled, partly controlled and uncontrolled. The parameters used in this system are: frequency of diurnal and nocturnal respiratory symptoms, activity limitation, use of rescue therapy, determining the forced expiratory volume in one second (FEV1) or peak expiratory flow (PEF) and the exacerbations. The patient's participation on the asthma classification has also been considered through the self application of asthma control questionnaire (ACT). Patients with high risk of death are classified in the group of difficult asthma control (ADC), requiring major and minor criteria to define it; the common denominator is the decontrol of the disease, high dose steroids and appropriate treatment previously established. Sort asthma with any of these systems, information about its impact on the patient's life and thus establish the recommended treatment schedule for each patient group.

[Clinical symptom relief in obese patients with persistent moderate asthma secondary to decreased obesity]. / Alivio de síntomas clínicos en pacientes obesos con asma moderada persistente secundario a la disminución de obesidad.

BACKGROUND: The prevalence of asthma and obesity has increased last years implying important economical and social consequences. A relationship between asthma severity and obesity grade has been found. Therefore, it is necessary to evaluate if obesity decline has a beneficial impact on asthma severity. OBJECTIVE: To evaluate the effect of obesity decline on control symptoms and asthma severity. PATIENTS AND METHODS: Ninety-six patients with obesity and moderate chronic asthma were randomized to group A or B and were maintained for 40 days on a low calorie diet. At baseline and at the end of the study, symptoms, measurement of obesity, spirometry, inflammatory cytokines and immunoglobulin's levels were assessed. Diets' safety was evaluated based on laboratory test. Data were analyzed with Student's t test. RESULTS: After 40 days on a low calorie diet, in group A, there were significant decreases of obesity (p < 0.001) and IgE, symptoms almost disappeared (cough persisted in 20%) and medication was suspended in 80%. Group B had obesity decline but IgE levels remained (> 100 UI/mL), symptoms and drug regimen remained unchanged. Both diets were not harmful for patients. CONCLUSION: These results show that asthmatic obese patients maintained for 40 days on low calorie diet A, had obesity and IgE levels decrease and symptoms and asthma severity relief.

Effect of allergic rhinitis, asthma and rhinobronchitis on dental malocclusion in adolescents.

OBJECTIVE: To determine the effect of allergic rhinitis (AR), asthma, rhinobronchitis (ARB) on dental malocclusion in adolescents. METHOD: This is a cross-sectional, observational, retrospective and sample descriptive study of 2556 adolescents aged 14-20 years. AR, asthma and ARB were defined by self-reported. Malocclusion was identified by direct physical examination. Data were analyzed by the SPSS 10.0 version statistical program, adjusted OR value (Odds Ratio) using a logistic regression model was determined, ji square was calculated, an 95% Confidence Intervals was used. Equal or smaller values of p < 0.05 were considered statistically significant. RESULTS: Percentage of male sex was 42.7% and female 57.3%. Prevalence of AR was 39.3%, asthma 6.9%, ARB 4.5%, and malocclusion, 37.2%. A higher percentage of malocclusion was found in adolescents with asthma (48.3% vs 36.3%). For the groups of asthma (adjusted OR = 1.78; p = 0.017) and RA (fit OR = 1.20, p = 0.032) were inferred that these pathologies to favor the malocclusion in adolescents, this did not happen with the group of RBA (OR fit = 0.81; p = 0.511). The prevalence of open bite was greater in adolescents with asthma (44.3% vs. 31.3%). For the asthma group (OR fit = 1.66; p = 0.037) we deduced that the development of anterior open bite is favored, this was not thus for the groups of RBA (OR fit = 1.01; p = 0.956) and RA (OR fit = 1.17; p = 0.071). Nor AR, asthma orARB have any effect on posterior open bite. CONCLUSIONS: Asthma is related to malocclusion in adolescents, particularly to anterior open bite. AR and ARB do not favor the development of malocclusion.

[Antifungal and phagocytic immunostimulation treatment of chronic disseminated dermatophytosis]. / Dermatofitosis diseminada crónica asociada a fagocitosis deficiente tratada con antimicóticos e inmunoestimulación fagocitaria.

A 39 years old man with a long-standing disseminated dermatophytosis even with several antifungal treatments is presented. From lesions, Trichophyton rubrum var. typical downy, T. tonsurans and Candida albicans were isolated and showed sensivity to azolic compounds in vitro. The phagocytic activity in vitro compared with normal control was depressed. Treatment with itraconazole and immunomodulation using a bacterial antigen was indicated. During the last two years the patient has been clinical and mycologically healthy, and his phagocytosis activity has become normal. In patients with chronic and relapsing dermatophytosis, the immune response evaluation is recommended, and immunomodulation could be useful as a rational measure in patients with a particular immunodeficiency.

Dermatofitosis diseminada crónica asociada a fagocitosis deficiente tratada con antimicóticos e inmunoestimulación fagocitaria / Antifungal and phagocytic immunostimulation treatment of chronic disseminated dermatophytosis

Se presenta el caso de un hombre de 39 años de edad con dermatofitosis crónica diseminada. De las lesiones se aislaron Trichophyton rubrum var. vellosa típica, T. tonsurans y Candida albicans, todos sensibles in vitro a compuestos azólicos. La actividad fagocítica in vitro comparada con un control normal mostró deficiencia en la misma. Se indicó tratamiento con itraconazol e inmunoestimulación con antígeno bacteriano. Durante los dos últimos años el paciente se ha mantenido clínica y micológicamente sano y su actividad fagocitaria es normal. En los pacientes con dermatofitosis crónica recidivante es recomendable la valoración de la respuesta inmune y la inmunomodulación puede ser útil como parte del tratamiento.

A 39 years old man with a long-standing disseminated dermatophytosis even with several antifungal treatments is presented. From lesions, Trichophyton rubrum var. typical downy, T. tonsurans and Candida albicans were isolated and showed sensivity to azolic compounds in vitro. The phagocytic activity in vitro compared with normal control was depressed. Treatment with itraconazole and immunomodulation using a bacterial antigen was indicated. During the last two years the patient has been clinical and mycologically healthy, and his phagocytosis activity has become normal. In patients with chronic and relapsing dermatophytosis, the immune response evaluation is recommended, and immunomodulation could be useful as a rational measure in patients with a particular immunodeficiency.

[Drug allergy assessed by modified Shelley's test. A case series]. / Alergia a medicamentos evaluada con la prueba de Shelley modificada. Serie de casos.

BACKGROUND: The frequency of allergy to drugs is 5-10% in the general population, The Shelley's test is a method in vitro for its diagnosis and it is considered positive when it is equal o greater than 20%. OBJECTIVE: To show the allergy to drugs frequency evaluated by the Shelley's Modified Test. MATERIAL AND METHODS: We included 165 patients with clinical diagnosis of allergy to drugs to those who the test of Shelley's was applied modified test for one or several medicines. The study was made in the period of January 1st to December 3st 2002. RESULTS: 88% (145 patients) were positive, and 12% (20 patients) were negative in correlation with clinical findings. The female was more determinant (2:1 relation), with an average age of 45 years. The drugs that caused reactions of allergy in were the antibiotics (sulfas, penicillin, quinolones), analgesic (ASA, naproxen, diclofenac), antihypertensive (enalapril, captopril, verapamil) and others with 95, 170, 48 and 97 cases respectively. The most frequent clinical features were urticaria, angioedema, anaphylactic shock and erythema. CONCLUSION: The Shelley's test is useful to support the diagnosis of allergy to drugs, although does not exclude it. The antibiotics intake is the most common cause and the most common clinical manifestation was urticaria.

[Current and future approaches for the treatment of inflammatory diseases of inferior respiratory tract]. / Abordajes actuales y futuros para el tratamiento de las enfermedades inflamatorias de las vías aéreas inferiores.

Among the allergic disorders we emphasize the inflammatory diseases of the inferior respiratory tract by their incidence, repercussion in daily activities, and by their high cost of medical attention. For their treatment, they require more than one inhaled or systemic drug. Current medicines tend to have adverse or secondary effects, such as: osteoporosis, type 3 diabetes mellitus, tremor or tachycardia. New medicines are being developed with less adverse or secondary effects, and much more selective and specific in the molecules involved in the allergic disease's physiopathology. Among them we find pascolizumab, which inhibits the differentiation made to Th2, as well as the citokines production. Other drugs are: mepolizumab, monoclonal antibody antiCD23, and the selective inhibitor of IgE (AJP13358) Rhu-Mab-E25. Currently, they are being developed some new drugs, such as SB-207499 (SKB) and LAS 31025, which are selective inhibitors of fosfodiesterase. Within the currently studied medicines that offer high specificity to inhibit the synthesis of interleukines we emphasize the presence of humanized monoclonal antibodies antireceptor IL-4. The anti IL-5 (SB-240563) is administered in asthmatic patients to reduce eosinofilia in expectoration. Tosilate of suplatast is a selective IL-4 and IL-5 inhibitor. Ramatroban (BAY or 3405) is an antagonist of the tromboxane A2 receptor, which reduces the inflammatory process of the nasal mucose without hemodynamic effects. Immunotherapy with peptides avoids the response of IgE by the allergen, without mast cell degranulation.

[Reactions to drugs. A review of literature]. / Reacciones a medicamentos. Revisión de la literatura.

Adverse drug reactions are originated by immunological and non-immunological mechanisms. Estimated incidence is of 6.7%, and the incidence of mortal reactions is of 0.32%. In women, skin reaction incidence is 35% higher than in men, and it is 20 times higher than presenting contrast medium-related reactions. Allergic reaction is classified accordingly to Gell and Coombs criteria. It is unknown the pathogenic mechanism of the drug-induced fever. Predictable reaction depends on the dose and it is frequently related to the drug. Unpredictable reaction depends on the individual and pseudoallergic features of each patient; no immunological mechanism is involved. For diagnosis, lymphocyte transformation test measures the T cell proliferation to an in vitro drug; furthermore, it is the most sensitive. There are just a few options to evaluate and manage those patients. When it is impossible to make the exposition test the alternative is to withdraw the drug and try another treatment option. If there is no other available drug, desensitization must be considered.

[Occupational asthma and reactive airway dysfunction syndrome]. / Asma ocupacional y síndrome de disfunción reactiva de las vías respiratorias.

Occupational asthma could be defined as a reversible lung disorder characterized by attacks of breathing difficulty, wheezing, and cough, which are caused by various agents found in the workplace. Incidence varies from 2 to 15% in adult work population; actually there is no data for the child population. Allergic occupational asthma is due to allergic sensitization to a specific substance or material present at the workplace; non-allergic occupational asthma occurs because of the high exposure to an irritant also at the workplace. Over the past few years, more people have been diagnosed as having asthma because of some workplace exposure. The identification of occupational asthma in workers is important because early detection may lead to the control of the worker's symptoms and control of the chemicals in the workplace. In Latin America there is no data about occupational asthma, maybe for the scarce information about it or for its difficult diagnosis.

[Unknown fixed cutaneous sporotrichosis]. / Esporotricosis cutánea fija incógnita.

Sporotrichosis is the most frequent subcutaneous mycosis in Mexico. The clinical forms are commonly described as lympho-cutaneous and cutaneous-fixed. The case of a male patient who developed an eritematous plaque with radial growth is reported. The patient received empirical therapy and topic steroids which modified the clinical picture with vesicles to vesicles, ulcers and blood and honey crusts. Diagnosis of fixed cutaneous sporotrichosis incognito was established by clinical, mycological and histopathological studies. Delayed cellular immunity in vitro and in vivo were normal. The patient received oral itraconazole showing clinical and mycological cure after four months.

[Autoimmune urticaria. Treatment with methotrexate]. / Urticaria autoinmunitaria. Tratamiento con metotrexato.

BACKGROUND: It has been established that 27-50% of patients with idiopathic chronic urticaria have antibodies directed against the alpha chain of the high-affinity IgE receptor, which are indirectly detected by cutaneous tests with autoserum. Thus, an autoimmune urticaria diagnosis can be settled. OBJECTIVE: To prove methotrexate's efficiency in patients with autoimmune urticaria. MATERIAL AND METHODS: Seven patients took part in the study. A series of tests was performed in order to rule out any possible infectious, metabolic, or physical etiology. Initial treatment with methotrexate with doses of 2.5 mg every 12 hours, two days a week was provided. In case there were no toxicity data, doses would increase to three days a week for a 6-week period. RESULTS: Statistically significant improvement was observed in the itching, as well as the presence of spots, repercussion on daily activities, sleep disorders. There was no statistical difference regarding the extension of the lesions and the presence of angioedema. Adverse effects were not significant. CONCLUSION: We conclude that methotrexate is effective in the treatment of autoimmune urticaria.

[Prevalence and potential triggering factors of chronic urticaria and angioedema in an urban area of northeastern Mexico]. / Prevalencia y factores desencadenantes potenciales de urticaria crónica y angioedema en un área urbana del noreste de México.

BACKGROUND: Urticaria and angioedema are illnesses of easy diagnosis, but to solve them or to determine their cause is complex, as well as the therapeutic management of chronic cases. OBJECTIVE: To determine the prevalence, possible precipitating factors and chronic urticaria characteristics. MATERIAL AND METHODS: A questionnaire was applied to 4,000 persons selected at random, from the ages of 18-50 years, women and men. We made up simple frequencies, odds ratio, confidence interval at 95%. Possible interventions from the some variables were determined through regression logistic model. RESULTS: Chronic urticaria and angioedema prevalence was 4.8%. From the 147 sick persons, 71.4% were women (p = 0.00) 51.70% had only wheals, 10.88% angioedema alone and 37.41% of the patients with chronic urticaria also have angioedema. Potential triggering factors that we found were 18.36% drugs (p = 0.00) and 4.08% foods (p = 0.00). Family (p = 0.00) and personal allergy (p = 0.00) antecedents were documented in 55.8% and 68.70%, respectively. In 40.1% symptoms interfere with daily activities of the patients and 53.1% of patients had symptoms at night. CONCLUSIONS: Despite of being a retrospective study, the results show us that the chronic urticaria and angioedema are important health problems in the northeastern of Mexico. We can not identify the etiology, and the symptoms can disturb quality of life of the patients. Female sex, family and personal allergy antecedent could be important for these pathology presentations.

Angioedema heredofamiliar de Osler (informe de un caso) / Angioedema to heredofamiliar of osler (report of a case)

Se comunica un caso clínico de angioedema heredofamiliar de Osler, que presentó edema de cara, cuello, manos y pies, dificultad respiratoria, náuseas, vómito, diarrea y dolor abdominal cólico, desde los siete años de edad.

Cefotaxima más amikacina asociadas a inmunomodulación en el tratamiento de actinomicetoma resistente a tratamiento convencional / Cefotaximine plus amikacin associated to immunomodulation in actinomycetoma treatment resistant to conventional therapy

El actinomicetoma es un síndrome de localización subcutánea de evolución crónica. Se presenta el caso de un paciente con micetoma abdominal causado por Nocardia brasiliensis, que había sido resistente a diferentes esquemas terapéuticos durante varios años y que, además, presentaba deficiencia en la función fagocitaria. En este caso, la curación se obtuvo con la administración de dos ciclos (con duración de 23 días cada uno); se administró cefotaxima (1g cada 8 horas) y amikacina (50 mg cada 12 horas). La inmunomodulación se llevó a cabo mediante la administración de una dosis semanal de levamisol de 300 mg, durante cuatro semanas, y la aplicación dos veces por semana de 1 ml de antígeno bacteriano a una concentración 600,000,000 de bacterias por ml durante 20 meses. Se discute la utilidad del antibiograma en estos pacientes y la importancia de la investigación de la función inmunológica en pacientes con resistencia a los tratamientos convencionales

Interferón alfa2b en el dolor por herpes zoster. Informe preliminar / Interferon alpha2b in the pain herpes zoster. A case report

Se estudiaron 40 pacientes con herpes zoster, 22 de ellos con cuadro agudo, 18 con neuralgia postherpética, que se consideraron crónicos. Por medio de la escala visual análoga se evaluó el efecto del interferón alfa2b (INF alfa2b) en el control del dolor debido a cuadros de herpes zoster agudo y en los pacientes con neuralgia secundaria crónica severa en comparación con la evolución del tratamiento. Los pacientes con dolor agudo ingresaron con una escala visual análoga del dolor entre 10 y 2 puntos, con una media de 7.7, DS: 2.1: (p< 0.6), en la prueba de t de Student. La mejoría en los pacientes con dolor agudo fue de 6 a 0 puntos, DS: 2.7 con media de 0.27 (DS: 1.2), y en los crónicos fue de 6 a 0 puntos, con una media de 1.2 (DS: 2.4), con diferencia significativa por t de Student para comparar la escala inicial y final (p< 0.0001.) comparando la mejoría en días. En ambos grupos los agudos respondieron más rápidamente que los crónicos, con diferencias significativa (p< 0.0001). La comparación del dolor en pacientes agudos y crónicos al inicio y al final mostró una diferencia significativa (p< 0.001)