Pediatric chronic urticaria: Clinical and laboratory characteristics and factors linked to remission.

BACKGROUND: Chronic urticaria (CU) is defined as the occurrence of wheals/angioedema for ≥6 consecutive weeks. Until now, guidelines and publications addressing CU have focused mainly on adults. As a result, evidence and guidance in the pediatric population are scarce. METHODS: This study aims to describe clinical and laboratory findings in pediatric CU and to determine factors associated with remission. RESULTS: 185 patients, 54% female, median age at onset of 8.8 years. Angioedema was present in almost half. The most common type of CU was chronic spontaneous urticaria (CSU) in 74%. At least one atopic comorbidity was found in almost a third (35%). In addition, 8% had an autoimmune disorder (exclusively in CSU) and 9% had a psychiatric condition. Basopenia was found in 67% and was more frequently associated with CSU. The basophil activation test (BAT) was positive in 40%. With regard to remission, being of male sex, angioedema absence, the absence of physical triggers, and eosinophil counts >0.51 × 109 /L were associated with shorter CU duration. CONCLUSION: Atopy is a common condition in pediatric CU. CSU is the most common type. Autoimmune comorbidities and basopenia were significantly more common in CSU. In addition, ours is one of the few studies, assessing BAT utility in the pediatric population, being positive in a relevant percentage (40%). BAT positivity was more frequent in CSU. Our results suggest that the absence of angioedema and physical triggers, male sex, and eosinophil counts >0.51 × 109 /L appear to be associated with a better prognosis in terms of remission.

Identification of Potentially Tolerated Fish Species by Multiplex IgE Testing of a Multinational Fish-Allergic Patient Cohort.

BACKGROUND: Although recent studies indicated that many fish-allergic patients may safely consume certain fish species, no clinical guidelines are available for identification of the exact species tolerated by specific patients. OBJECTIVE: To investigate whether multiplex immunoglobulin E (IgE) testing reveals potentially tolerated fish through absence of IgE to parvalbumin (PV) and extracts from specific species. METHODS: Sera from 263 clinically well-defined fish-allergic patients from Austria, China, Denmark, Luxembourg, Norway, and Spain were used in a research version of the ALEX2 multiplex IgE quantification assay. Specific IgE to PVs from 10 fish species (9 bony and 1 cartilaginous), and to extracts from 7 species was quantified. The IgE signatures of individual patients and patient groups were analyzed using SPSS and R. RESULTS: Up to 38% of the patients were negative to cod PV, the most commonly used molecule in fish allergy diagnosis. Forty-five patients (17%) tested negative to PVs but positive to the respective fish extracts, underlining the requirement for extracts for accurate diagnosis. Between 60% (Spain) and 90% (Luxembourg) of the patients were negative to PV and extracts from ray, a cartilaginous fish, indicating its potential tolerance. Up to 21% of the patients were negative to at least 1 bony fish species. Of the species analyzed, negativity to mackerel emerged as the best predictive marker of negativity to additional bony fish, such as herring and swordfish. CONCLUSIONS: Parvalbumins and extracts from multiple fish species relevant for consumption should be used in fish-allergy diagnosis, which may help identify potentially tolerated species for individual patients.

Uterus transplantation in a sheep model: novel surgical technique with long-term survival and uterus vitality. First case series in Argentina.

OBJECTIVE: To develop a sheep autologous uterus transplantation (UT) program with an innovative surgical technique and assess long term uterus vitality and animal survival. METHODS: A novel surgical technique consisting of the procurement of the complete uterus and the two ovaries, back table vascular reconstruction, and subsequent implantation in the same animal, performing only two arterial and two venous anastomoses. RESULTS: Four autologous transplantations were performed; anesthesia and surgery were well tolerated by all the animals without complications. Direct observation and Doppler US performed a week after UT and laparoscopy performed three months later confirmed uterus vitality. All animals were alive more than a year after transplantation. CONCLUSIONS: Our study was the first to describe a novel surgical technique for sheep uterus autologous transplantation in Latin America, showing long-term survival and uterus vitality.

Relationship Between Atopic Dermatitis and Food Allergy.

Consistent evidence has been found on the relationship between food allergy (FA) and atopic dermatitis (AD) in some children. Food sensitization can be often found in these patients. Allergy should be confirmed, though, with a food challenge test (FC) before advising a restrictive diet which could be harmful for the patient. Younger children with AD frequently show sensitization to egg, milk or peanut, while older ones and adults are more often sensitized to environmental allergens such as house dust mites, moulds, animal dander or pollens. It is well known that a barrier disturbance plays a main role in the development of sensitization and allergy. Therefore, due to the early appearance of AD, preventive newborn skincare with emollients and early introduction of food appear to be very important to determine food tolerance.

What format of treatment do patients with emotional disorders prefer and why? Implications for public mental health settings and policies.

OBJECTIVE: We analyzed the preference of three psychological intervention formats-individual, group, and online-in a sample of 267 patients with a primary diagnosis of emotional disorder in Spanish public mental health settings. METHOD: We studied patients' preferences considering sociodemographic characteristics, diagnoses, history of psychological treatments, number of sessions, and satisfaction with past interventions. RESULTS: Most participants (85.4%) preferred psychological treatment in an individual format, 14.2% in group, and 0.4% online. When comparing the people who chose individual and group treatment, no demographic or clinical differences were found. The arguments against group format were the lack of privacy and expression difficulties. Regarding online format, these included being considered impersonal and ineffective. CONCLUSION: The rejection of group and online psychotherapy formats allows us to define the actions we should carry out in public mental health settings to improve the acceptance of more cost-effective therapy formats.

Caracterización de adultos mayores hipertensos en un área de salud / Characterization of hypertensive senior adults in a health area

Introducción: la hipertensión arterial es la enfermedad crónica no transmisible que más afecta la salud de los adultos mayores, es también un factor de riesgo para las patologías cardiovasculares, cerebrovasculares y renales. Objetivo: caracterizar a los adultos mayores con hipertensión arterial. Métodos: estudio observacional, descriptivo y transversal, con el objetivo de describir las características clínicas-epidemiológicas de la hipertensión arterial en adultos mayores, pertenecientes al Consultorio Médico 2 del Policlínico Universitario Pedro Borrás Astorga de Pinar del Río, entre noviembre y diciembre del 2016. El universo estuvo conformado por 86 adultos mayores hipertensos, y la muestra quedó conformada por 80 pacientes que decidieron participar en la investigación. Resultados: el sexo predominante fue el femenino con 58,8 por ciento y el grupo de 65 y más años con el 68,7 por ciento; prevaleció el tabaquismo como factor de riesgo en un 88,8 por ciento, así como la enfermedad crónica cardiopatía isquémica con 41,3 por ciento; mientras que el tratamiento con dos fármacos predominó en el 60 por ciento de los pacientes. Conclusiones: se caracterizaron los adultos mayores con hipertensión arterial en un consultorio médico teniendo en cuenta aspectos clínicos y epidemiológicos. La hipertensión arterial es un problema clínico-epidemiológico para los adultos mayores de dicha área de salud(AU)

Introduction: High blood pressure is the chronic noncommunicable disease that most affects the health of senior adults, being also a risk factor for cardiovascular, cerebrovascular and renal pathologies. Objective: To characterize the elderly with high blood pressure. Methods: An observational, descriptive and cross-sectional study with the objective of describing the clinical-epidemiological characteristics of high blood pressure in senior adults who belong to the Medical Office 2 of Pedro Borrás Astorga University Polyclinic of Pinar del Río, from November to December 2016. The sample consisted of 86 hypertensive senior adults, and the sample consisted of 80 patients who decided to participate in the research. Results: The predominant gender and age group was the female sex (58.8 percent) and 65 years or more (68.7 percent), respectively. Smoking prevalence as a risk factor represented 88.8 percent, as well as the chronic ischemic heart disease with 41.3 percent, while treatment with two drugs predominated in 60 percent of patients. Conclusions: Senior adults with high blood pressure were characterized in a doctor's office taking into account clinical and epidemiological aspects. High blood pressure is a clinical-epidemiological problem for senior adults in this health area(AU)

Caracterización de adultos mayores hipertensos en un área de salud / Characterization of hypertensive senior adults in a health area

Introducción: la hipertensión arterial es la enfermedad crónica no transmisible que más afecta la salud de los adultos mayores, es también un factor de riesgo para las patologías cardiovasculares, cerebrovasculares y renales. Objetivo: caracterizar a los adultos mayores con hipertensión arterial. Métodos: estudio observacional, descriptivo y transversal, con el objetivo de describir las características clínicas-epidemiológicas de la hipertensión arterial en adultos mayores, pertenecientes al Consultorio Médico 2 del Policlínico Universitario Pedro Borrás Astorga de Pinar del Río, entre noviembre y diciembre del 2016. El universo estuvo conformado por 86 adultos mayores hipertensos, y la muestra quedó conformada por 80 pacientes que decidieron participar en la investigación. Resultados: el sexo predominante fue el femenino con 58,8 por ciento y el grupo de 65 y más años con el 68,7 por ciento; prevaleció el tabaquismo como factor de riesgo en un 88,8 por ciento, así como la enfermedad crónica cardiopatía isquémica con 41,3 por ciento; mientras que el tratamiento con dos fármacos predominó en el 60 por ciento de los pacientes. Conclusiones: se caracterizaron los adultos mayores con hipertensión arterial en un consultorio médico teniendo en cuenta aspectos clínicos y epidemiológicos. La hipertensión arterial es un problema clínico-epidemiológico para los adultos mayores de dicha área de salud(AU)

Introduction: High blood pressure is the chronic noncommunicable disease that most affects the health of senior adults, being also a risk factor for cardiovascular, cerebrovascular and renal pathologies. Objective: To characterize the elderly with high blood pressure. Methods: An observational, descriptive and cross-sectional study with the objective of describing the clinical-epidemiological characteristics of high blood pressure in senior adults who belong to the Medical Office 2 of Pedro Borrás Astorga University Polyclinic of Pinar del Río, from November to December 2016. The sample consisted of 86 hypertensive senior adults, and the sample consisted of 80 patients who decided to participate in the research. Results: The predominant gender and age group was the female sex (58.8 percent) and 65 years or more (68.7 percent), respectively. Smoking prevalence as a risk factor represented 88.8 percent, as well as the chronic ischemic heart disease with 41.3 percent, while treatment with two drugs predominated in 60 percent of patients. Conclusions: Senior adults with high blood pressure were characterized in a doctor's office taking into account clinical and epidemiological aspects. High blood pressure is a clinical-epidemiological problem for senior adults in this health area(AU)

Non-Hodgkin lymphoma in pediatric patients with common variable immunodeficiency.

UNLABELLED: Common variable immunodeficiency (CVID) is a heterogeneous primary immunodeficiency associated with an increased risk of malignancy in adulthood, with lymphoma as one of the major causes of death. The aim of this study is to describe those malignancies detected in our cohort of pediatric CVID patients. We reviewed the clinical and laboratory data and the treatments and their outcomes in all pediatric CVID patients from our institution that developed a neoplasia. Four malignancies were diagnosed in three out of 27 pediatric CVID patients. Three malignancies were non-Hodgkin lymphoma (NHL) of B cell origin (mean age at diagnosis: 8 years old), and the remaining was a low-grade astrocytoma. Among NHL, two were mucosa-associated lymphoid tissue (MALT) lymphomas and one was associated with Epstein-Barr virus infection. NHL developed before CVID diagnosis in two patients. CVID patients showed different clinical phenotypes and belonged to different groups according Euroclass and Pediatric classification criteria. CONCLUSIONS: Malignancies, especially lymphoma, may develop in pediatric CVID patients with no previous signs of lymphoid hyperplasia and even before CVID diagnosis. Consequently, strategies for cancer prevention and/or early diagnosis are required in pediatric CVID patients.

Validación del Analyz-Strep A Rapid Test en el diagnóstico de la faringitis aguda / Validation Analyz-Strep A Rapid Test in the diagnosis of acute pharyngitis

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Specific oral desensitization in children with IgE-mediated cow's milk allergy. Evolution in one year.

UNLABELLED: Cow's milk allergy is the most frequent childhood food allergy. Children older than 5 who have not become tolerant have less probabilities of natural tolerance. Specific oral desensitization methods are being investigated in reference centres. The aims of our study were to assess the efficacy of our guideline of specific oral desensitization to cow's milk in children and to know its suitability for anaphylactic children. Both clinical and specific IgE outcomes were evaluated. Eighty-seven children aged 5 to 16 years with a history of cow's milk allergy were included. Prior to desensitization, skin prick test, specific IgE to cow's milk proteins and a double-blind placebo control food challenge were performed in all. Of the 87 patients, 21 had a negative challenge; they were considered tolerant, and they were told to follow a free diet. Of the positive, 44 were anaphylactic and 22 non-anaphylactic. All of them were included. In non-anaphylactic patients, 6 achieved partial and 16 maximum desensitization after 23.1 weeks. In the anaphylactic group, 7 achieved partial and 35 maximum desensitization after 26.4 weeks. Cow's milk-specific IgE levels and casein-specific IgE levels were significantly lower in the tolerant patients at baseline. One year after desensitization, the medium specific cow's milk levels and casein IgE levels had dropped significantly. CONCLUSIONS: Our guideline for specific oral desensitization to cow's milk is efficacious even in patients with anaphylactic reactions to cow's milk and represents a significant life change. Immunological changes in 1 year show a drop in cow's milk protein-specific IgE.

Decision trees as a simple-to-use and reliable tool to identify individuals with impaired glucose metabolism or type 2 diabetes mellitus.

OBJECTIVE: The prevalence of unknown impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or type 2 diabetes mellitus (T2DM) is high. Numerous studies demonstrated that IFG, IGT, or T2DM are associated with increased cardiovascular risk, therefore an improved identification strategy would be desirable. The objective of this study was to create a simple and reliable tool to identify individuals with impaired glucose metabolism (IGM). DESIGN AND METHODS: A cohort of 1737 individuals (1055 controls, 682 with previously unknown IGM) was screened by 75 g oral glucose tolerance test (OGTT). Supervised machine learning was used to automatically generate decision trees to identify individuals with IGM. To evaluate the accuracy of identification, a tenfold cross-validation was performed. Resulting trees were subsequently re-evaluated in a second, independent cohort of 1998 individuals (1253 controls, 745 unknown IGM). RESULTS: A clinical decision tree included age and systolic blood pressure (sensitivity 89.3%, specificity 37.4%, and positive predictive value (PPV) 48.0%), while a tree based on clinical and laboratory data included fasting glucose and systolic blood pressure (sensitivity 89.7%, specificity 54.6%, and PPV 56.2%). The inclusion of additional parameters did not improve test quality. The external validation approach confirmed the presented decision trees. CONCLUSION: We proposed a simple tool to identify individuals with existing IGM. From a practical perspective, fasting blood glucose and blood pressure measurements should be regularly measured in all individuals presenting in outpatient clinics. An OGTT appears to be useful only if the subjects are older than 48 years or show abnormalities in fasting glucose or blood pressure.

[Validation of a rapid antigenic test in the diagnosis of pharyngitis caused by group a beta-haemolytic Streptococcus]. / Validación de una técnica antigénica rápida en el diagnóstico de la faringitis por estreptococo betahemolítico del grupo A.

OBJECTIVE: To determine the validity of the rapid antigen test (RAT) OSOM StrepA Genzyme for the diagnosis of acute pharyngitis caused by group A beta-haemolytic strep (GABHS). DESIGN: Diagnostic techniques survey. SETTING: Urban primary care centre, Spain. PARTICIPANTS: All patients over 14 years old seen in 6 surgeries with sore throat and 2 or more Centor criteria: pharyngotonsillar exudate, tender laterocervical nodes, absence of coughing, and/or history or presence of fever. PRINCIPAL MEASUREMENTS: Pharyngeal swabs were taken from all the patients, one for RAT and another to send for culture in the microbiology department. RESULTS: A total of 182 patients were evaluable, with a mean age of 30.6 (12.1) years of which 116 were women (63.7%); 63 patients had 2 Centor criteria; 83 had 3 and 36, the 4 criteria. The culture was positive in 102 patients (56%), with GABHS showing infection in forty (22%; 95% confidence interval [CI], 21.2-22.8). Group C Streptococcus was isolated in 26 patients (14.3%). GABHS was higher among patients with four Centor criteria (38.9% vs 25.3% observed among those with 3 criteria and 7.9% with 2 criteria; P<.001). Sensitivity of RAT was 95%, with a specificity of 93%, a positive predictive value of 79.2% and a negative predictive value of 98.5%. CONCLUSIONS: These results show the usefulness of RAT for diagnosing streptococcal pharyngitis. Its use should be spread to all primary care practices.

Validación de una técnica antigénica rápida en el diagnóstico de la faringitis por estreptococo betahemolítico del grupo A / Validation of a rapid antigen test in the diagnosis of pharyngitis caused by group A beta-haemolytic streptococcus

Objetivo. Determinamos la validez de latécnica antigénica rápida (TAR) OSOMStrepA Genzyme en el diagnóstico de lafaringitis aguda causada por estreptococobetahemolítico del grupo A (EBHGA).Diseño. Estudio de pruebas diagnósticas.Emplazamiento. Equipo urbano de atenciónprimaria.Participantes. Todos los pacientes mayoresde 14 años atendidos en 6 consultas consíntomas de odinofagia y 2 o más de loscriterios de Centor (exudado faringoamigdalar,adenopatías laterocervicales dolorosas,ausencia de tos y/o historia o presenciade fiebre).Mediciones principales. A todos los pacientesse les tomó una muestra faringoamigdalarcon 2 hisopos, uno para TAR y otro que fueremitido al servicio de microbiología pararealizar cultivo.Resultados. Fueron evaluables 182 sujetos,con una edad media de 30,6 ± 12,1 años,116 mujeres (63,7%). Presentaron 2, 3y 4 criterios de Centor 63, 83 y 36 sujetos,respectivamente. El cultivo fue positivo en102 casos (56%), observándose infección porEBHGA en 40 pacientes (22%; intervalode confianza [IC] del 95%, 21,2-22,8); en26 casos se aisló estreptococo del grupo C(14,3%). La infección por EBHGA presentóuna mayor prevalencia entre los pacientescon 4 criterios (un 38,9% frente a un 25,3%observado con 3 criterios y frente al 7,9%con 2 criterios; p < 0,001). La TAR tuvo unasensibilidad del 95%, una especificidad del93%, un valor predictivo positivo del 79,2%y un valor predictivo negativo del 98,5%.Conclusiones. Estos resultados demuestranla utilidad de la TAR para el diagnósticode la faringitis estreptocócica. Su uso deberíaextenderse a todas las consultas de atenciónprimaria

Objective. To determine the validity of therapid antigen test (RAT) OSOM StrepAGenzyme for the diagnosis of acutepharyngitis caused by group Abeta-haemolytic strep (GABHS).Design. Diagnostic techniques survey.Setting. Urban primary care centre, Spain.Participants. All patients over 14 years oldseen in 6 surgeries with sore throat and 2or more Centor criteria: pharyngotonsillarexudate, tender laterocervical nodes, absenceof coughing, and/or history or presence offever.Principal measurements. Pharyngeal swabswere taken from all the patients, one forRAT and another to send for culture inthe microbiology department.Results. A total of 182 patients wereevaluable, with a mean age of 30.6 (12.1)years of which 116 were women (63.7%); 63patients had 2 Centor criteria; 83 had 3 and36, the 4 criteria. The culture was positive in102 patients (56%), with GABHS showinginfection in forty (22%; 95% confidenceinterval [CI], 21.2-22.8). Group CStreptococcus was isolated in 26 patients(14.3%). GABHS was higher amongpatients with four Centor criteria (38.9% vs25.3% observed among those with 3 criteriaand 7.9% with 2 criteria; P<.001). Sensitivityof RAT was 95%, with a specificity of 93%,a positive predictive value of 79.2%and a negative predictive value of 98.5%.Conclusions. These results show theusefulness of RAT for diagnosingstreptococcal pharyngitis. Its use shouldbe spread to all primary care practices

Al·lèrgia i intolerància a proteïnes de llet de vaca / No disponible

No disponible