Chronic gastritis associated with Helicobacter pylori in Mexican children: histopathological patterns.

The objective of this study was to analyze the histopathological patterns of inflammation, distribution, severity, and degree of gastric mucosa of Helicobacter pylori (Hp)-infected children in Northern Mexico, as well as the correlation between colonization density and inflammation intensity. We carried out a cross-sectional study of gastric biopsies performed on children ranging from 2 to 17 years of age who underwent upper gastrointestinal endoscopy for diverse gastroduodenal disorders. This study includes only children who were found to be Hp carriers, with positive results for tests of Hp antigens in feces and in gastric biopsy studies. We studied 107 patients (age 8.2 ± 3.7 years). In 47.7% of patients, the density of Hp colonization was low; only 21.5% had a marked density. Mononuclear leukocyte infiltration showed a similar distribution. Thirty-seven percent of patients had follicular gastritis. An acute inflammatory response was absent in 65% and mild in 20.6% of patients. When inflammation was present, it was primarily located in the antrum (79%). There were no cases of intestinal metaplasia or atrophy. A link was found between Hp density and age, infiltration by mononuclear cells, the presence of follicular gastritis, and the level of neutrophil infiltration (P  =  0.001). Despite the high rates of Hp infection in the region, the histopathological findings in these children were mild and were limited primarily to the antral mucosa. These data indicate the need to study the behavior of this disease in children in diverse study populations to provide localized prevention and treatment strategies.

[Comparison between two educative strategies for clinical aptitude in unknown origin fever]. / Aptitud clínica en fiebre de origen oscuro. Comparación de dos estrategias educativas.

OBJECTIVE: to evaluate the benefit of a participative educative strategy (PES) in the development of clinical skills to study patients with fever of unknown origin (CAFUO) by internal medicine residents (IMR). METHODS: twenty-two IMR participated. They were distributed at random in two groups; group I received passive strategy and group II received PES. Assessment tool consisted of 144 items of multiple choice questions using six clinical cases. The assessment was discussed and answered by 10 internal medicine specialists and a pilot test with 15 medical students was performed. The tests were applied pre- and post-exhibition of the strategy. RESULTS: there were no differences between groups, or in pre- and post-strategy, neither in the same group. Pre-strategy did not demonstrate differences between both groups. In group II, the post-strategy showed difference in the global results. The evaluation of each clinical case by group showed in group I there was statistical difference in case 2; in group II (experimental) there was difference in cases 1, 2, 4 and 6. CONCLUSIONS: both strategies were useful, the residents developed comparable aptitude.

Immunochromatographic monoclonal test for detection of Helicobacter pylori antigen in stool is useful in children from high-prevalence developing country.

BACKGROUND: Tests to detect Helicobacter pylori antigens in feces for diagnosis of infection in children demonstrate controversial results. One novel and fast monoclonal test improves diagnostic accuracy in adults, but clinical evidence of its usefulness at pediatric age is insufficient to date. The objective of this work was to evaluate the diagnostic accuracy of this test in a sample of Mexican children. METHODS: We conducted a transversal study in 150 selected children with digestive symptoms suggestive of organic disease in whom a clinical history was conducted in addition to a fast monoclonal test (ImmunoCardSTAT HpSA, Meridian Diagnostics) performed by immunochromatography. Patients were submitted to endoscopy and histopathologic study. RESULTS: Of the 150 children (mean age 7.8 +/- 4.7 years), 107 (71.3%) were positive for the test, and presence of H. pylori was confirmed histologically in 109 (72.7%) children, with sensitivity of 96.3% (95% CI = 95.8-96.8), specificity of 95.1% (95% CI = 93.9-96.4), and accuracy of 96.0% (95% CI, -95.6 to -96.3); pretest probability was 0.73, while post-test probability was 0.98. Infection rate and test accuracy increased with age. CONCLUSIONS: This test is useful for detecting H. pylori infection in children of all ages, and is a good alternative for screening studies in developing countries with elevated prevalence, due to its being fast, noninvasive, inexpensive, and easy to carry out.

[Depression's prevalence and risk factors in hospitalized seniors]. / Prevalencia de depresión y factores de riesgo en el adulto mayor hospitalizado.

OBJECTIVE: To determine the prevalence of depression and associated factors in hospitalized seniors. MATERIALS AND METHODS: A prospective and transversal study was made in female and male seniors at General Hospital number 16 of the Mexican Institute of Social Security in Torreón, Coahuila, México between June and December of 2003. There were applied Yesavage, Katz, Lawton and Folstein scales. RESULTS: There were included 320 patients with a mean age of 72 years. Ten patients with dementia (prevalence of 3.1%) were excluded. Depression was found in 50% and dependence in 62% according to Katz index, and 75% of the patients had dependence in daily life activity according to the Lawton scale. In the bivariate analysis, the following variables were associated with depression: age over 80, female gender, patients that have been hospitalized in the internal medicine department, living alone, to be dependent, and to have a chronic illness. In the multivariate analysis using logistic regression four former variables (female sex, living alone, dependence, and to be hospitalized in Internal Medicine department) had a significant association. CONCLUSIONS: The prevalence of depression among hospitalized older patients is high. The strongest factors associated were dependence of other people and to have chronic disease.

[Burnout syndrome in medical staff affiliated to a tertiary care hospital]. / Síndrome de agotamiento profesional en personal médico de un hospital de tercer nivel.

INTRODUCTION: the burnout syndrome (BS) is common among physicians, affecting their behavior, personality and professional goals; thus deteriorating the quality of their performance. OBJECTIVE: to determine the BS prevalence among physicians affiliated to a tertiary care hospital and its associated risk factors. MATERIAL AND METHODS: The study was conducted through a cross-sectional design. The sampling was nonprobabilistic. Participating physicians were interviewed using the Maslach Burnout Inventory and the Beck's depression inventory. The analysis included ascertainment of the BS prevalence and use of chi(2) and logistic regression analysis. The local Internal Review Board and the Ethics Committee approved the project and all participants gave their informed consent. RESULTS: 166 physicians participated; the average age was 42 years, most were men. The response rate was 87.4 %. The prevalence of depression with more than 10 points in the Beck inventory was 18.6 % (95 % CI: 12-24). Depression in the last two years was 38.6%; the prevalence of BS was 26%; 15. 2 % scored above 27 in emotional exhaustion and 19.3 % scored more than 10 points in depersonalization. The risk of being depressed due to BS was five times higher (OR 5.163; 95 % CI 2.130-12.5). Working in the night shift, living without a permanent couple and being depressed were the main risk factors for BS. CONCLUSIONS: BS is common among physicians and is associated with organizational and personal variables.

[Globalization in medical education. Opinions of Mexican medical teachers]. / La globalización en la educación médica. Opinión de médicos docentes mexicanos.

OBJECTIVE: To explore the opinions on globalization and medical education of a group of Mexican physicians who are also teachers. MATERIAL AND METHODS: This was a descriptive, transversal and prospective study. A self-administrated questionnaire was made, validated and applied. The frequency of answers and its association with certain variables were analysed. RESULTS: Most of the participants agreed to define education in quality terms, but not to favor technological aspects over humanistic ones; 40% of the sample disregarded or didn't agree that technical orientation has to do with the globalization process; a third of it didn't know the programs and standards proposed by institutions of higher education. CONCLUSIONS: There is a diversity of opinions on the influence of globalization on medical education. The highest academic level, time of teaching and research activities are associated with the greatest controversy.

Eustachian tube dysfunction in allergic rhinitis.

OBJECTIVE: To assess eustachian tube function in patients with allergic rhinitis and compare them with a control group. STUDY DESIGN AND SETTING: Tympanometry was performed in 130 patients (260 ears), divided into 2 groups: 80 cases with allergic rhinitis and 50 healthy controls. Cases underwent skin hypersensitivity tests. RESULTS: Cases, age 21.1 +/- 14.9; Controls, age 23.9 +/- 15.6. Most frequent skin hypersensitivity: Dermatophagoides pt (62%), Zea Maiz (44%), and Cockroach (37%). Tympanometry of cases showed negative values of peak tympanometric pressure in both children and adults (P < or = 0.05). Among children under 11 years of age, 15.5% tympanograms showed abnormal curves (13% C curves and 3% B curves); among the control group only normal curves were found (type A). CONCLUSION: Allergic rhinitis patients have a higher risk of eustachian tube dysfunction, particularly during childhood. Tympanometry is a noninvasive, readily available procedure that may be useful in these patients to prevent chronic middle-ear disease.

Serum lead, cadmium, and zinc levels in newborns with neural tube defects from a polluted zone in Mexico.

Serum lead, cadmium and zinc levels from 31 newborns with neural tube defects (NTD), and 54 healthy controls living in a polluted area in Mexico were estimated using atomic absorption spectrophotometry (AAS). NTD family history was found to be of greater importance in the case group (OR 6.95, 95% CI 1.51-36.3, p=0.002). In 25% of the children, serum lead concentrations were above the admissible maximum level (AML) of 10 microg/dL within 24 h of extra-uterine life. Cadmium concentrations were below the AML. Zinc deficiency was found in nine (29%) of the cases and four (9.3%) of the controls (p=0.04). The logistic regression multivariate analysis showed no correlation between NTD and high levels of any of these metals; however, a positive correlation was found to zinc deficiency (OR 5.0, 95% CI 1.07-23.00, p=0.04). These results focus attention to the surrounding nutritional and maternal health factors of major importance in disease etiology.

[Fungal spores in the environment of the asthmatic patient in a semi-desert area of Mexico]. / Fungosporas en el hábitat del paciente asmático en una zona semidesértica en México.

OBJECTIVE: To analyze the frequency and type of fungal spores in the habitat of sensitized asthmatic patients, its relationship with skin test reactivity to fungi and indoor factors favoring the fungi development. MATERIAL AND METHODS: Indoor airborne fungi were collected from the houses of 85 patients using fungal culture methods and adherent cover glasses. Data were analyzed as a cross sectional study. RESULTS: The prevalence of positive fungi skin test reactivity was 22%, the main reactivity was for Aspergillus (54%), Alternaria (51%) and Monilia (48%), and most frequent cultured fungi were: Cladosporium (76%), Alternaria (57.5%) and Aspergillus (51.3%). Another molds (Dreshlera, Rhodotorula) not included in the skin test reactivity panel nor immunotherapy plans were cultured. The fungus spores mean concentration was 1788/m3 +/- 1637 (930 to 10,230/m3) without qualitative or quantitative differences when several house areas were compared. The association of skin reactivity and indoor exposure were significant only for Aspergillus (RR 3.14, 95% CI 1.77-5.58). The use of ventilation-air-conditioning systems (42%), personal humidifier or nebulizers (43%), dampness inside the houses were important characteristics. CONCLUSIONS: Indoor fungus pollution is also important in semi-desert areas, due to high prevalence of many factors that contribute for its development and proliferation.

Asma y medio ambiente en la Comarca Lagunera / Asthma and enviromental pollution in the Lagunera Region

Antecedentes: el desconocimiento actual acerca de la magnitud y las características de los problemas ambientales, así como sus posibles efectos en la salud, dificulta la identificación de la población en riesgo y la planeación de las medidas necesarias para su protección. En la Comarca Lagunera el asma es un problema prioritario de salud. Objetivo: analizar las características del medio ambiente que puedan influir en la aparición del asma. Material y métodos: se recolectó información de diferentes dependencias y registros regionales de la que se identificó que la coexistencia de algunos factores, como: las características climáticas de la región, con temperaturas extremas y la frecuencia de tolvaneras, la creciente deforestación, el tipo de flora predominante y la contaminación aguda y crónica por material particulado, preferentemente en las zonas urbanas, pueden explicar el comportamiento epidemiológico de la enfermedad en esta zona conurbada, por lo que la participación interdisciplinaria es necesaria para la solución del problema. Resultados: en la Comarca Lagunera coexisten algunos factores precipitantes de síntomas en los sujetos asmáticos: características climatológicas que favorecen los procesos inflamatorios y el aumento de la susceptibilidad a las infecciones del tracto respiratorio que pueden desencadenar crisis asmáticas. Conclusión: el comportamiento epidemiológico del asma en la región puede estar asociado con las características climatológicas.

El grado de hipersensibilidad cutánea como posible indicador de severidad del asma en el sujeto atópico / The degree of cutanea hypersensitivity like possible indicator of severity of the asthma in the atopico subject

Antecedentes: en la determinación de la severidad del asma se han implicado muchos factores, entre los que se incluyen los hereditarios, el estado atópico y los ambientales. Objetivo: evaluar si el grado de hipersensibilidad cutánea es un indicador útil de la severidad del asma en sujetos atópicos. Material y método: en un diseño prospectivo se incluyeron 140 pacientes con asma alérgica. Se midió el grado de hipersensibilidad cutánea por intradermorreacción a 54 alergenos comunes, y se clasificaron en cuatro grupos según el porcentaje de pruebas positivas. Se realizó seguimiento durante un año, se registró la frecuencia de síntomas y exacerbaciones, tolerancia al ejercicio, asma nocturna, frecuencia y tipo de medicamentos requeridos. La función pulmonar se evaluó por espirometría y pletismografía cada seis meses. La severidad del asma se clasificó con base en los criterios GINA (Global Initiative for Asthma) y requerimiento de fármacos. Se analizó con estadística descriptiva y correlación de Spearman. Se estratificó por grupos de edad. Resultados: la edad media fue 25.57 ñ 12.12 años, 59 por ciento femeninos. Tuvieron asma intermitente 42 por ciento, leve persistente 31 por ciento, moderada persistente 18 por ciento y severa persistente 9 por ciento. El grado de hipersensibilidad cutánea fue <25 por ciento en 26 pacientes, 25-50 por ciento 60 pacientes, 51-75 por ciento en 36 y >75 por ciento en 15. No se encontró correlación para el grupo en general y en el análisis estratificado sólo fue significativa para el grupo de 5-15 años (p<0.05) pero con bajo valor predictivo. Conclusiones: el grado de hipersensibilidad cutánea no fue un indicador útil de la severidad del asma en este estudio.

Asthmatic exacerbations and environmental pollen concentration in La Comarca Lagunera (México)

Para determinar la correlación entre la concentración ambiental de polen y la frecuencia de exacervaciones asmáticas en La Comarca Lagunera se estudió una cohorter de 104 pacientes con diagnóstico de asma alérgica, efectuándose seguimiento mensual (julio 1993 a julio 1995) en el que se registró la presencia de exacervaciones asmáticas. Se realizó muestreo ambiental semanalmente durante el mismo periodo con un muestreador de alto volumen PST (Andersen Samplers INC). Las muestras se procesaron con técnica de acetólisis y el conteo de granos de polen por m a la tercera potencia de aire con paquete estadístico SAS. El seguimiento fue de 1469 personas mes (media de 15.5 meses y la correlación entre las tasas de exacervaciones asmáticas y la concentración ambiental de polen fue significativa (r = 09.63, r² = 0.39, p< 0.01). Al restringirse las exacervaciones de asma asociadas a procesos infecciosos de las vías respiratorias, la correlación se incrementó (r = 0.70, r² = 0.49 y p< 0.01). Concluimos que la concentración ambiental de polen influye en la precipitación de crisis asmáticas en pacientes con asma alérgica

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 treatment 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 patietns each. Results. No significant statistical difference was observed among the groups using and 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