[Allergic rhinitis in asthmatic patients]. / Rinitis alérgica en pacientes asmáticos.

BACKGROUND: Allergic rhinitis and bronchial asthma are airways chronic inflammatory processes, with a correlation of 28-78%. OBJECTIVES: To determine the prevalence and classification of allergic rhinitis on asthmatic patients, according to the workshop Allergic Rhinitis and its Impact on Asthma (ARIA), and to assess the total serum concentrations of IgE and the presence of nasal and blood eosinophilia. MATERIAL AND METHOD: A study was done with asthmatic patients ages 7 to 14, attending the Pediatric Service at the Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela. Subjects were polled for signs and symptoms suggesting allergic rhinitis and its impact on quality of life. Blood and nasal swab samples were taken to perform laboratory tests in study. RESULTS: There were 60 asthmatic patients, 73.3% males and 70% scholar age patients. The prevalence of allergic rhinitis was 93.3%, according to ARIA classification. Mild intermittent group was the most frequent type, with 42.8% the most frequent clinic sign was the allergic shiners (86.6%), and the predominant symptom was the nasal aqueous trickle (83.3%), while sleep disorders were the most common affection of quality of life (39.2%). In 85.7% of patients eosinophil percentage was higher than 3%, whereas in 75% total serum IgE values were higher than 100 Ul/mL. In patients with rhinitis, 61.9% of the nasal mucus showed altered eosinophils percentage higher than 10%. CONCLUSION: A high prevalence of allergic rhinitis is present in asthmatic patients, confirmed by laboratory tests, which proves an inflammatory response mediated by IgE.

Antecedentes: la rinitis alérgica y el asma bronquial son procesos inflamatorios crónicos de las vías respiratorias, con una correlación que varía entre 28 y 78%. Objetivos: determinar la prevalencia de rinitis alérgica en pacientes asmáticos y clasificarla según las guías Rinitis Alérgica y su Impacto en Asma (ARIA), así como detectar las concentraciones séricas de IgE total y la existencia de eosinofilia nasal y en sangre periférica. Material y método: estudio en el que pacientes asmáticos entre 7 y 14 años de edad, consultantes del servicio de Pediatría del Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela, fueron encuestados acerca de signos y síntomas sugerentes de rinitis alérgica y su efecto en la calidad de vida. Se tomaron muestras sanguíneas e hisopado nasal para hacer las determinaciones objeto de estudio. Resultados: se evaluaron 60 pacientes asmáticos, 73.3% del sexo masculino y 70% escolares. La prevalencia de rinitis alérgica se estableció en 93.3%, el tipo más frecuente según ARIA fue el intermitente leve, con 42.8%. El signo clínico más frecuente fueron las ojeras alérgicas (86.6%) y el síntoma predominante fue el goteo nasal acuoso (83.3%), la afectación en cuanto a calidad de vida estuvo representada por trastornos del sueño (39.2%). El 85.7% de los encuestados tuvo porcentajes de eosinófilos mayores a 3% y 75% tuvo valores mayores de 100 UI de IgE total sérica. El 61.9% de las muestras de moco nasal de pacientes con rinitis mostró porcentajes de eosinófilos mayores a 10%. Conclusión: existe alta prevalencia de rinitis alérgica en asmáticos confirmada mediante pruebas de laboratorio que evidencian una respuesta inflamatoria mediada por IgE.

Increased expression of cytokines, soluble cytokine receptors, soluble apoptosis ligand and apoptosis in dengue.

Several studies have been performed to determine biomarkers that define the risk factors to developing severe forms of dengue. In this study, the levels of TNF-α, IL-6, IL-1, IL-17, soluble interleukin-1 receptor like 1 protein (sST2), soluble TNF-related apoptosis-inducing ligand (sTRAIL), IL-12 and soluble receptors for TNF (sTNF-RI and sTNF-RII) were determined by ELISA in dengue patients and monocyte/macrophage cultures. Dengue was classified as dengue without warning symptoms (DNWS), with warning symptoms (DWWS) and severe dengue (SD). High values of IL-6, sTNFRI, sTNFRII and sST2 were observed in DWWS and/or SD and IL-12 and sTRAIL in DNWS. TNF-α and IL-17 were increased not associated to the disease severity. High production of TNF-α, IL-1ß, IL-12, IL-17, sST2 and sTRAIL and apoptosis expression were observed in dengue monocyte/macrophage cultures. This study shows that beneficial or deleterious biomarkers can be present in dengue regardless the disease severity and that monocytes may be in part the source of studied molecules.

[Science, reason for the existence of the University]. / Ciencia, razón de ser de la Universidad.

More than a century after the foundation of the illustrious University of Zulia, research is still the subject of unfair treatment; the importance of science in university life is discussed over and over again, with authorities feeling proud of the quantity and quality of researchers, but such pride is divorced from the support received by research centers, departments and institutes. However, science transcends all obstacles; research must be the ultimate goal of our University, so that it continues to be the University.

[Viral etiology of acute respiratory infections]. / Etiología viral de las infecciones respiratorias agudas.

Acute respiratory infections (ARI) are pathologies that affect the respiratory tract from the proximal pharynx to the lungs, with an evolution of less than 15 days. They constitute the most frequent cause of morbimortality in the world. With the purpose of identifying the viral agents associated to this type of infections in patients of Zulia State, Venezuela, between February 2005 and July 2006, a total of 102 samples of the respiratory tract (oropharyngeal swab, nasopharyngeal swab, nasopharyngeal washing, spit and bronchoalveolar lavage) were studied. Viral isolation was made through a cellular culture and the identification of the pathogenic agents by the technique of direct immunofluorescence. Forty six positive samples were obtained (45%). The greater incidence was found in the groups of 41 to 64 years old patients, followed by lactanting babies (1 to 23 months). There were no significant differences between sexes. Within the isolated viral pathogens, Respiratory Syncytial Virus (RSV) was the agent most frequently found (32.6% p < 0.05), followed by Adenovirus (28.2%), Parainfluenza (23.9%) and Influenza (15.2%). The respiratory infections of the low respiratory tract were the most frequent (67.4%). A high incidence of associated viral agents to ARI in Zulia State is demonstrated. A high incidence in adult patients and the greatest positivity was found for RSV.

Etiología viral de las infecciones respiratorias agudas / Viral etiology of acute respiratory infections

Las infecciones respiratorias agudas (IRA) son patologías que afectan el tracto respiratorio desde la faringe proximal hasta los pulmones, con una evolución de menos de 15 días y constituyen la causa más frecuente de morbimortalidad en el mundo. Con la finalidad de identificar los agentes virales asociados a este tipo de infecciones en pacientes del estado Zulia, Venezuela, entre febrero 2005 y julio de 2006, se estudiaron un total de 102 muestras provenientes del tracto respiratorio (hisopado nasal, faríngeo y/o nasofaríngeo, esputo y lavado broncoalveolar) de pacientes con clínica de IRA. El aislamiento viral se realizó a través del cultivo celular y la identificación del agente patógeno por la técnica de inmunofluorescencia directa. Se obtuvieron 46 muestras positivas (45%), la incidencia estuvo homogéneamente distribuida en todos los grupos de estudio aun cuando se observó predominio en el grupo de 41 a 64 años, seguido de los lactantes. No hubo diferencias significativas en cuanto al sexo. Dentro de los patógenos virales aislados el Virus Sincicial Respiratorio (VSR) fue el agente con mayor frecuencia (32,6%) (p<0,05), seguido de Adenovirus (28,2%), Parainfluenza (23,9%) e Influenza (15,2%). Las infecciones respiratorias del tracto inferior fueron las más frecuentes (67,4%). Se demuestra una alta incidencia de agentes virales asociados a IRA en el estado Zulia. Se destaca la alta frecuencia en pacientes adultos y la mayor positividad para VSR.

Acute respiratory infections (ARI) are pathologies that affect the respiratory tract from the proximal pharynx to the lungs, with an evolution of less than 15 days. They constitute the most frequent cause of morbimortality in the world. With the purpose of identifying the viral agents associated to this type of infections in patients of Zulia State, Venezuela, between February 2005 and July 2006, a total of 102 samples of the respiratory tract (oropharyngeal swab, nasopharyngeal swab, nasopharyngeal washing, spit and bronchoalveolar lavage) were studied. Viral isolation was made through a cellular culture and the identification of the pathogenic agents by the technique of direct immunofluorescence. Forty six positive samples were obtained (45%). The greater incidence was found in the groups of 41 to 64 years old patients, followed by lactanting babies (1 to 23 months). There were no significant differences between sexes. Within the isolated viral pathogens, Respiratory Syncytial Virus (RSV) was the agent most frequently found (32.6% p<0.05), followed by Adenovirus (28.2%), Parainfluenza (23.9%) and Influenza (15.2%). The respiratory infections of the low respiratory tract were the most frequent (67.4%). A high incidence of associated viral agents to ARI in Zulia State is demonstrated. A high incidence in adult patients and the greatest positivity was found for RSV.

Presencia de rabia urbana en el estado Zulia Venezuela: años 1996-2006 / Presence of urban rabies in Zulia state Venezuela: years 1996-2006

La rabia es una enfermedad viral zoonótica y en el estado Zulia constituye un problema de salud pública de alto impacto social, debido al reporte de casos en humanos. En este estudio se determinó la presencia de rabia urbana en el estado Zulia y se identificó su distribución según municipios y especies afectadas durante los años 1996 -2006. En el marco de un estudio descriptivo, se realizó revisión documental de los registros de la Coordinación Regional de Zoonosis del estado Zulia para el período en estudio. Se observó una ocurrencia total de 1033 casos de rabia, de los cuales 1017 fueron en animales y 16 en humanos. La mayor incidencia fue para los Municipios Maracaibo (31,40 por ciento) y San Francisco (15,68 por ciento). El tipo de rabia predominante fue la urbana, el principal reservorio y transmisor fue el canino (91,60 por ciento). De los casos reportados en humanos la mayor incidencia fue en el Municipio Maracaibo (37,5 por ciento) y el grupo etario más afectado fueron menores de 15 años (81,2 por ciento). Se presentó un bajo porcentaje en la cobertura de vacunación (33 por ciento). Se evidencia una alta incidencia de rabia en el estado Zulia a pesar de ser ésta una enfermedad inmunoprevenible. Se determinó una correlación positiva entre el número de ingresos y de casos (rs=0,948 p < 0,01). Es necesario implementar un abordaje efectivo de los focos de infección y mantener una cobertura mínima de vacunación del 80 por ciento en caninos; además, implementar programas de educación comunitaria, para disminuir el riesgo de infección y la ocurrencia de casos.

[Indication for haemoderivatives in dengue]. / Indicación de hemoderivados en dengue.

Management of patients with dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) requires especial care. It is based on physiological replacement therapy and fluid control. The use of blood products has its own criteria, especially during the disseminated intravascular coagulation (DIC) in the hemorrhagic phase. Monitoring bleeding manifestations and laboratory tests are needed. It has been shown that preventive transfusion does not have advantages in the treatment of this disease; on the contrary it increases the length of hospitalization and the development of pulmonary edema, among other transfusion-related risks.

[Presence of urban rabies in Zulia State, Venezuela. Years 1996-2006]. / Presencia de rabia urbana en el estado Zulia, Venezuela. Años 1996-2006.

Rabies is a zoonotic viral disease and in Zulia State, it constitutes a public health problem of a high social impact, due to the report of cases in human beings. In this study, the presence of urban rabies was determined in Zulia's State and its distribution was identified according to municipalities and affected species during 1996-2006. In the scope of a descriptive study, a documented revision of Zulia's State Zoonosis Regional Coordination registries for the period in study was carried out. A total occurrence of 1.033 rabies cases was observed, 1.017 were in animals and 16 in human beings. The biggest incidences were for Maracaibo (31.40%) and San Francisco (15.68%) municipalities. The type of predominant rabies was the urban one; the principal reservoir and transmitter was the canine one (91.60%). Of the reported cases in human beings, the biggest incidence was in in Maracaibo Municipality (37.5%) and the most affected age group was <15 years (81.2%). A low percentage in the coverage of vaccination was presented (33%). A high incidence of rabies is demonstrated in Zulia's State in spite of this being a preventable immune disease. A positive correlation was determined between the number of admissions and cases (rs=0.948 P<0.01). It is necessary to implement an effective control of the sources of infection and to support a minimal coverage of vaccination of 80% in canines and furthermore, to implement community education programs, to diminish the risk of infection and the occurrence of cases.

[Hantavirus in Zulia state?]. / Hantavirus en el estado Zulia?

During the last years, there has been a worldwide rise in the number of infectious diseases caused by newly discovered agents, in some cases and in others, by variants known as emergent or reemergent pathogens. The analysis of the nucleotide sequences of four RNA-positive hantaviruses (S. altoni) suggests that the Caño Delgadito virus is widely distributed in the Venezuelan plains. A similar distribution has been found for some isolates and strains of a novel hantavirus (proposed name "Mamporal"), which is phylogenetically very closely related to the pulmonary syndrome--causing hantaviruses of southern South America. There have not been clinical cases described or isolates of these viruses in Zulia state, Venezuela. However, some positive serological evidences suggest that their presence in this geographic area should be taken into consideration and further investigated.

Capacidad larvívora del gold fish (Carassius auratus auratus) y del guppy salvaje (Poecilia reticulata) sobre larvas de Aedes aegypti en condiciones de laboratorio / Larvivorous capacity of the gold fish (Carassius auratus auratus) and the wild guppy (Poecilia reticulata) on larvaes of Aedes aegypti in laboratory conditions

El control biológico de vectores de importancia médica se presenta como una alternativa al uso de plaguisidas. La utilización de peces larvívoros se promueve como una nueva estratégia para el control de vectores. El propósito de este estudio es evaluar el potencial de dos especies ícticas para el control biológico de mosquitos Aedes aegypti (principal vector de dengue) en condiciones de laboratorio. Un creciente número de larvas de A. aegyptis en estadíos I, II y III (n: 25, 50, y 100) fueron colocados en acuarios con goldfish (Carassius auratus) y guppys salvajes (Poecilia reticulata). Se cuantificó la relación peso corporal/larvas ingeridas/hora en diez ensayos. La especie Poecilia reticulata reflejó una mayor (P<0,001) capacidad larvívora que C. auratus, dado que cuando se administraron 25, 50 y 100 larvas, los Poecilia reticulata obtuvieron valores promedio de eliminación de 3,15 ± 0,12; 5,50 ± 0,31 y 10,95 ± 0,25, respectivamente, frente a 1,21 ± 0,03; 2,45 ± 0,02 y 4,73 ± 0,06 de los C. auratus. Los resultados obtenidos son indicativos de que bajo las condiciones ensayadas, ambas especies de peces poseen alta capacidad de eliminación de larvas de mosquito A. aegypti; sin embargo, consederando su capacidad larvívora, disponibilidad, costo, características reproductivas y resistencia a las condiciones climáticas, la especie Poecilia reticulata ofrece ventajas importantes ante C. auratus auratus cuando ambos se evalúan integralmente como controladores poblacionales de mosquitos vectores.

[Economic impact of dengue and dengue hemorrhagic fever in the State of Zulia, Venezuela, 1997-2003]. / Impacto económico del dengue y del dengue hemorrágico en el Estado de Zulia, Venezuela, 1997-2003.

OBJECTIVES: To determine the direct and indirect costs of medical care provided to cases of dengue and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) between 1997 and 2003 in Zulia State, Venezuela. METHODS: The total number of patients with dengue and DHF/DSS was obtained from records belonging to the Regional Epidemiology Office of the state of Zulia and from reports of cases that were confirmed in the Virology Section of Dr. Americo Negrette's Clinical Research Institute, Zulia University, Maracaibo, Venezuela, between 1 January 1997 and 31 December 2003. Direct costs included the cost of emergency medical care for all cases and hospital costs for cases with DHF/DSS (cost per bed-day and laboratory expenses). The costs connected to absence from work among patients over 15 years of age and mothers who accompanied their children under 15 years of age comprised the indirect costs, which were adjusted for the proportion of men and women in the labor force. Calculations were based on the minimum yearly wage, and results were given in United States dollars, converted according to each year's average exchange rate. RESULTS: During the study period, 33,857 cases of dengue and DHF/DSS were seen. Of them, 30 251 (89.35%) were cases of dengue, and 3606 (10.65%) were cases of DHF/DSS. Six cases of DHF/DSS died (lethality rate: 0.2 per 100 cases of DHF/DSS). Direct costs were 474,251.70 US dollars; of these costs, 132,042.30 US dollars were spent on emergency medical care and 342,209.40 US dollars on the hospital costs of DHF/DSS cases. Indirect costs were 873,825.84 US dollars and comprised 64.8% of overall expenditures (1 ,48,077.54 US dollars) connected to this disease during the study years. CONCLUSIONS: This is the first study on the economic impact of dengue in the state of Zulia and in Venezuela. In spite of some limitations, results show that dengue is an important public health problem that causes great expense because of temporary absenteeism from work and that undermines regional and national economic development.

Impacto económico del dengue y del dengue hemorrágico en el Estado de Zulia, Venezuela, 1997-2003 / Economic impact of dengue and dengue hemorrhagic fever in the State of Zulia, Venezuela, 1997-2003

OBJETIVOS: Determinar los costos directos e indirectos asociados con la atención de los casos de dengue y de dengue hemorrágico o síndrome de choque por dengue (DH/SCD) entre los años 1997 y 2003 en el Estado de Zulia, Venezuela. MÉTODOS: El número total de pacientes con dengue y DH/SCD se obtuvo de los registros de la Dirección Regional de Epidemiología del Estado de Zulia y de los informes de casos confirmados en la Sección de Virología del Instituto de Investigaciones Clínicas Dr. Américo Negrette, de la Facultad de Medicina, Universidad del Zulia, Maracaibo, entre el 1.° de enero de 1997 y el 31 de diciembre de 2003. Como costos directos se consideraron el costo de la atención médica de urgencia de todos los casos y los costos de hospitalización de los casos con DH/SCD (costo por día-cama y costos de laboratorio). Los costos asociados con la ausencia laboral de los enfermos mayores de 15 años y de las madres acompañantes de los enfermos menores de 15 años conformaron los costos indirectos, ajustados según la proporción de hombres y mujeres en la fuerza laboral activa del país. Para el cálculo se utilizó el salario mínimo anual y los resultados se expresaron en dólares estadounidenses, según la tasa de cambio promedio de cada año. RESULTADOS: En el período estudiado se atendieron 33 857 casos de dengue y de DH/SCD; de ellos, 30 251 (89,35 por ciento) fueron de dengue y 3 606 (10,65 por ciento) de DH/SCD. Seis de estos fallecieron (letalidad 0,2 por 100 casos de DH/SCD). Los costos directos fueron US$ 474 251,70; de esa suma, US$ 132 042,30 correspondieron a la atención en los servicios de urgencia y US$ 342 209,40 a los gastos de hospitalización de los casos con DH/SCD. Los costos indirectos ascendieron a US$ 873 825,84 y representaron 64,8 por ciento del gasto total (US$ 1 348 077,54) relacionado con esta enfermedad en los años estudiados. CONCLUSIONES: Este es el primer estudio acerca del impacto económico del dengue en el Estado de Zulia y en Venezuela. A pesar de que el estudio tuvo algunas limitaciones, los resultados demuestran que el dengue constituye un importante problema de salud pública que ocasiona grandes gastos por ausentismo laboral temporal y que afecta considerablemente al desarrollo de la economía regional y nacional.

In vitro, melatonin treatment decreases nitric oxide levels in murine splenocytes cultured with the venezuelan equine encephalomyelitis virus.

The purpose of this work was to determine the effect of melatonin on the nitric oxide levels in murine splenocytes cultured with the Venezuelan equine encephalomyelitis virus. After incubation, nitric oxide levels were measured by the diazotization assay. Those cultures with the Venezuelan equine encephalomyelitis virus increased nitric oxide levels. Splenocytes infected and treated with 100 and 150 microg/ml of melatonin, decreased significantly the nitric oxide levels when compared to infected and non-treated splenocytes. These findings show that splenocytes infected with the Venezuelan equine encephalomyelitis virus generate important amounts of nitric oxide and suggest that melatonin protects the mice infected with the Venezuelan equine encephalomyelitis virus by a mechanism involving the decreasing of nitric oxide concentrations in tissue.

[Hepatic alterations in patients with dengue]. / Alteraciones hepáticas en pacientes con dengue.

Clinical features of Dengue are very variable due to multiple alterations induced by the virus in the organism. Increased levels of transaminases similar to those produced by the Hepatitis virus have been reported in patients with Dengue from hiperendemic zones in Asia. The objectives of this study were to determine alterations in the liver tests in patients with Dengue and to relate them to the disease, clinically and serologically. Clinical history, hemathological tests serum transaminases (ALT y AST) and bilirubin assays were performed in 62 patients with clinical and serological diagnosis of Dengue. According to clinical features 38.7% of the patients with classical (CD) and hemorrhagic (DHF) forms of Dengue reffered abdominal pain and 2 patients with DHF had ictericia and hepatomegaly. Laboratory test findings showed leucopenia in 72.5% in both forms of Dengue and of patients with DHF severe thrombocytopenia (< 50.000 platelets x mm3), long PT and PPT in 70.9%, 23.0% and 42.3%, respectively. Transaminase values five fold higher than the normal values (p < 0.005) were observed in 36.8% and 74.4% of patients with CD and DHF respectively; AST was predominant in both groups. Our results suggest liver damage during the course of Dengue. A differential diagnosis has to be done between the hepatic involvement of Dengue cases and others viral diseases with hepatic disfunctions.