Pre-eclampsia-like syndrome induced by severe COVID-19: a prospective observational study.

OBJECTIVES: To investigate the incidence of clinical, ultrasonographic and biochemical findings related to pre-eclampsia (PE) in pregnancies with COVID-19, and to assess their accuracy to differentiate between PE and the PE-like features associated with COVID-19. DESIGN: A prospective, observational study. SETTING: Tertiary referral hospital. PARTICIPANTS: Singleton pregnancies with COVID-19 at >20+0  weeks. METHODS: Forty-two consecutive pregnancies were recruited and classified into two groups: severe and non-severe COVID-19, according to the occurrence of severe pneumonia. Uterine artery pulsatility index (UtAPI) and angiogenic factors (soluble fms-like tyrosine kinase-1/placental growth factor [sFlt-1/PlGF]) were assessed in women with suspected PE. MAIN OUTCOME MEASURES: Incidence of signs and symptoms related to PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, abnormal UtAPI and increased sFlt-1/PlGF. RESULTS: Thirty-four cases were classified as non-severe and 8 as severe COVID-19. Five (11.9%) women presented signs and symptoms of PE, all five being among the severe COVID-19 cases (62.5%). However, abnormal sFlt-1/PlGF and UtAPI could only be demonstrated in one case. One case remained pregnant after recovery from severe pneumonia and had a spontaneous resolution of the PE-like syndrome. CONCLUSIONS: Pregnant women with severe COVID-19 can develop a PE-like syndrome that might be distinguished from actual PE by sFlt-1/PlGF, LDH and UtAPI assessment. Healthcare providers should be aware of its existence and monitor pregnancies with suspected pre-eclampsia with caution. TWEETABLE ABSTRACT: This study shows that a pre-eclampsia-like syndrome could be present in some pregnancies with severe COVID-19.

Dynamics of dermatophytosis frequency in Mexico: an analysis of 2084 cases.

We analysed 15,101 biological samples from patients presenting with superficial mycoses who attended outpatient services over a 10-year period. Scale samples were processed for direct microscopic examination with 15% KOH and cultured on Sabouraud glucose agar plus chloramphenicol and cycloheximide. Laboratory examination confirmed 4,709 cases of superficial mycosis (31.18%), of which 2,084 (44.26%) were dermatophytoses. The species most frequently encountered was Trichophyton rubrum (71.2%), followed by T. tonsurans (6.9%), T. mentagrophytes (5.5%), Microsporum canis (4.5%) and Epidermophyton floccosum (1.3%). The most frequent clinical form of dermatophytosis was tinea unguium (59.9%), followed by tinea pedis (24.5%). We demonstrate that the number of cases of T. rubrum is increasing in Mexico.

Estudio del tiempo de procesamiento de un sistema preanalítico en un laboratorio de atención primaria / Study of the processing time of a preanalytical system in a primary care laboratory

Objetivo: adaptación del sistema preanalítico modular (MPA) conectado a un sistema modular analítico SWA (Roche Diagnostics) y estudio de la optimización del tiempo de procesamiento preanalítico basándose en cambios en el proceso de alicuotación. Material y métodos: descripción de la arquitectura y de la configuración funcional del sistema preanalítico. Estudio observacional basado en la carga de trabajo diaria, comparando los tiempos y las velocidades de procesamiento de las muestras tal y como está definido el sistema en la actualidad, con los que se obtendrían de 2 modelos teóricos basados en la agrupación de destinos correspondientes a los analizadores de inmunoquímica. Resultados: se comentan los cambios en el diseño inicial del sistema. El tiempo de procesamiento para una media de 1.364 especímenes/día es de 255,9 min. La velocidad de procesamiento resultante es de 319 especímenes/h para una media de 0,95 alícuotas/espécimen. El tiempo de procesamiento se reduce un 18,3% con la combinación más favorable de los modelos teóricos. Conclusiones: el diseño actual del sistema preanalítico se adecua a las características del laboratorio (volumen de muestras elevado y horario laboral limitado), aunque deben realizarse mejoras. Con el modelo teórico más favorable, no se disminuye suficientemente el tiempo de procesamiento como para permitir hacer una alícuota destinada al archivo de muestras. Se necesitan estudios suplementarios que incluyan el tiempo total de procesamiento de las muestras en los analizadores, para comprobar si una futura agrupación de analizadores de inmunoquímica y, en concreto, cuál de ellas aumentaría la eficiencia del proceso total(AU)

Objective: Adjustment of a Modular Preanalytics (MPA) and Modular Analytics System SWA (Roche Diagnostics) to our laboratory. A study was carried out in order to optimize the turnaround times of the process, changing the system configuration to reduce the number of aliquots. Material and methods: Description of the preanalytical system and its operational configuration. The study of turnaround times of the preanalytical process on the daily workload was compared with 2 theoretical models in which the serum destined for the immunoassay analyzers were grouped in 2 different ways. Results: There are comments about the changes in the initial design of the system. For an average workload of 1364 serum samples/day, the turnaround time of the current configuration was 255.9 min. The resulting rate was 319 samples/h with an average of 0.95 aliquots/sample. In the theoretical models, with the most favorable combination of aliquots, the reduction in turnaround time was 18.3%. Conclusions: The present design of the preanalytical system was adapted to the characteristics of our laboratory, with a large number of samples and with limited working hours, however, improvements should be made. Even the more favorable theoretical model does not allow us to make an aliquot for storage of serum in our work time. Additional studies are needed, including the total turnaround time of process in the immunoassay analyzers, to verify if a possible grouping of immunoassay analyzers and, in particular. which of them, will increase the efficiency of the overall analytical process(AU)

[Sentinel lymph node in tumors of the larynx: technique and results]. / El ganglio centinela en tumores de laringe: técnica y resultados obtenidos.

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential.

El ganglio centinela en tumores de laringe: técnica y resultados obtenidos / Sentinel lymph node in tumors of the larynx: technique and results

Objetivos: Determinar la aplicabilidad de la técnica del ganglio centinela (GC) en tumores N0 de laringe. Material y métodos: Realizamos un estudio prospectivo en 19 pacientes con tumores N0 de laringe. Infiltramos peritumoralmente 1mCi de nanocoloides de albúmina marcados con 99mTc con endoscopio rígido bajo anestesia general. Detectamos el GC intraoperatoriamente con una sondagamma durante el vaciamiento cervical. Los resultados histológicos del GC se comparan con los del vaciamiento cervical. Resultados: Identificamos el GC en 17 pacientes (89,47%). Once pacientes presentaron GC libres de tumor, reflejando correctamente el estatus del cuello (pN0). Tres pacientes presentaron metástasis en el GC l. Encontramos 3 falsos negativos. La sensibilidad de la técnica fue 50,0% (3/6) y el VPN de un 78,6%. Conclusiones: Pensamos que para que la técnica del GC sea aplicable en tumores de laringe se precisan de un mayor número de estudios, siendo fundamental la realización de un correcta selección de los pacientes

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential

[Detection of Coccidioides immitis infection in Coahuila, Mexico]. / Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México.

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural No 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93%) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

[Clinical evaluation of the patient with a chronic snoring disease]. / Evaluación clínica del paciente con roncopatía.

INTRODUCTION: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. MATERIALS AND METHODS: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. RESULTS: The patient's mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. CONCLUSIONS: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS.

Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México / Detection of Coccidioides immitis infection in Coahuila, Mexico

La coccidioidomicosis es una micosis inicialmente pulmonar causada por Coccidioides immitis; puede diseminarse principalmente a sistema nervioso central, huesos y piel. En México se desconoce la frecuencia exacta de esta enfermedad. Nuestro objetivo fue determinar, por intradermorreacción y por serología, los casos de infección por C. immitis en 12 comunidades (10 rurales y dos urbanas) atendidas en el Hospital Rural Nº 79 del Instituto Mexicano del Seguro Social (IMSS) del estado de Coahuila, México. Se estudiaron 668 individuos adultos de ambos sexos; se les aplicó 0,1 ml de coccidioidina por vía intradérmica; después de 72 hs. se midió el diámetro de induración. Fueron seleccionados 180 individuos y a partir del suero se determinaron los niveles de inmunoglobulinas anti-C. immitis por ELISA. Fueron positivos a la coccidioidina 621 sujetos (93%), frecuencia mucho mayor a la reportada previamente en Coahuila. De los 180 sueros estudiados los promedios de densidad óptica (DO) fueron: IgG1, 1,55; IgG2, 0,94; IgG total, 0,33; IgG3, 0,29; IgG4, 0,27; IgM, 0,08. Los valores de IgG1, IgG2 e IgM comparados con las otras inmunoglobulinas fueron estadísticamente significativos. Los valores de IgG1 e IgG2 sugieren contacto frecuente con los antígenos e incluso probables casos de enfermedad no diagnosticada.

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural Nº 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93%) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

Evaluación clínica del paciente con roncopatía / Clinical evaluation of the patient with a chronic snoring disease

Introducción: Los pacientes con trastornos respiratorios relacionados con el sueño son sometidos habitualmente a un examen otorrinolaringológico antes de tomar una decisión terapéutica. Este examen debería ser predictivo sobre la existencia de síndrome de apnea obstructiva del sueño (SAOS), reproducible y debería determinar las zonas de obstrucción de la vía aérea. Hemos evaluado el examen clínico ORL y comparado con la literatura con el ánimo de estandarizar el mismo. Material y métodos: Hemos realizado el mismo protocolo de anamnesis y exploración a 181 pacientes, de los cuales 127 tienen realizada también una polisomnografía (PSG). Resultados: La edad media de los pacientes fue de 49,6 años, con un IMC de 29,3 kg/m2. El 92,7% presentaron un paladar patológico, el 4,5% presentaron una hipertrofia amigdalar importante y el 66,5% índices de Mallampati modificados elevados. El 68,8% se estadió como Fujita IIb y un 39,2% presentó obstrucción nasal. Conclusiones: La exploración de la vía aérea superior (VAS) es muy importante para el diagnóstico de la roncopatía crónica. La mayoría de los pacientes presentan alteraciones morfológicas que se pueden representar mediante escalas visuales para hacerla más reproducible. La zona de obstrucción no predice la severidad del síndrome de apnea del sueño

Introduction: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. Materials and methods: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. Results: The patient’s mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. Conclusions: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS

[Sentinel node in tumours of the lip and the oral cavity]. / Estudio del ganglio centinela en tumores de labio y cavidad oral.

OBJECTIVES: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. PATIENTS AND METHOD: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. CONCLUSIONS: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients.

Estudio del ganglio centinela en tumores de labio y cavidad oral / Sentinel node in tumours of the lip and the oral cavity

Objetivos: Este estudio muestra los resultados obtenidos mediante la aplicación del ganglio centinela en tumores de labio y cavidad oral; elaboramos un mapa linfográfico de dichos tumores. Material y método: Estudiamos prospectivamente 14 pacientes con tumores de labio y cavidad oral N0 clínicos. Inyectamos de forma peritumoral, 1 mCi de nanocoloides de albúmina marcada con Tc99 preoperatoriamente, para posteriormente localizar el ganglio centinela. Una vez localizado éste, se envía separadamente del resto de cadenas ganglionares para su estudio anatomopatológico. Resultados: En todos los pacientes se identificó el ganglio centinela. En 11 casos el ganglio centinela fue negativo para metástasis prediciendo correctamente el estadio cervical. En 3 casos el ganglio centinela fue el único ganglio que contenía metástasis. No hubo ningún caso de falso negativo. La sensibilidad de la técnica fue del 100%. Conclusiones: Los resultados muestran esta técnica como un método fiable en esta localización que podría evitar los vaciamientos cervicales en pacientes N0 clínicos

Objectives: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. Patients and method: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. Results: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. Conclusions: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

[Drug use in a neonatal ICU: a prospective study]. / Utilización de medicamentos en una UCI neonatal: estudio prospectivo.

INTRODUCTION: Many drugs prescribed in pediatric units do not meet the conditions of use defined in their corresponding prescription information sheets, or their use has not been approved by the Spanish Health Authorities. The lack of clinical trials in children, and of adequate dosage forms, reduces drug safety, assuming both the physician and the pharmacist the responsibility for the drug use. OBJECTIVE: To assess drug prescription status within a neonatal intensive care unit in a third-level hospital. MATERIAL AND METHODS: A 3-months prospective study was performed, and information was collected from all admitted children along four time periods. Sixty-one complete therapies were evaluated, with a total of 236 drugs prescribed. Fifty percent were off-label, 13% were unlicensed, and 37% were correctly used. CONCLUSIONS: These figures resemble those from, similar studies carried out in other European hospitals. This is therefore a common practice resulting from the need to treat. Health authorities should encourage clinical trials so that drug therapies for children become evidence-based.

Utilización de medicamentos en una UCI neonatal: estudio prospectivo / Drug use in a neonatal ICU: a prospective study

Introducción: Muchos de los fármacos pautados en unidades pediátricas, no siguen las condiciones de uso marcadas en su correspondiente ficha técnica (fármacos denominados “off-label”)o no están autorizados por la Dirección General de Farmacia y Productos Sanitarios (“unlicensed”). La falta de ensayos clínicos en niños y de formulaciones adecuadas, disminuye la seguridad de uso de los medicamentos, recayendo la responsabilidad en el médico y el farmacéutico. Objetivo: Evaluar la situación de la prescripción de medicamentos dentro de la unidad de cuidados intensivos neonatal en un hospital de tercer nivel. Material y métodos: Para ello se realizó un estudio prospectivo de tres meses de duración, recogiéndose la información de todos los niños ingresados en un total de cuatro cortes. Se evaluaron 61 tratamientos completos, con un número total de 236 fármacos pautados. El 50% fue “off-label”, el 13% “unlicensed” y el 37% se utilizaba bajo las condiciones correctas. Conclusiones: Esta cifra se asemeja a la de estudios similares realizados en hospitales europeos. Es por tanto un práctica habitual que resulta de la necesidad de tratar al paciente. Las autoridades sanitarias deben incentivar la realización de ensayos clínicos para que los tratamientos farmacológicos en niños estén basados en la evidencia

Introduction: Many drugs prescribed in pediatric units do not meet the conditions of use defined in their corresponding prescription information sheets, or their use has not been approvedby the Spanish Health Authorities. The lack of clinical trials in children, and of adequate dosage forms, reduces drug safety,assuming both the physician and the pharmacist the responsibility for the drug use. Objective: To assess drug prescription status within a neonatal intensive care unit in a third-level hospital. Material and methods: A 3-months prospective study was performed, and information was collected from all admitted children along four time periods. Sixty-one complete therapies were evaluated, with a total of 236 drugs prescribed. Fifty percent were “off-label”, 13% were“unlicensed”, and 37% were correctly used. Conclusions: These figures resemble those from, similar studies carried out in other European hospitals. This is therefore a common practice resulting from the need to treat. Health authorities should encourage clinical trials so that drug therapies for children become evidence-based

Nuestros hallazgos en la videofibrosomnoscopia / Our findings in the sleep endoscopy exams

Introducción: La videofibrosomnoscopia es una técnica que permite la visualización de la faringe de un paciente al que se le ha inducido el sueño farmacológicamente. De este modo se puede diagnosticar la o las zonas causantes de la vibración y colapso de los pacientes con roncopatía crónica. Material y métodos: La prueba se realizó a un total de 51 pacientes. A todos se les realizó una anamnesis estándar y una exploración otorrinolaringológica como parte del diagnóstico habitual. Resultados: La zona de obstrucción más frecuentemente encontrada fue el velo del paladar en el 90,4%, seguido de la base de la lengua en el 38,5%. El colapso multinivel se dio en el 60,7%. No se han hallado correlaciones entre la obstrucción hallada en la consulta y la vista durante la VFS. Conclusiones: La VFS es una técnica útil en el diagnóstico del paciente con roncopatía y es aconsejable su utilización para saber con certeza el tipo de obstrucción del paciente

Introduction: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. Materials and methods: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. Results: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. Conclusions: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient´s obstruction

Detección de infección por Coccidioides immitis en zonas del estado de Coahuila, México. / [Detection of Coccidioides immitis infection in Coahuila, Mexico]

Coccidioidomycosis is a mycosis firstly pulmonar caused by Coccidioides immitis; it can be disseminated to central nervous system, bones and skin, principaly. In Mexico, the real frequency of the disease is unknown. The aim of this work was to determine, by skin test and by serology, the infection cases by C. immitis in twelve communities (10 rural and two urban), attended in the Hospital Rural No 79 at the Instituto Mexicano del Seguro Social (IMSS) from the Coahuila State, Mexico. Six hundred and sixty eight adult individuals of both sexes were studied, to whom 0.1 ml of coccidioidin by intradermal route was applied; 72 h after, the induration diameter was measured. One hundred eighty individuals were selected and seric anti-C. immitis immunoglobulins levels were determined by ELISA. Six hundred twenty one individuals (93

) were positive to coccidioidin, the frequency was much higher than that previously reported in Coahuila. From 180 sera studied, the means of optical density (OD) were: IgG1, 1.55; IgG2, 0.94; total IgG, 0.33; IgG3, 0.29; IgG4, 0.27; IgM, 0.08. The values of IgG1, IgG2 and IgM compared with the other immunoglobulins were statistically significant. The high values of IgG1 and IgG2 suggest frequent contact with the antigen, and probable cases of undiagnosed disease.

[Changes in immunoglobulin levels following adenoidectomy and tonsillectomy]. / Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía.

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

Inmunoglobulinas en pacientes con actinomicetoma por Nocardia brasiliensis / Immunoglobulins in patients with Nocardia brasiliensis actinomycetoma

Considerando que algunos autores han reportado un aumento en la cantidad de algunas inmunoglobulinas en los pacientes con actinomicetoma, en este trabajo nos propusimos determinar diferencias en la producción de IgG1, IgG2, IgG3, IgG4 e IgM en 25 pacientes con actinomicetoma por Nocardia brasiliensis y 25 personas sanas provenientes de una zona endémica de micetoma. La determinación de inmunoglobulinas se realizó por medio de la técnica de ELISA. Para sensibilizar las placas se emplearon 6 antígenos de N. brasiliensis: un antígeno crudo denominado NB y cinco derivados del mismo (NB2, NB4, NB6, NB8 y NB10) separados por punto isoeléctrico. Los niveles de las cuatro subclases de IgG fueron mayores en los sueros de los pacientes que en el suero de los controles, con una diferencia máxima en IgG3 e IgG4; para esta última subclase, los seis antígenos fueron altamente reactivos. La concentración de IgM fue igual en ambos grupos. Es probable que como ocurre en otras infecciones, en la fisiopatogenia del actinomicetoma influya no sólo el aumento o deficiencia de una clase de inmunoglobulina, sino la relación que existe entre las diferentes subclases.

Considering that some authors have reported an increasing of some immunoglobulins in actinomycetoma patients, in this study we propose to determine differential production of IgG1, IgG2, IgG3, IgG4 and IgGM in 25 patients with actinomycetoma and 25 healthy individuals from a mycetoma endemic area. Immunoglobulins were determined by ELISA technique. To sensibilize the plates, six Nocardia brasiliensis antigens were used: a crude antigen denominated NB and five derivatives (NB2, NB4, NB6, NB8 and NB10) obtained by their isoelectric point. Results showed that all IgG subclasses were higher in the patients’ sera than in control sera, with a maximal difference to IgG3 and IgG4. To the latter subclass, six antigens were highly reactives. IgM levels were similar in both groups. As it occurs in other infections, in the actinomycetoma pathogenesis probably participate the increase or deficiency of a determined immunoglobulin class, as well as the relationship between different subclasses.

[Benign tumors of the parotid gland]. / Tumores benignos de la glándula parótida.

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We shelted an amount of 145 cases. The pathologic distribution between benign and malign tumors was as following: 119 benign tumors (83%) and 26 malign tumors (17%). Here we study benign parotid tumors, which represent 83% of total parotid tumors. We performed suprafacial parotidectomies in 72% and total parotidectomy in 19% of cases. Nodulectomy was realized in 9% of patients in those tumors that arise in the lower part of the parotid gland and usualy they were Warthin tumors. The main complications of surgery were facial nerve dysfunction and Frey syndrome. We didn't have any case of permanent facial nerve dysfunction but transitory facial nerve disfunction occurred in 26% of patients. Frey syndrome appeared in 10% of patients operated of parotidectomy. Benign mixed tumor was the only one benign tumor in recurring and the frequency was 5% of patients.