Clinical and immunological features of common variable immunodeficiency in Mexican patients.

BACKGROUND: Common variable immunodeficiency (CVID) is characterised by hypogammaglobulinaemia and a broad clinical spectrum, mainly showing recurrent bacterial infections accompanied sometimes by increased susceptibility to chronic lung disease, autoimmunity, and neoplastic diseases. OBJECTIVES: To evaluate the clinical and immunological characteristics of patients with CVID in Mexico. METHODS: This is a retrospective analysis of 43 patients with CVID from the Immunology Division of seven different reference centres in Mexico. Patients were diagnosed according to the diagnostic criteria of the European Society for Immunodeficiency Diseases. We collected demographics, clinical and immunological data from each patient and a statistical analysis was performed. RESULTS: There were 23 (53.5%) male and 20 (46.5%) female patients. Median age at onset of disease was 13.7 years, and median age at diagnosis was 19 years. Average delay in diagnosis was 12.5 years. The median total serum levels of IgG, IgM, and IgA at diagnosis were 175, 18, and 17.8mg/dL, respectively. The mean percentage of CD19+ B cells was 8.15%. Sinusitis (83%), pneumonia (83%), gastrointestinal infection (70%), and acute otitis media (49%) were the most common manifestations. Bronchiectasis was present in 51% of the patients, 44% manifested non-infectious chronic diarrhoea, and 70% experienced weight loss. Autoimmunity was present in 23% of the patients; haemolytic anaemia and autoimmune thrombocytopenic purpura were the most common presentations. Allergy was present in 30.2% of patients, with allergic rhinitis and asthma being the most frequent types. Two patients developed malignancy. All the patients received Intravenous immunoglobulin (IVIG) as a fundamental part of the treatment at a mean dose of 408mg/kg. CONCLUSION: This is the first cohort of CVID reported in Mexico We found that infection diseases were the most frequent presentations at onset. Moreover, patients had an average diagnosis delay of twelve years and thus a major prevalence of bronchiectasis. We suggest performing an extended analysis of patients with CVID patients in other Latin American countries.

[Treatment of strabismus associated with psychomotor impairment using botulinum toxin]. / Tratamiento con toxina botulínica para estrabismo en retraso psicomotor.

PURPOSE: Strabismus is associated with 80% of people with psychomotor retardation. Surgical treatment is difficult owing to brain instability. The aim of this study is to determine the efficacy of a direct application of botulinum toxin in cases strabismus related to psychomotor retardation. METHODS: This is a retrospective, longitudinal, observational study of treatment of strabismus associated to brain damage (under the Laws of Health of Mexico) using a direct application technique of botulinum toxin, considering age, type of strabismus, number of toxin applications, response and cause of brain damage. RESULTS: We analyzed 30 patients, age: 3.5 years old (S.D.: 2), follow-up 12.7 (S.D.: 2.3 months). Eighty percent of the patients had moderate psychomotor retardation and 20% had a severe retardation. The response was good in 44% and moderate in 24%, there were no cases without response. The patients were treated with 1.7 (S.D.:1) injections of toxin. Age and type of strabismus was not related to success of treatment (X2: 9.4; 7.8 to null hypothesis). First application of toxin determines the response to treatment (Fisher test: <0.05). Moderate retardation was related to better response. Bad results were related to unstable brain disease. CONCLUSIONS: The difficulty and prognosis of surgical treatment of strabismus in patients with brain damage and psychomotor retardation, causes us to consider the use of botulinum toxin as the first choice for this cases.

Tratamiento con toxina botulínica para estrabismo en retraso psicomotor / Treatment of strabismus associated with brain damage using botulinum toxin

Objetivo: El retraso psicomotor se asocia a estrabismo en un 80 por ciento, su tratamiento quirúrgico es difícil por la inestabilidad cerebral. El objetivo es determinar la eficacia del tratamiento con aplicación directa de toxina botulínica para estrabismo asociado a Retraso psicomotor. Material y métodos: Estudio retrospectivo, longitudinal, observacional del uso de toxina botulínica para tratamiento de estrabismo asociado a retraso psicomotor, según Reglamento General de Salud de México. Variables: edad, tipo de estrabismo, número de aplicaciones de toxina, respuesta, grado y etiología del daño cerebral.Resultados: Se analizaron 30 pacientes. Edad 3,5 (D.E.: 2 años). Seguimiento 12,7 (D.E.: 2,3 meses). Grado de retraso psicomotor leve-moderado en 80 por ciento, grave en el 20 por ciento. Resultado bueno en 44 por ciento y regular en 24 por ciento. Promedio de aplicaciones 1,7 (D.E.: 1). No hubo relación entre edad de tratamiento y tipo de estrabismo con el grado de respuesta (X2: 9,4; 7,8 hipótesis nula). La primera aplicación de toxina determinó la respuesta al tratamiento (prueba exacta de Fisher: <0,05) a menor retraso psicomotor mejor efecto. Los resultados malos se relacionaron a enfermedad cerebral inestable.Conclusiones: La dificultad y pronóstico del tratamiento quirúrgico del estrabismo asociado a retraso psicomotor hacen considerar a la toxina botulínica como la primera elección para este estrabismo (AU)

[Botulinum toxin as a treatment for strabismus in systemic diseases]. / Utilidad de la toxina botulínica en el tratamiento del estrabismo en enfermedades sistémicas.

PURPOSE: To demonstrate the effectiveness of botulinum toxin for treating strabismus secondary to systemic diseases. MATERIAL AND METHODS: 141 patients with secondary strabismus were studied. To reduce risks, the treatment with botulinum toxin was made by a direct technique proposed by the authors. The response to the treatment was classified according to the different physiopathogenic groups. RESULTS: We found a positive response in: Central Neurological damage: 71%, Endocrinopathies: 78.6%, Brain infection: 80%, Trauma: 60%, Psychomotor defficiency: 72%, Prematurity: 74%, Myasthenia 75%, Hemathological diseases: 75%. The average of botulinum toxin applications was 1.5 infections. CONCLUSIONS: We show that the effectiveness of botulinum toxin in strabismus secondary to systemic disease is up to 74%. We can offer rehabilitation in all of these cases even during the sometimes long diagnostic period or in patients under treatment. We also suggest our direct technique for the application of botulinum toxin (without electromyography) to avoid risks in this type of patients. We are reporting the use and positive effect of the botulinum toxin chemodenervation in Myasthenia gravis, Human Acquired Immune-deficiency Syndrome, and mental defficiency.

Utilidad de la toxina botulínica en el tratamiento del estrabismo en enfermedades sistémicas / Botulinum toxin as a treatment for strabismus in systemic diseases

Objetivo: Demostrar la efectividad de la quimiodenervación con toxina botulínica para el tratamiento del estrabismo secundario a enfermedades sistémicas. Material y Método: Se estudiaron 141 pacientes con estrabismo secundario, a los cuales se les aplicó toxina botulínica con técnica directa para minimizar riesgos. Se clasificaron y registraron las respuestas al tratamiento por grupos de entidades fisiopatogénicas. Resultados: Los porcentajes en el rubro de buenos resultados fueron: Neurológico Central: 71 per cent, Endócrinos 78,6 per cent, Neuroinfección: 80 per cent, Traumáticos: 60 per cent, Retraso en el Desarrollo Psicomotor: 72 per cent, Prematuridad: 74 per cent, 75 per cent en Miastenia gravis, Hematológicos: 75 per cent. El promedio de aplicación de toxina botulínica fue de 1,5 inyecciones. Conclusiones: Demostramos la efectividad hasta un 74 per cent de buen resultado del tratamiento con toxina botulínica para el estrabismo secundario a enfermedades sistémicas, esto permite rehabilitar al paciente incluso en su período de diagnóstico o de tratamientos sistémicos, quimioterápicos, etc. Sugerimos la técnica de aplicación directa sin electromiógrafo para minimizar los riesgos en este tipo de pacientes. Se reporta especialmente la efectividad del tratamiento con toxina botulínica para el estrabismo secundario a miastenia gravis, Síndrome de Inmunodeficiencia Adquirida Humana y Retraso en el Desarrollo Psicomotor (AU)

[Rapid diagnosis of principal respiratory viruses in the city of Havana, 1995-97]. / Diagnóstico rápido de los principales virus respiratorios en Ciudad de la Habana, 1995-97.

Acute respiratory diseases (ARD) are the most common infections in humans and difficult to prevent. Viruses have been recognized as predominant ethiological agents. In Cuba, ARD constitute a major problem of health and are the first cause of morbidity and important cause of mortality. In this paper, rapid diagnosis was performed to 516 clinical samples which arrived to the Reference Respiratory Viruses Laboratory of the Pedro Kourí Institute of Tropical Medicine (IPK) from different parts of Havana City during 1995, 1996 and 1997. The results obtained have shown 218 positive samples (Influenza A, 89; respiratory syncytial virus 52; Influenza B, 45; Adenovirus, 13; human parainfluenza virus(HPIV)-1, 6; HPIV-2, 3 and HPIV-3, 10). Influenza A was the virus most frequently found in adults, whereas in closed population of teen-agers and adults, Influenza B was frequently found. Furthermore, respiratory syncytial virus was the most important pathogen in children's under 1 year of age.

Diagnóstico rápido de los principales virus respiratorios en Ciudad de la Habana, 1995-97 / Rapid diagnosis of principal respiratory viruses in the city of Havana, 1995-97

Acute respiratory diseases (ARD) are the most common infections in humans and difficult to prevent. Viruses have been recognized as predominant ethiological agents. In Cuba, ARD constitute a major problem of health and are the first cause of morbidity and important cause of mortality. In this paper, rapid diagnosis was performed to 516 clinical samples which arrived to the Reference Respiratory Viruses Laboratory of the Pedro KourÝ Institute of Tropical Medicine (IPK) from different parts of Havana City during 1995, 1996 and 1997. The results obtained have shown 218 positive samples (Influenza A, 89; respiratory syncytial virus 52; Influenza B, 45; Adenovirus, 13; human parainfluenza virus(HPIV)-1, 6; HPIV-2, 3 and HPIV-3, 10). Influenza A was the virus most frequently found in adults, whereas in closed population of teen-agers and adults, Influenza B was frequently found. Furthermore, respiratory syncytial virus was the most important pathogen in children's under 1 year of age.

Diagnóstico rápido de los principales virus respiratorios en Ciudad de la Habana, 1995-97 / Rapid diagnosis of principal respiratory viruses in the city of Havana, 1995-97

Acute respiratory diseases (ARD) are the most common infections in humans and difficult to prevent. Viruses have been recognized as predominant ethiological agents. In Cuba, ARD constitute a major problem of health and are the first cause of morbidity and important cause of mortality. In this paper, rapid diagnosis was performed to 516 clinical samples which arrived to the Reference Respiratory Viruses Laboratory of the Pedro KourY Institute of Tropical Medicine (IPK) from different parts of Havana City during 1995, 1996 and 1997. The results obtained have shown 218 positive samples (Influenza A, 89; respiratory syncytial virus 52; Influenza B, 45; Adenovirus, 13; human parainfluenza virus(HPIV)-1, 6; HPIV-2, 3 and HPIV-3, 10). Influenza A was the virus most frequently found in adults, whereas in closed population of teen-agers and adults, Influenza B was frequently found. Furthermore, respiratory syncytial virus was the most important pathogen in childrens under 1 year of age.(AU)

Diagnóstico rápido de los principales virus respiratorios en Ciudad de la Habana, 1995-97. / [Rapid diagnosis of principal respiratory viruses in the city of Havana, 1995-97]

Acute respiratory diseases (ARD) are the most common infections in humans and difficult to prevent. Viruses have been recognized as predominant ethiological agents. In Cuba, ARD constitute a major problem of health and are the first cause of morbidity and important cause of mortality. In this paper, rapid diagnosis was performed to 516 clinical samples which arrived to the Reference Respiratory Viruses Laboratory of the Pedro Kourí Institute of Tropical Medicine (IPK) from different parts of Havana City during 1995, 1996 and 1997. The results obtained have shown 218 positive samples (Influenza A, 89; respiratory syncytial virus 52; Influenza B, 45; Adenovirus, 13; human parainfluenza virus(HPIV)-1, 6; HPIV-2, 3 and HPIV-3, 10). Influenza A was the virus most frequently found in adults, whereas in closed population of teen-agers and adults, Influenza B was frequently found. Furthermore, respiratory syncytial virus was the most important pathogen in childrens under 1 year of age.