Antioxidant supplementation and nasal inflammatory responses among young asthmatics exposed to high levels of ozone.

The inflammatory response to ozone in atopic asthma suggests that soluble mediators of inflammation are released in response to oxidant stress. Antioxidants may alleviate additional oxidative stress associated with photochemical oxidant pollution. This study investigates the impact of antioxidant supplementation on the nasal inflammatory response to ozone exposure in atopic asthmatic children. We conducted a randomized trial using a double-blinded design. Children with asthma (n = 117), residents of Mexico City, were given randomly a daily supplement of vitamins (50 mg/day of vitamin E and 250 mg/day of vitamin C) or placebo. Nasal lavages were performed three times during the 4-month follow-up and analysed for content of interleukin-6 (IL-6), IL-8, uric acid and glutathione (GSx). IL-6 levels in the nasal lavage were increased significantly in the placebo group after ozone exposure while no increase was observed in the supplement group. The difference in response to ozone exposure between the two groups was significant (P = 0.02). Results were similar for IL-8, but with no significant difference between the groups (P = 0.12). GSx decreased significantly in both groups. Uric acid decreased slightly in the placebo group. Our data suggest that vitamin C and E supplementation above the minimum dietary requirement in asthmatic children with a low intake of vitamin E might provide some protection against the nasal acute inflammatory response to ozone.

Genetic polymorphism of GSTM1 and antioxidant supplementation influence lung function in relation to ozone exposure in asthmatic children in Mexico City.

BACKGROUND: We recently reported that antioxidant supplementation with vitamins C and E mitigated ozone related decline in forced expiratory flow (FEF(25-75)) in 158 asthmatic children in an area with high ozone exposure in Mexico City. METHODS: A study was undertaken to determine whether deletion of glutathione S-transferase M1 (GSTM1 null genotype), a gene involved in response to oxidative stress, influences ozone related decline in FEF(25-75) and the benefit of antioxidant supplementation. RESULTS: GSTM1 null children receiving placebo had significant ozone related decrements in FEF(25-75) (percentage change per 50 ppb of ozone 2.9 (95% CI -5.2 to -0.6), p=0.01); GSTM1 positive children did not. Conversely, the effect of antioxidants was stronger in children with the GSTM1 null genotype. CONCLUSIONS: Asthmatic children with a genetic deficiency of GSTM1 may be more susceptible to the deleterious effects of ozone on the small airways and might derive greater benefit from antioxidant supplementation.

Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with beclomethasone or beclomethasone-salmeterol.

Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 micrograms per puff) or Ibe + Isal (B 2 puff/12 hr, 100 micrograms per puff and S 2 puff/12 hr, 25 micrograms per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 +/- 2.18 (mean +/- SD) years, baseline K was 4.57 +/- 0.43 mEq/l, after B K 4.38 +/- 0.39 IU and after BS K 4.38 +/- 0.40. The CPK-MB level were baseline 14.75 +/- 4.5, after B 20.10 +/- 6.9 and after BS 21 +/- 8.05 (p < 0.05). Baseline QTc was 0.416 +/- 0.02 msec, after B 0.425 +/- 0.027, and after BS 0.415 +/- 0.029. We conclude that the treatment of children with asthma with 400 micrograms per day of Ibec or concomitantly with 100 micrograms of Isal for 6 weeks does not alter the serum K+ or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased.

Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with Blecomethasone or Blecomethasone-Salmeterol

Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 μ g per puff) or Ibe + Isal (B 2 puff/12 hr, 100 μg per puff and S 2 puff/12 hr, 25 μ g per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 ± 2.18 (mean ± SD) years, baseline K was 4.57 ± 0.43 mEq/l, after B K 4.38 ± 0.39 IU and after BS K 4.38 ± 0.40. The CPK-MB level were baseline 14.75 ± 4.5, after B 20.10 ± 6.9 and after BS 21 ± 8.05 (p < 0.05). Baseline QTc was 0.416 ± 0.02 msec, after B 0.425 ± 0.027, and after BS 0.415 ± 0.029. We conclude that the treatment of children with asthma with 400mg per day of Ibec or concomitantly with 100 μ g of Isal for 6 weeks does not alter the serum K + or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased (AU)

El componente inflamatorio crónico del asma ha justificado el manejo con antiinflamatorios de tipo esteroide inhalados solos o en combinación con 2 de acción prolongada para manejo habitual del asma moderada crónica persistente (AMCP). El objetivo fue comparar los efectos de beclometasona frente a salmeterol con beclometasona en IDM sobre el potasio sérico, el intervalo QTc y en los valores de las enzimas del músculo cardíaco CPK-MB en niños asmáticos sin crisis del servicio de alergia del Hospital Infantil de México Federico Gómez. Se hizo un ensayo clínico prospectivo, longitudinal, ciego, cruzado, comparativo de dos tratamientos. administrados de forma aleatoria en diferentes tiempos en un mismo grupo de 30 pacientes de 7 a 17 años con AMCP de acuerdo a la clasificación del GINA. A los pacientes seleccionados se les determinó potasio, CPK-MB y trazo de ECG antes y después de las 6 semanas de tratamiento (salmeterol 100 g/día con beclometasona 400 g/día (Sal-Beclo) y beclometasona (Beclo) sola a la misma dosis. El inicio del tratamiento fue de tipo aleatorio quedando 14 pacientes con Sal-Beclo y 16 con Beclo, con 1 semana de lavado después del primer tratamiento para continuar el grupo que inició con Sal-Beclo con Beclo y el de Beclo con Sal-Beclo.Resultados: hubo 9 niñas y 20 hombres con una media de 11 ñ 2,18 años. Con K basal de 4,57 ñ 0,43 mEq/l con Beclo de 4,38 ñ 0,39 y con Sal-Beclo de 4,38 ñ 0,40. La CPK-MB basal fue de 14,75 ñ 8,45 después con Beclo 20,10 ñ 6,9 y con Sal-Beclo 21 ñ 8,05. Los cambios en la CPK-MB basal frente a CPK-MB con Beclo y la CPK-MB basal con Sal-Beclo se obtuvieron valores significativos (p 0,05).Conclusión: la administración de 400 g al día de beclometasona sola o en combinación con 100 g/día de salmeterol en inhalador de dosis medida por 6 semanas en el tratamiento habitual de niños con ACMP no induce cambios cardiovasculares importantes a pesar de haberse visto una elevación significativa de la CPK-MB en niños sin crisis (AU)

[Procedure for bronchodynamic tests with inhaled allergens]. / Procedimiento para realizar pruebas broncodinámicas con alergenos inhalados.

The asthma is one of the most frequent chronic illnesses in the children. It is characterized by hyperreactivity from the air roads to inspecific stimuli (metacholin and histamin) and specific (allergens). The broncodynamics tests determines the broncolability asthmatic boy's and they help to settle down the I diagnose functional. They should be carried out with antigenic extracts of high quality, lyophilized watery and standardized; you can use an open or closed circuit and a dosimeter, the initial dose of the allergen it is lower than with the one that the positive cutaneous reactivity was obtained, carrying out successive increments until the VEF-1 descend 15% or more. The patient's security is fundamental, they should be carried out for specialized personnel.

[Degree and duration of bronchodilatation with an agonist beta 2 administered alone versus an agonist beta 2 administered with ipratropium bromide in children with acute asthma]. / Grado y duración de la broncodilatación mediante la administración de un agonista beta 2 solo vs un agonista beta 2 más bromuro de ipratropio en niños con asma aguda.

BACKGROUND: The asthma is the chronic illness of the most frequent respiratory tract of the pediatric age. MATERIAL AND METHOD: Prospective study, longitudinal, double blind, at random with 40 patient (split into two groups) with asthmatic crisis with ages of 8 to 15 years. To all was them accomplished tests of effected pulmonary function of basal way and subsequent to the inhalation of the medication. The medication were administered in two inhalations by three steps and with intervals of 10 minutes between each dose. It was considered that the treatment was effective if the improvement of the pulmonary function tests (VEF1) were presenting an increase of the 15% of their initial value. RESULTS: For each one of the tests accomplished in the different times were found meaningful increases in VEF1 (p < 0.05) in both groups compared with the basal and stayed meaningful until eight hours after the administration of both therapeutic plans. CONCLUSION: The bronchodilator effect of the salbutamol alone and in combination with bromide of ipratropio is similar in intensity and in action time demonstrated by the VEF1.

[Air flow measurement in children with mite allergies before and after skin prick test]. / Medición de la flujimetría en niños alérgicos a ácaros antes y después del reto con pruebas por prick.

OBJECTIVE: To determine the obstruction of the air flow by flujimetry subsequent to the application of tests cutaneous specific (Dermatophagoides pteronisinnus) in sensitive children. MATERIAL AND METHODS: They were studied 44 patient of one and other sex with diagnostic of asthma and antecedent of sensibility to the mite Dermatophagoides pteronisinnus through tests cutaneous for prick, with an average age of 6 to 16 years, captured of the external consult of the allergy service of the Hospital Infantil de Mexico Federico Gómez. It is a longitudinal study, prospective, blind, cross, in the one which previously was made a challenge test with antigen standardized of Dermatophagoides pteronisinnus or glycerine, previous reading of flujimetry. RESULTS: Of the patients challenged with antigen in 23 there was decrease of the respiratory maximum flow, with a p < 0.05, but without clinical meaning. When they were challenged with placebo only it reduced in patient seven the respiratory maximum flow, also significative statistically, but without clinic relevancy. CONCLUSION: The cutaneous tests are a useful tool in allergy and sure, since almost they do not produce serious systemic reactions.

Malnutrition in childhood lymphoblastic leukemia: a predictor of early mortality during the induction-to-remission phase of the treatment.

BACKGROUND: Previous reports have shown that undernourished children with acute lymphoblastic leukemia (ALL) have a poorer long-term survival as compared with children with normal nourishment status. It has been shown that both the relapse and mortality rates of undernourished children with ALL are higher during the continuation phase of the chemotherapy and are apparently related to a poor tolerance of ablative chemotherapy. No previous articles have analyzed the early mortality rate of these patients. METHODS: We carried out a case-control study, and have studied the effect of severe malnutrition on the mortality of 17 children with ALL during the initial induction-to-remission phase of the treatment. These 17 cases were compared with 76 controls who had survived at least the phases of induction and consolidation. RESULTS: It was found that the chance of dying during the initial phase of the treatment was 2.6 times higher (confidence interval 95%: 0.55-11.89) in undernourished children with ALL than in those children with normal nourishment status. The risk of death increased with the severity of undernourishment (p = 0.04). CONCLUSIONS: These data confirm the prognostic value of malnutrition in children with ALL and suggest that undernourishment may also influence early mortality during the induction-to-remission phase of the treatment.

[Wheezing in infants]. / Sibilancias en el lactante.

The wheeze are a common symptom in nursing, especially when suffer infections of the respiratory tract. They are common in 75 to 85% of the children, who have wheezes during some stage of their development between 2 to 5 years old. They can be related to smoking motherly during the pregnancy, exposition to the smoke of the tobacco to the subsequent stage to the birth, exposition to environmental and certain factor infections veers them. The wheezes in patient with atopy maybe they are related to a IgE two standard deviations up above of what is normal and persist as asthma in late stages. The wheeze is an affection syndromatic therefore it is obligatory to seek the factor unfetter you to arrive to a definitive diagnosis.