B subset cells in patients with chronic granulomatous disease in a Mexican population

Introduction: Chronic granulomatous disease (CGD) is a disorder of phagocyte function, characterized by pyogenic infections and granuloma formation caused by defects in NADPH oxidase complex activity. Although the effect of CGD mainly reflects the phagocytic compartment, B cell responses are also impaired in patients with CGD. Materials and methods: Flow cytometric analysis was performed on peripheral blood samples from 35 CGD patients age-matched with healthy controls (HC). The target cells of our study were the naive (IgD+/CD27-), memory (IgD-/CD27+), and B1a (CD5+) cells. Immunoglobulins (Igs) were also measured. This study was performed in a Latin American cohort. Results: We found significantly higher levels of naive B cells and B1a cells, but lower levels of memory B cells were found in CGD patients compared to HC. There was no significant difference of cell percentages per inheritance type. Discussion: Our findings suggest that the deficiency of NADPH oxidase components can affect the differentiation of naive B cells to memory B cells. Consequently, memory cells will be low, which also influenced the expression of CD27 in memory B cells and as a result, the percentage of naive cells increases. An altered phenotype of B lymphocytes in CGD patients may contribute to the opportunistic infections and autoimmune disorders that are seen in this disease

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Microdeletion 22q11.2 syndrome: Does thymus incidental surgical resection affect its immunological profile?

Background: The del22q11 syndrome patients present immunological abnormalities associated to thymus alterations. Up to 75% of them present cardiopathies and thymus is frequently removed during surgery. The thymectomy per se has a deleterious effect concerning lymphocyte subpopulations, and T cell function. When compared to healthy controls, these patients have higher infections propensity of variable severity. The factors behind these variations are unknown. We compared immunological profiles of del22q11.2 Syndrome patients with and without thymectomy to establish its effect in the immune profile. Methods: Forty-six del22q11.2 syndrome patients from 1 to 16 years old, 19 of them with partial or total thymectomy were included. Heart disease type, heart surgery, infections events and thymus resection were identified. Immunoglobulin levels, flow cytometry for lymphocytes subpopulations and TREC levels were determined, and statistical analyses were performed. Results: The thymectomy group had a lower lymphocyte index, both regarding total cell count and when comparing age-adjusted Z scores. Also, CD3+, CD4+ and CD8+ lower levels were observed in this group, the lowest count in those patients who had undergone thymus resection during the first year of life. Their TREC level median was 23.6/μL vs 16.1 miL in the non-thymus group (p = 0.22). No differences were identified regarding immunoglobulin levels or infection events frequencies over the previous year. Conclusion: Patients with del22q11.2 syndrome subjected to thymus resection present lower lymphocyte and TREC indexes when compared to patients without thymectomy. This situation may be influenced by the age at the surgery and the time elapsed since the procedure

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Cross-over clinical trial for evaluating the safety of camel's milk intake in patients who are allergic to cow's milk protein

Background: Cow's milk protein allergy (CMPA) affects between 0.6 and 0.9% of the general population, and its treatment implies the total elimination of the intake of this protein. Camel's milk has been suggested as an alternative for patients over one year of age who suffer from CMPA due to the difference in the amino acid sequence from that of cow's milk. The objective of this study was to evaluate the safety and tolerability of camel's milk in children with CMPA. Methods: Crossed clinical trial for the use of camel's milk vs. amino acid formula, carried out at the Dr. Federico Gómez Children's Hospital of Mexico (HIMFG) on patients between one and 18 years of age with diagnosed CMPA confirmed through double-blind, placebo-controlled food challenges (DBPCFCs). Only those whose allergies were confirmed were randomly placed into two groups: those to be administered camel's milk and those to be administered the amino-acid formula for two weeks, followed by a six-week wash-out period, and then a group crossing for a further two weeks. Results: 49 patients with suspected CMPA were included in the study; the diagnosis was confirmed through DBPCFCs in 15 patients, who were those who participated in the study. After having been administered camel's milk, none of the patients presented adverse effects. Conclusions and clinical relevance Camel's milk is safe and tolerable in patients above one year of age with CMPA and can be considered as a good alternative given the benefit of its taste compared to other formulas (AU)

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Dermatophagoides pteronyssinus: changes in sensitisation in the past 11 years and comparison with other centres in Mexico

BACKGROUND: House dust mites are a ubiquitous air allergen in the human habitat. It has been shown that exposure to them is a fundamental factor in sensitisation and development of atopic disease. The objective of the study was to analyse changes in sensitisation to Dermatophagoides pteronyssinus (Der p.) in children treated in a tertiary level care hospital in Mexico City for a period of 11 years and compare with other studies carried out in Mexico. METHODS: A retrospective study was performed at the Hospital Infantil de México Federico Gómez (HIMFG). Information was gathered from skin tests for Der p. performed in the Allergy Laboratory from January 2004 to April 2015. Patients 2-18 years old who presented for examination of some type of allergic condition and who had immediate hypersensitivity tests to Der p. were included in the study. Results were compared with prior reports from other institutions. Descriptive analysis and 2 statistics were used. RESULTS: A total of 8794 patients were included in the study; 49.3% of the tests (95% CI 48-50) were positive for Der p. The percentage of monosensitised to mites was 2.7% for Der p. (95% CI 2-3). A significant difference was found between the results of older patients and those <6 years old. The frequency of sensitisation had a tendency to decrease during the 11 years analysed in all age groups. Conclusions and clinical relevance: The frequency of sensitisation to Der p. increased with age until reaching adolescence. In the last 11 years a decrease in sensitisation to this air allergen was observed

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The increase in seroprevalence to Toxocara canis in asthmatic children is related to cross-reaction with Ascaris suum antigens

Background: It has been suggested that the presence of Toxocara canis larvae in lungs is an underlying factor in the onset of asthma. Although the association of asthma and seropositivity to Toxocara has been observed, there are no studies that indicate whether these antibodies are specific against T. canis antigens. Methods: Seroprevalence to T. canis excretion-secretion antigens (TcES Ag) were compared between asthmatic children (n=285) and non-asthmatic children (n=152), using IgG-ELISA and IgE-ELISA. The recognition patterns of TcES Ag were determined using Western blot (WB). Results: IgG-ELISA seroprevalence was 30.8% for asthmatic children and 19.7% for non-asthmatic children (p<0.05). IgE-ELISA seroprevalence was 7.7% for asthmatic children and 6.5% for non-asthmatic children, respectively (p>0.05). Sera of both groups positive to IgG-ELISA recognised 11 TcES Ag bands for IgG. No differences between the groups were observed regarding recognition patterns; the asthmatic group, however, presented significantly higher cross-reaction to Ascaris suum somatic antigens (AsS Ag) than the non-asthmatic group. Sixty-three sera from asthmatic children positive to IgG-ELISA were evaluated by WB for IgE and 58.7% revealed a recognition pattern for IgE. In the group of non-asthmatic children positive to IgG-ELISA, 80% presented IgE band recognition. No differences were observed between the groups regarding recognition patterns. Conclusions: The results observed suggest that differences in seroprevalence determined by IgG-ELISA between groups of asthmatic and non-asthmatic children reported by other authors occur because of a higher frequency of cross-reaction in asthmatic children (AU)

A comparative study of bronchodilator reversibility with albuterol, between asthma symptomatic and asymptomatic children according to ISAAC Questionnaire in Mexico City

Background: Asthma is an important childhood disease. Recent surveys of the International Study of Asthma and Allergies in Childhood (ISAAC) suggest that the prevalence of asthma is increasing but these surveys do not include any pulmonary tests to confirm the possible diagnosis of asthma. Objective: To compare bronchodilator reversibility with the albuterol test in symptomatic and asymptomatic 6-7-year-old children with asthma participating in the ISAAC survey and living in Mexico City. Patients and methods: We performed an observational, descriptive, comparative, cross sectional study in children participating in phase 3b of the ISAAC study. According to the ISAAC questionnaire children were classified as asthma symptomatic or asymptomatic. Both groups had bronchodilator reversibility with the albuterol test, using the guidelines of the American Thoracic Society to confirm or rule out the diagnosis of asthma. Results: The asymptomatic group had a baseline FEV1 of 1.70 ± 0.34 l/sec (mean ± SD) and an endpoint FEV1 of 1.76 ± 0.42 l/sec; in the symptomatic group the respective values were 1.51 ± 0.41 l/sec and 1.57 ± 0.44 l/sec (p < 0.05). A positive reversibility test was found in 13/136 (9.6 %) children in the asymptomatic group and in 22/112 (19.6 %) children in the symptomatic group (p < 0.05). Conclusion: Because of its low sensitivity, bronchodilator reversibility cannot be considered a diagnostic tool to confirm diagnosis of asthma (AU)

Introducción: El asma es una enfermedad infantil importante. Las encuestas recientes del Estudio Internacional sobre Asma y Alergias en la Infancia (ISAAC, por sus siglas en inglés) sugieren un aumento de la prevalencia del asma, si bien este instrumento de estudio no incluye ninguna prueba pulmonar para confirmar el posible diagnóstico de la enfermedad. Objetivo: Comparar la reversibilidad con tratamiento broncodilatador a base de albuterol entre niños asmáticos sintomáticos y asintomáticos según el estudio ISAAC, de edades comprendidas entre los 6 y 7 años y residentes en Ciudad de México. Pacientes y métodos: Se trató de un ensayo comparativo transversal, de carácter descriptivo y basa- do en la observación, realizado sobre niños que participaron en una encuesta de la fase 3b del ISAAC. Según el cuestionario del ISAAC, los niños se clasificaron como asmáticos sintomáticos o asintomáticos para asma. Ambos grupos fueron sometidos a la prueba de reversibilidad con tratamiento broncodilatador a base de albuterol, siguiendo las directrices de la Sociedad Torácica Americana, para confirmar o descartar el diagnóstico de asma. Resultados: El grupo asintomático presentó un FEV1 inicial de 1,70 ñ 0,34 l/seg (media ñ DE) y un FEV1 final de 1,76 ñ 0,42 l/seg; en el grupo sintomático, los valores respectivos fueron 1,51 ñ 0,41 l/seg y 1,57 ñ 0,44 l/seg (p < 0,05). En el grupo asintomático, 13 de 196 niños (el 9,6 por ciento) dieron positivo en la prueba de reversibilidad; en el grupo sintomático dieron positivo 22 de 112 niños (el 19,6 por ciento) (p < 0.05). Conclusión: La reversibilidad con tratamiento broncodilatador no puede considerarse una herramienta para confirmar el diagnóstico del asma debido a su bajo nivel de precisión (AU)

Formoterol vs. Albuterol administered via Turbuhaler System in the emergency treatment of acute asthma in children

Background: Formoterol is a new β2-agonist with a duration of 8-12 hours. Albuterol is a β2-agonist with rapid onset of action and a duration of approximately 6 hours.Objective: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler®. Material and method: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 μg or salbutamol 200 μg. The two drugs were administered through a Turbohaler® system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. Results: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 ± 15.0 for formoterol and 82 ± 14.4 for albuterol at 60 minutes (p > 0.05). Conclusions: Formoterol 12 μg has a similar onset of action and potency to albuterol 200 μg when administered via a Turbuhaler® in children with a mild acute asthma crisis (AU)

Información básica: Formoterol es un nuevo Beta2-agonista con un efecto de 8-12 horas. Salbutamol es un Beta2-agonista con una acción de comienzo rápido que dura aproximadamente 6 horas. Objetivo: El objetivo del presente estudio era comparar el inicio de la acción entre formoterol y salbutamol, ambos administrados mediante Turbohaler. Material y método: En un estudio doble ciego y de grupos paralelos se distribuyó aleatoriamente a 36 pacientes para recibir formoterol 12 mg o salbutamol 200mg. Los dos fármacos se administraron por medio de un sistema Turbohaler. Se evaluó la respuesta ( por cientoFEV1) 3, 30 y 60 minutos después de la administración del fármaco. Resultados: Los valores de por cientoFEV1 a los 3, 30 y 60 minutos fueron semejantes entre los grupos (p > 0,05), p. ej., 82 ñ 15,0 con formoterol y 82 ñ 14,4 con salbutamol a los 60 min. Conclusiones: Formoterol 12mg tuvo un inicio de acción y una potencia similares a las de salbutamol 200mg cuando se administraron a través de Turbuhaler a niños con crisis asmáticas agudas leves (AU)

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)

Exercise induced bronchospasm in asthmatic and non-asthmatic obese children

Aim: to investigate the spirometric response to the exercise challenge in asthmatic and non-asthmatic obese children. Patients, materials and methods: it was a prospective, longitudinal, open label clinical trial with four groups of children from 8 to 16 years. The group 1 had 15 asthmatic non-obese children. The group 2 had 15 asthmatic obese children. The group 3 had 15 non-asthmatic obese children. The group 4 had 13 control healthy children. Spirometry measures were realized at baseline, and after exercise at 2, 5, 10, 15, 20, 25, 30 and 60 minutes. Exercise challenge was performed on a walking band at 6 km/h speed and a slope of 10° with a duration of 6 to 8 minutes. Data were are analized by repeated measures ANOVA. Results: the mean age was 11.8 ± 2.1, and the mean height was 150.2 ± 11.3 cm, the mean weight was 46.3 ± 17.15 in the group 1, 59.4 ± 11.9 in the group 2, 67.8 ± 20.6 in the group 3, and 44.2 ± 9.7 in the group 4. The mean values of forced expiratory volume in one second (FEV1) for each group are shown on table II. Conclusions: the non-asthmatic obese children had a significant decrease in FEV1, meanwhile the asthmatic obese children had a deeper decrease in FEV1 than the asthmatic non-obese children. Obesity ay be a conditioning factor for bronchial hyperreactivity to the exercise (AU)

La obesidad en el niño se ha incrementado en la última década. Desafortunadamente las alteraciones de la función pulmonar han sido poco estudiadas en niños obesos con y sin patología respiratoria como el asma. Nuestro objetivo fue evaluar la función pulmonar al reto con ejercicio en niños obesos con asma y sin asma. Se realizó un estudio prospectivo, longitudinal, abierto, en 58 niños de 8 a 16 años, divididos en cuatro grupos: grupo 1 (15 asmáticos no obesos), grupo 2 (15 asmáticos obesos), grupo 3 (15 obesos no asmáticos) y grupo 4 (13 niños sanos). Antes de iniciar el reto con ejercicio se realizó una espirometría basal y posteriormente a los 2', 5', 10', 15', 20', 25', 30' y 60'. La prueba de ejercicio fue en una banda sin fin con una velocidad inicial de 1 km/h y una inclinación de 0° hasta llegar a 6 km/h y 10° por 6 a 8'. Cuando el FEV1 disminuía más del 15 por ciento de los valores basales y/o tenían sibilancias y tos se consideraba que el paciente presentaba una obstrucción de la vía aérea de gran calibre, diagnosticándose así broncoespasmo inducido por ejercicio. El estudio estadístico fue mediante el análisis de varianza de medidas repetidas.Resultados: la edad media de los cuatro grupos fue de 11,8 ñ 2,1 años y la talla de 150 ñ 11,3 cm.De acuerdo a cada grupo el peso medio del grupo 1 fue de 46,3 ñ 17,1 kg, grupo 2: 59,4 ñ 11,9, grupo 3: 67,8 ñ 20,64 y grupo 4: 44,2 ñ 9,7 kg. El descenso del FEV1 mayor del 15 por ciento después del ejercicio se presentó en el 80 por ciento (12/15) del grupo 1, en el 100 por ciento del 2, en el 73,3 por ciento (11/15) del grupo 3 y en 1 de los 13 del grupo 4. De acuerdo con esto, los obesos no asmáticos tuvieron una respuesta al ejercicio semejante a los asmáticos no obesos (p = 0,05) y los obesos asmáticos respondieron más al ejercicio comparado con los asmáticos no obesos (p < 0,01) (tabla II). Conclusiones: la obesidad es un factor que condiciona una mayor respuesta bronquial al ejercicio tanto en niños asmáticos como no asmáticos y es de llamar la atención que los obesos sin asma tengan hiperreactividad bronquial al ejercicio semejante a la de los asmáticos no obesos. (AU)