Positive Mental Health Questionnaire (PMHQ) for Healthcare Workers: A Psychometric Evaluation.

The Positive Mental Health Questionnaire (PMHQ) has been validated across various populations but has displayed diverse psychometric structures depending on the procedures used. The original version of the PMHQ includes 39 items organized into 6 factors, although there are reports that indicate a reduced structure of between 1 and 4 factors. The aim of this study was to assess the psychometric properties of the PMHQ with 1, 4 and 6 factors. A total of 360 healthcare workers aged 23 to 77 (M = 37.06; SD = 10.79) participated. Construct validity was assessed through confirmatory factor analysis using weighted root mean square residual. The original 6-factor (χ2/df: 3.40; RMSEA: 0.085; CFI: 0.913; TLI: 0.906) and a reduced 4-factor (χ2/df: 2.90; RMSEA: 0.072; CFI: 0.931; TLI: 0.926) structure showed acceptable fit. The fit of the 1-factor model was unacceptable. The internal consistency was evaluated through McDonald's ω, and it was acceptable for 4 of 6 factors of the original structure and for 3 of 4 factors of the reduced structure. In conclusion, these findings suggest that the 6-factor and 4-factor models are valid for measuring positive mental health. However, issues with internal consistency must be investigated.

Burnout and Its Relationship with Work Engagement in Healthcare Professionals: A Latent Profile Analysis Approach.

The aim of this study was to use latent profile analysis to identify specific profiles of burnout syndrome in combination with work engagement and to identify whether job satisfaction, psychological well-being, and other sociodemographic and work variables affect the probability of presenting a profile of burnout syndrome and low work enthusiasm. A total of 355 healthcare professionals completed the Spanish Burnout Inventory, the Utrecht Work Engagement Scale, the Job Satisfaction Scale, and the Psychological Well-Being Scale for Adults. Latent profile analysis identified four profiles: (1) burnout with high indolence (BwHIn); (2) burnout with low indolence (BwLIn); (3) high engagement, low burnout (HeLb); and (4) in the process of burning out (IPB). Multivariate logistic regression showed that a second job in a government healthcare institution; a shift other than the morning shift; being divorced, separated or widowed; and workload are predictors of burnout profiles with respect to the HeLb profile. These data are useful for designing intervention strategies according to the needs and characteristics of each type of burnout profile.

Immunostimulants for preventing respiratory tract infection in children: A systematic review and meta-analysis.

Childhood acute respiratory tract infections (ARTIs) are a significant cause of morbidity and mortality, so, immunostimulants have been used as a preventative measure. Despite this, there is no updated evidence regarding the safety and efficacy of immunostimulant drugs for this purpose. This study aimed to determine the effectiveness and safety of immunostimulants in preventing ARTIs in children based on the most recent scientific evidence. Data sources such as PubMed, Cochrane Central Register of Controlled Trials, Embase, Google Scholar, and Scopus were searched from 1965 to 10 January 2022 to identify randomized controlled trials (RCTs) comparing immunostimulants administered by any method, with placebo to prevent ARTIs on children under 18 years of age without immunodeficiencies, anatomical, genetic, or allergic conditions. In order to analyze data from the studies, we used Review Manager 5.4 (The Cochrane Collaboration, 2020), assessed the certainty of the evidence with Grading of Recommendations, Assessment, Development and Evaluations (GRADE), and assessed the quality and risk of bias of the studies using the RoB tool 1.0. Further, outcomes were combined and analyzed using meta-analysis, subgroup analysis, and sensitivity analysis. Throughout the review, we included 72 placebo-controlled clinical trials involving 12,229 children. The meta-analyses, however, included only 38 studies (52.8%) with 4643 children (38% of the total) with data on mean number of ARTIs. These studies demonstrated a reduction in the ARTIs (MD -1.12 [95%CI -1.39 to -0.85]) and ratio of means of ARTIs (0.61 [95%CI 0.54-0.69]), corresponding to a percentage reduction of 39% (95%CI, 46%-31%) with moderate-quality data. Nevertheless, since there was considerable to substantial heterogeneity and bias was unclear in all domains in 32 out of 72 trials, the quality of the evidence for efficacy was deemed low. Only 14 trials reported adverse events. The review indicates that immunostimulants reduce the incidence of ARTIs by 40% on average in susceptible children, despite low-quality evidence, heterogeneity, and the possibility of publication bias. However, further studies are needed to establish immunostimulants' safety and efficacy profiles. This review was conducted without the support of any funding and has no registered number.

Tracing COVID-19 Source of Infection Among Health Personnel in a Pediatric Hospital.

Health personnel (HP) have been universally recognized as especially susceptible to COVID-19. In Mexico, our home country, HP has one of the highest death rates from the disease. From the beginning of the SARS-CoV-2 pandemic, an office for initial attention for HP and a call center were established at a COVID-19 national reference pediatric hospital, aimed at early detection of COVID-19 cases and stopping local transmission. The detection and call center implementation and operation, and tracing methodology are described here. A total of 1,042 HP were evaluated, with 221 positive cases identified (7.7% of all HP currently working and 26% of the HP tested). Community contagion was most prevalent (46%), followed by other HP (27%), household (14%), and hospitalized patients (13%). Clusters and contact network analysis are discussed. This is one of the first reports that address the details of the implementation process of contact tracing in a pediatric hospital from the perspective of a hybrid hospital with COVID-19 and non-COVID-19 areas.

Characteristics and Outcomes of Cases of Children and Adolescents With Pediatric Inflammatory Multisystem Syndrome in a Tertiary Care Center in Mexico City.

Background: Pediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City. Methods: This was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiologic evaluations, treatment, and clinical outcomes were analyzed. Results: Seventy-five cases fulfilled the case definition criteria for PIMS [median age: 10.9 years, Interquartile range (IQR): 5.6-15.6]. Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms. Conclusion: There were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

Association of Genetic Polymorphisms and Serum Levels of IL-6 and IL-8 with the Prognosis in Children with Neuroblastoma.

There is evidence that high circulating levels of IL-6 and IL-8 are markers of a poor prognosis in various types of cancer, including NB. The participation of these cytokines in the tumor microenvironment has been described to promote progression and metastasis. Our objective was to evaluate the prognostic role of genetic polymorphisms and serum levels of IL-6 and IL-8 in a cohort of Mexican pediatric patients with NB. The detection of the SNPs rs1800795 IL-6 and rs4073 and rs2227306 IL-8 was carried out by PCR-RFLP and the levels of cytokines were determined by the ELISA method. We found elevated circulating levels of IL-8 and IL-6 in NB patients compared to the control group. The genotype frequencies of the rs1800795 IL-6 and rs4073 IL-8 variants were different between the patients with NB and the control group. Likewise, the survival analysis showed that the GG genotypes of rs1800795 IL-6 (p = 0.014) and AA genotypes of rs4073 IL-8 (p = 0.002), as well as high levels of IL-6 (p = 0.009) and IL-8 (p = 0.046), were associated with lower overall survival. We confirmed the impact on an adverse prognosis in a multivariate model. This study suggests that the SNPs rs1800795 IL-6 and rs4073 IL-8 and their serum levels could be promising biomarkers of a poor prognosis, associated with overall survival, metastasis, and a high risk in Mexican children with NB.

Alergia ocular / Ocular allergy

Resumen La alergia ocular consiste en un grupo de enfermedades caracterizadas por inflamación de la conjuntiva ocular, dentro de las que podemos encontrar a la conjuntivitis alérgica estacional (CAE) o perenne (CAP), la queratoconjuntivitis vernal, la queratoconjuntivitis atópica y la blefaroconjuntivitis de contacto. Aqueja aproximadamente al 10% de la población mundial, y los más afectados son pacientes con otras patologías alérgicas. El diagnóstico es clínico y se integra mediante los síntomas y hallazgos encontrados durante la exploración física oftalmológica presentes en el sujeto al momento de la visita. Los principales objetivos del tratamiento en la conjuntivitis alérgica son minimizar y controlar los signos y síntomas de la enfermedad, incluyendo la reducción del prurito, de la hiperemia y del edema de la conjuntiva y párpados, así como mejorar la calidad de vida del paciente. El tratamiento incluye medidas no farmacológicas, como evitar estímulos irritantes, el uso de lágrimas artificiales, la aplicación de compresas frías y medicamentos como vasoconstrictores, antihistamínicos, estabilizadores de mastocitos, agentes de acción dual, esteroides y fármacos inmunomoduladores, así como inmunoterapia alérgeno específica. Los cambios desencadenados por la inflamación de la conjuntiva, producen daño corneal mecánico, y en los casos graves y crónicos de la enfermedad, el daño corneal puede resultar en la disminución de la agudeza visual, lo cual disminuye la calidad de vida del paciente.

Abstract Ocular allergy is a group of diseases characterized by inflammation of the ocular conjunctiva and include seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis and contact blepharoconjunctivitis; affects approximately 10% of world population being most affected those patients with other allergic diseases; the diagnosis is clinical and is integrated through the symptoms and findings found during the physical examination. The main goals of treatment in allergic conjunctivitis are minimize and control the signs and symptoms of the disease, including the reduction of pruritus, hyperemia and edema of the conjunctiva and eyelids as well as improving the quality of life of the patient; treatment includes non-pharmacological measures such as avoiding irritant stimuli, use of artificial tears, application of cold compresses and medications such as vasoconstrictors, antihistamines, mast cell stabilizers, dual acting agents, steroids and immunomodulatory drugs, as well as specific allergen immunotherapy. Changes triggered by inflammation of the conjunctiva produce mechanical corneal damage and in severe and chronic cases of the disease, corneal damage can result in decreased visual acuity, which results in a decrease patient's quality of life.

Asma en pediatría / Asthma in pediatrics

Resumen El asma es un trastorno inflamatorio crónico de las vías respiratorias, que lleva a episodios recurrentes de sibilancias, disnea, sensación de opresión torácica y tos. Actualmente se considera como un problema de salud pública en diversos países, y en México su prevalencia se estima en un 8%. Se puede dividir en 2 grandes grupos: asma alérgica, mediada por inmunoglobulina E (IgE) y desencadenada principalmente por aeroalérgenos, y asma no alérgica, cuyos factores etiológicos son las infecciones, irritantes, etc. Los principales componentes a identificar antes de iniciar el tratamiento son: la gravedad, el control, la respuesta a medicamentos y la incapacidad provocada. El tratamiento farmacológico se basa en medicamentos rescatadores, que se utilizan en situaciones agudas, y controladores administrados de forma continua y encaminados a disminuir la inflamación y los síntomas a largo plazo. Las decisiones de la terapéutica instalada deben de ser dinámicas, pasando de una etapa a otra, de acuerdo con los síntomas. En el caso de que exista algún alérgeno como desencadenante de los cuadros, se recomienda utilizar la inmunoterapia para reducir la respuesta alérgica, principalmente en los casos en los que el alérgeno no pueda evitarse.

Abstract Asthma is a chronic inflammatory disorder of the airways, which leads to recurrent episodes of wheezing, shortness of breath, chest tightness and/or cough; now is considered a public health problem in many countries, in Mexico the prevalence is estimated in 8%. Asthma can be divided in two groups: allergic asthma, IgE-mediated and primarily triggered by airborne allergens and no allergic asthma whose etiological factors are infections, irritants, etc. The main components to be identified before starting treatment are: severity, control, response to drugs and disability. Medications to treat asthma can be classified as relievers, drugs used in acute situations or controllers, medications taken daily on a long-term basis to keep asthma under clinical control chiefly through their anti-inflammatory effects. The therapeutic decisions must be installed dynamic, moving from one to another stage, according to the symptoms. In case an allergen is the trigger of the symptoms, the recommended treatment is immunotherapy in order to reduce the allergic response especially in cases where the allergen can not be avoided.

[Antihistamines for the treatment of urticaria in Mexico]. / Antihistamínicos en el tratamiento de la urticaria en México.

There are four types of histamine receptors. Allergic symptoms, especially those in rhinoconjunctivitis and urticaria, are mainly caused by activation of histamine receptor 1 (H1). Consequently, oral H1-antihistamines form and integral part of the treatment of these diseases. Antihistamines are inverse agonists that stabilize the non-active configuration of the histamine receptor. First generation H1-antihistamines cause a variety of adverse effects via several mechanisms: sedation (accumulation in the central nervous system), dry mouth, urinary retention, weight gain (low selectivity: stimulation of serotonin/muscarinic/alpha-adrenergic receptors) and drug interactions (substrate of CYP450-3A4). Generally second generation H1-antihistamines have a better safety profile. New guidelines on allergic rhinitis and urticaria recommend second generation H1-antihistamines as first line drugs, with -if necessary- four-times updosing to obtain control in urticaria. The enhanced efficacy of quadruple doses in urticaria, while maintaining a good safety profile, has been shown for bilastine, desloratadine and levocetirizine (rupatadine). For ebastine and fexofenadine only the safety of quadruple doses has been shown till now. Extreme precaution should be taken with astemizol and terfenadine that never should be up-dosed, as high serum concentrations can cause potentially fatal ventricular tachycardia. First generation antihistamines are not recommended as first line treatment and updosing is not safe.

Existen cuatro tipos de receptores histaminérgicos. Los síntomas de alergia, especialmente rinoconjuntivitis alérgica y urticaria, son principalmente causados por activación del receptor H1; por ende, los antihistamínicos H1 orales (anti-H1) forman parte integral del tratamiento de estas enfermedades. Los antihistamínicos son agonistas inversos, porque estabilizan la forma inactiva del receptor. Los antihistamínicos H1 de primera generación producen efectos adversos por varios mecanismos: sedación (fijación a receptores H1 cerebrales), boca seca, retención urinaria, aumento de peso (baja selectividad: estimulación de los receptores de serotonina, muscarina y alfa-adrenérgicos) e interacciones medicamentosas (con sustrato de citocromo P450-3A4). Los antihistamínicos H1 de segunda generación son generalmente más seguros. Las nuevas guías de tratamiento de la rinitis alérgica y urticaria recomiendan como manejo de primera intención a los antihistamínicos H1 de segunda generación. En urticaria se recomienda hasta cuadruplicar su dosis en caso necesario. El aumento de la eficacia en el control de la urticaria con cuádruple dosis, sin que se afecte la seguridad, se ha documentado para bilastina, desloratadina y levocetirizina (rupatadina). Respecto de ebastina y fexofenadina, hasta ahora, sólo se comprobó la seguridad de cuádruple dosis. Una rigurosa excepción son astemizol y terfenadina, que a concentraciones séricas elevadas pueden causar taquicardia ventricular. No se recomiendan los antihistamínicos H1 de primera generación y aumentar su dosis no es seguro.

[Radiographic changes in children with primary immunodeficiency]. / Alteraciones radiográficas en niños con inmunodeficiencia primaria.

BACKGROUND: Although we have epidemiological information on primary immunodeficiencies (PID), the available information is meager in Mexico. OBJECTIVE: To provide epidemiological information on the delay in the diagnosis of PID and its correlation to chronic lung damage. MATERIAL AND METHOD: A retrospective, analytical study was done in patients 0-18 year old age diagnosed with PID for 11 years at the HIMFG (Hospital Infantil de Mexico Federico Gomez). The variables studied were: age at symptom onset, age at diagnosis, time from onset of symptoms to diagnosis, number of previous pneumonias and studies with radiographic chronic lung damage data. RESULTS: 48 patients were obtained after meeting inclusion criteria; 33 showed lung damage at diagnosis, antibody deficiency being the most affected group. Relating age of onset of symptoms and the time difference of the onset of symptoms to diagnosis showed a strong correlation (p < 0.001, Rho > 0.80). A moderate correlation between the observed time difference vs number of pneumonias (p=0.005, Rho=0.495) and correlation between number of pneumonia and lung damage was highly significant (p <0.001, Rho=0.704). CONCLUSION: A strong relationship between the elapsed time from onset of symptoms and the number of pneumonia with lung injury time was found. So, the recurrent pneumonia (> 2) must make suspect the diagnosis of PID, as recommended in the literature.

Antecedentes: si bien se cuenta con información epidemiológica de las inmunodeficiencias primarias, la información disponible en México es escasa. Objetivos: dar información epidemiológica del retraso del diagnóstico de las inmunodeficiencias primarias y de su correlación con daño pulmonar crónico. Material y método: estudio retrospectivo, analítico, efectuado en pacientes de 0 a 18 años de edad con diagnóstico de inmunodeficiencias primarias durante 11 años en el Hospital Infantil de México Federico Gómez; las variables estudiadas fueron: edad al inicio de los síntomas, edad al diagnóstico, tiempo desde el inicio de los síntomas al diagnóstico, número de neumonías previas y estudios radiográficos con datos de daño pulmonar crónico. Resultados: se incluyeron 48 pacientes que cumplieron los criterios de inclusión; 33 tenían daño pulmonar al diagnóstico, el déficit de anticuerpos fue el grupo con mayor afectación. Al correlacionar la edad de inicio de los síntomas y la diferencia de tiempo del inicio de los síntomas al diagnóstico se obtuvo una fuerte correlación (p <0.001, Rho > 0.80). Se observó una correlación moderada entre la diferencia en tiempo vs número de neumonías (p=0.005, Rho=0.495) y la correlación entre número de neumonías y daño pulmonar mostró significación alta (p <0.001, Rho=0.704). Conclusión: se encontró una relación estrecha entre el tiempo transcurrido desde el inicio de los síntomas y el número de neumonías con el daño pulmonar, por lo que las neumonías de repetición (más de dos) deben hacer sospechar el diagnóstico de inmunodeficiencia primaria, como se recomienda en la bibliografía mundial.

[Mexican guidelines on the diagnosis and treatment of urticaria]. / Guía Mexicana para el Diagnóstico y el Tratamiento de la Urticaria.

BACKGROUND: Urticaria is a disease that a fifth of the population shallsuffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups -both specialists and primary health care workers-, necessary in Mexico. MATERIAL AND METHOD: Internationally recognized tools for guidelinedevelopment were used. An interdisciplinary group of clinical experts (some of them knowledgeable in methodology of guideline development) determined the objectives and scope of the Evidence Based Clinical Practice Guideline with SCOPE. It was decided to adapt and transculturize international guidelines on the diagnosis and treatment of urticaria. With AGREE-II three high-quality guidelines (Zuberbier 2014, Sánchez-Borges 2012, Powell 2007) were selected to function as basic guidelines (BG). A set of Clinical Questions was formulated that lead to recommendations/suggestions, based on these BG, taking into account the cultural and economic background of Mexico, according to GRADE recommendation development. RESULTS: By a formal process of discussion and voting during several working-sessions, experts and first level healthcare physicians determined the wording of the final guideline, taking particularly care of developing a document, adjusted to the reality, values and preferences of the Mexican patients. The use of oral second generation, non-sedating antihistamines as first line treatment is emphasized. CONCLUSION: This document is an Evidence Based Clinical Practice Guideline for the diagnosis and treatment of acute and chronic urticaria, based on three, high quality, international guidelines. It was developed by a multidisciplinary group. Tables and algorithms make the guideline user-friendly for both, first line health care physicians and specialists.

Antecedentes: la urticaria es una enfermedad que padece una quinta parte de la población en algún momento de su vida. Las guías internacionales recientes han propuesto unos cambios de fondo en su diagnóstico y tratamiento, por lo que había la necesidad de crear una guía nacional y multidisciplinaria, con base amplia en los gremios de especialistas y médicos de primer contacto en México. Material y método: un grupo interdisciplinario de expertos clínicos y algunos expertos en metodología determinó los objetivos y alcances de la Guía de Práctica Clínica Basada en Evidencia con el instrumento SCOPE. Se decidió llevar a cabo la adaptación y transculturización de guías internacionales para el diagnóstico y tratamiento de urticaria. Con el instrumento AGREE-II se seleccionaron las tres guías de alta calidad, como guías base (Zuberbier 2014, Sánchez-Borges 2012, Powell 2007) para formular y contestar la preguntas clínicas clave, en el contexto cultural y económico mexicano, según el método de desarrollo de recomendaciones GRADE. Resultados: mediante un proceso formal de discusión y votación durante varias juntas de expertos, se terminó la redacción de la forma final de la guía, con especial cuidado de lograr un ajuste a las realidades, valores y preferencias de los pacientes de México. Se hace hincapié en la administración de antihistamínicos vía oral de segunda generación, como tratamiento de primera elección. Conclusión: este documento es una Guía de Práctica Clínica Basada en Evidencia para el diagnóstico y tratamiento de urticaria aguda y crónica, basada en tres guías internacionales de alta calidad. Se desarrolló por un grupo multidisciplinario. Los cuadros y algoritmos hacen a la guía amigable para su uso por médicos de primer contacto y por especialistas.

Relación de la obesidad con el asma y la función pulmonar / Relationship among obesity, asthma and pulmonary function

La obesidad y el asma son problemas de salud pública y muchos estudios han demostrado la relación entre estas dos enfermedades. Existe una correlación positiva entre el índice de masa corporal y el asma; el riesgo de padecer asma aumenta con el incremento de la masa corporal. La probabilidad de desarrollar asma de un escolar obeso puede ser hasta de 50%. La asociación entre la obesidad y el asma se ha descrito con más frecuencia en mujeres, particularmente en estudios de adultos. La obesidad puede afectar directamente el fenotipo del asma por efectos mecánicos en la vía aérea, por reflujo gastroesofágico, por la producción de citocinas proinflamatorias en el tejido adiposo (interleucina 6, factor de necrosis tumoral, leptina, adiponectina), por la activación de genes comunes o por el aumento en la producción de estrógenos. La obesidad puede agravar los síntomas del asma y ser causante de su pobre control; la disminución del peso mejora los síntomas y la función pulmonar y reduce el uso de medicamentos antiasmáticos. Por lo tanto, es necesario que el manejo de los asmáticos obesos incluya un programa de control de peso.

Obesity and asthma are public health issues. Many studies have demonstrated a relation between both conditions. There is a positive correlation between body mass index and asthma; the risk of suffering from asthma is greater as body mass increases. The probability for developing asthma in an obese school-age child may be as high as 50%. An association between obesity and asthma has been described more frequently in females, particularly in adult surveys. Obesity may directly affect asthma phenotype by mechanical effects in the respiratory tract, gastroesophageal reflux, production of proinflammatory cytokines in fat tissue (interleukin 6, tumor necrosis factor, leptin, adiponectin), activation of common genes, or by increased estrogen production. Obesity may worsen asthma symptoms as well as causing poor control of the condition. Weight loss improves symptomatology and pulmonary function, along with reducing the use of antiasthmatic medication. Therefore, it is necessary that management of obese asthmatic patients includes a weight control program.

[Food allergy]. / Alergia a alimentos.

Food allergy is defined as an abnormal immunological reaction to food proteins, which causes an adverse clinical reaction. Most of the people become tolerant to many foods; however some time these tolerances fail and become an immunologic reaction. This is the first clinical expression of allergy, beginning with dermal o gastric manifestations and continues with asthma and rhinitis (the allergy march) and represents a very severe health problem, not only for many children and parents, but also for the entire medical and paramedical community. The evaluation of a child with suspected food allergy includes detailed medical history, physical examination, screening tests and response to elimination diet and to oral food challenge. None of the screening tests, alone or in combination, can definitively diagnose or exclude it. Regarding to the differential diagnosis, the clinician must know the different groups of foods. The treatment includes the exclusion of the involved food and the use of symptomatic medication when it is needed.

Aproximación práctica al diagnóstico de la alergia alimentaria / Practical approach to the diagnosis of food allergy

La alergia alimentaria representa la primera expresión clínica de atopia durante la vida, ya sea con manifestaciones gastrointestinales o cutáneas, seguidas de asma y rinitis. A este continuo desarrollo de enfermedades se ha denominado "marcha atópica". Es un problema importante de salud, no sólo para los pacientes sino también incluye al grupo familiar y social. Se define como una respuesta inmunológica anormal ante la ingesta de proteínas alimenticias que ocasionan una reacción clínica adversa. La mayoría de las personas desarrolla tolerancia a los antígenos alimentarios, los cuales constantemente acceden al organismo. Sin embargo, cuando la tolerancia falla, el sistema inmune responde con reacciones de hipersensibilidad. El diagnóstico de la alergia alimentaria todavía es un ejercicio clínico que depende de una historia cuidadosa, de la determinación específica de IgE, pruebas de parche, una apropiada dieta de exclusión y la realización de reto cegado.

Food allergy has become the first clinical expression of atopy, beginning with dermal o gastric manifestations to continue with asthma an rhinitis ("the atopic march"), a very severe health problem not only for many children and parents, but also for the entire medical and paramedical community. Food allergy is defined as an abnormal immunological reaction to food proteins, which causes an adverse clinical reaction. Most of the people become tolerant to many foods; however, these tolerances sometimes fail and become an immunological reaction. The evaluation of a child with suspected food allergy includes detailed medical history, physical examination, screening tests and response to elimination diet and to oral food challenge. None of the screening tests -alone or in combination- can definitely diagnose or exclude it.

[Risk factors of food allergy]. / Factores de riesgo de alergia alimentaria.

Food allergy or allergic food hypersensitivity is defined as an adverse immunologic reaction caused by immunologic mechanisms mediated or not by IgE. It is a complex disease influenced by polygenetic heritance and environmental factors. Many risk factors have been investigated, pre natal and post natal, and variable and controversial results have been obtained. The most important risk factors associated with food allergy are atopy, lack of breast feeding at least three to six months and early weaning (before four-six months).

[Difficult-to-control asthma. A bibliographical review]. / Asma de difícil control. Revisión de la bibliografía.

Difficult-to-control asthma is a disease that causes serious exacerbations, near-fatal attacks, frequent hospitalizations, and needs chronic use of high doses of inhaled corticosteroids or daily oral corticosteroid therapy. On the basis of epidemiological studies, the risk factors for serious asthma are: female gender, high BMI, sensitivity to aspirin, gastro esophageal reflux, sinusitis, pneumonia history, and beginning of asthma symptoms in adult late age. It has been found that in severe asthma the inflammatory profile commonly changes with major participation of neutrophils, and evidence of destruction and remodelling. The first step in the care of these patients is an evaluation to determine that asthma is the right diagnosis. A systematic and rigorous evaluation helps to asses adequately the differential diagnoses, the comorbilities and the unusual triggers. The aim of the treatment is to achieve the best results with minimum adverse effects. New immunomodulatory therapies are needed for these patients management.

Asma / Asthma

El asma es una enfermedad inflamatoria crónica de las vías aéreas en la cual muchas células y productos celulares juegan un papel importante. La inflamación crónica produce un incremento en la reactividad de la vía aérea y episodios recurrentes de sibilancias, dificultad respiratoria, tiraje intercostal, tos y opresión torácica, especialmente en la noche y en la mañana. Estos episodios se asocian con obstrucción del flujo aéreo, reversible espontáneamente o con tratamiento. La inflamación también causa un aumento en la respuesta bronquial a una gran variedad de estímulos. Es la enfermedad crónica más común en la infancia, los estudios epidemiológicos en América Latina han revelado diferencias en prevalencia del asma con cifras de 5.7 a 16.5% en la población pediátrica. En los últimos años se han realizado estudios en la Ciudad de México aplicando la metodología del ISAAC, determinando que la prevalencia es de 8 a 12%. Varios factores de riesgo se asocian con el desarrollo de esta enfermedad, a continuación se exponen éstos, así como la fisiopatología de la enfermedad, manifestaciones clínicas, estrategias de diagnóstico y opciones terapéuticas.

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. It is the most common respiratory disease in childhood, epidemiologic studies in Latin America report prevalence varying from 5.7 to 16.5%. Recent studies using ISAAC methodology in Mexico City have reported prevalence from 8 to 12%. Numerous risk factors have been associated with this disease. This factors, physiopathology, clinical presentation, diagnosis and therapeutics options are reviewed.

[Diagnosis and treatment in the emergency room of acute asthma in childhood]. / Diagnóstico y tratamiento de crisis asmatica infantil en la sala de urgencias.

Acute asthma is characterized by acute air way obstruction episodes presented as short breath, increased coughing, wheezing and difficult breathing, reversible with bronchodilator. It constitutes one of the most frequent causes of pediatric ER visits whose diagnosis and treatment is not always adequate. It is necessary to carry out a complete medical history searching for the number of previous attacks, risk factors, associated illnesses, triggers, prior hospitalizations, preventive and maintenance treatment used, along with a complete physical examination. During the management of moderate-severe attacks frequent systematic assessments are required to ensure treatment response. In children above 5 years old, monitoring of expiratory peak flow (EPF) during mild-moderate attacks is recommended. In general, a national consensus to classify and treat acute asthma in emergency services does not exist for which the need to develop a clinical practice guide of diagnosis and management arises.

[Adverse reactions to vaccines]. / Reacciones adversas a vacunas.

Vaccination is one of the medicine's achievements to control and/or eradicate certain infectious diseases. Vaccines contain antigenic doses derived from microorganisms and/or its toxins, besides they are composed of other substances such as aluminum, gelatin, egg proteins, mercury components (as thimerosal), and antibiotics; therefore, these substances can produce hypersensitivity reactions. The above-mentioned reactions can be evidenced with itch, edema, hives, asthmatic crisis, hypotension and even anaphylactic shock. Due to the importance of vaccination, especially in childhood, it is essential to know the benefits of vaccines, their impact in morbidity and mortality decrease of certain infected-contagious diseases, as well as the adverse effects and the allergic reactions to their application. As immunizations prevent natural infections, they might contribute to a free infectious environment that would allow atopic response. This paper reviews the allergic reactions to vaccines and their influence on the development of atopic disease.

[Uncommon manifestations of atopic dermatitis]. / Manifestaciones poco frecuentes de dermatitis atópica.

Atopic dermatitis is an inflammatory process characterized by a series of cutaneous alterations of typical morphology and distribution, with intense pruritus of nocturnal predominance, of chronic evolution, stational appearance, and with personal and family history of atopy. On genetically predisposed skin, dry and hypersensitive, the immune factors and other types are implicated in determining the abnormal reactions to multiple endogenous and environmental factors. The diagnosis is clinical, generally obtained by a group of signs and symptoms known as the Hanifin and Rajka criteria. The patients with atopic dermatitis can present with clinical typical manifestations, or minimized and localized variations as well, considered a stigma of atopic constituent. In some patients there can be observed clinical and morphological variations with special localizations denominated atypical variations of atopic dermatitis. The identification of these atypical presentations of atopic dermatitis leads to the differential diagnosis, with an early establishment of the disease's diagnosis and the appropriate and early treatment.