RESUMEN
OBJECTIVE: To explore whether the IFNL3/4 rs12979860 genotype may influence serum levels or production of interferon-inducible protein-10 (IP-10) by peripheral blood mononuclear cells from patients with systemic lupus erythematosus (SLE). METHODS: Sixty-six patients with SLE and 22 healthy blood donors (controls) were included. The IFNL3/4 rs12979860 polymorphism was genotyped by real-time polymerase chain reaction. IP-10 levels in sera supernatants of IFNα stimulated peripheral blood mononuclear cells were measured by enzime-linked immunosorbent assay. RESULTS: Allelic frequencies were CC (29%), CT (52%) and TT (20%) in SLE, and CC (32%), CT (41%) and TT (27%) in healthy controls. Median serum IP-10 levels were higher in SLE patients than in controls (190.8 versus 118.1 pg/ml; p < 0.001), particularly in those with high disease activity (278.5 versus 177.2 pg/ml; p = 0.037). However, serum IP-10 levels were not influenced by IFNL3/4 genotypes. Higher IP-10 production by peripheral blood mononuclear cells was found in both SLE patients (median 519.3 versus 207.6 pg/ml; p = 0.012) and controls (median 454.0 versus 201.7 pg/ml; p = 0.034) carrying the IFNL3/4 C allele compared with carriers of the T allele. CONCLUSIONS: Although IFNL3/4 rs12979860 allele C does not appear to influence serum IP-10 levels in SLE, it plays an important role in the production of IP-10 by peripheral blood mononuclear cells after IFNα stimulation.
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Quimiocina CXCL10/sangre , Interferones/genética , Interleucinas/genética , Leucocitos Mononucleares/metabolismo , Lupus Eritematoso Sistémico/genética , Adulto , Alelos , Estudios de Casos y Controles , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Lupus Eritematoso Sistémico/sangre , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido SimpleRESUMEN
The term cardiovascular diseases (CVD) refers to disorders of heart and blood vessels, and include coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure, among others. Atherosclerosis is a common background of these diseases. It is not infrequent that some acute diseases, such as coronary syndromes, appear superimposed on a chronic arterial disease. Acute coronary syndromes (ACS), found worldwide among the leading causes of death, can be the origin of disabling chronic CVD such as heart failure [46]. Clinical and experimental evidence associates this group of alterations with an inflammatory process that takes part in its pathophysiology. In fact, inflammation is one of the most important factors for its initiation, progression, and consolidation [6].
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Biomarcadores , Cardiopatías , Inflamación , Síndrome Coronario Agudo , Animales , Aterosclerosis , Biomarcadores/sangre , Enfermedad Crónica , Cardiopatías/diagnóstico , Cardiopatías/fisiopatología , HumanosRESUMEN
OBJECTIVE: To assess the impact of different doses of anti-interferon gamma (anti-IFNγ) F(ab')2 fragments, administered prophylactically, on survival and on serum concentration of cytokines in a murine model of sepsis induced by cecal ligation and puncture (CLP). We further explore the impact of therapeutic administration of the most protective dose on survival. SUBJECTS AND TREATMENT: Balb/c mice were prophylactically treated by the intraperitoneal route with anti-IFNγ initiated 2 h before CLP and every 24 h for a total of five times in each of the following doses: 0.01, 0.1, or 1 mg/kg. Sham and control groups received sterile saline solution in a similar scheme. METHODS: Serum tumor necrosis factor (TNF), interleukin (IL)-1ß, IL-6, IL-10 and IFNγ were measured at 3, 24 and 48 h after CLP by ELISA. Survival curves were compared using a Mantel-Haenzel method. RESULTS: Significant prophylactic protection was found only with 0.01 mg/kg, in association with regulation of IL-1ß and IL-10 concentrations. As therapy, anti-IFNγ fragments were protective only when initiated 24 h after CLP. CONCLUSIONS: Delicate modulation of IFNγ at the correct timing, even when the septic process has begun, is an exciting alternative to explore in the treatment of sepsis.
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Fragmentos de Inmunoglobulinas/química , Interferón gamma/metabolismo , Sepsis/inmunología , Animales , Modelos Animales de Enfermedad , Ensayo de Inmunoadsorción Enzimática/métodos , Humanos , Interferón gamma/biosíntesis , Interleucina-10/biosíntesis , Interleucina-1beta/biosíntesis , Interleucina-6/biosíntesis , Masculino , Ratones , Ratones Endogámicos BALB C , Proteínas Recombinantes/metabolismo , Sepsis/patología , Factores de TiempoRESUMEN
Predictors for erosive arthritis in systemic lupus erythematosus (SLE) are poorly understood. We performed a pilot, descriptive case-series study to identify whether different biomarkers differentiate SLE patients from those additionally developing erosive arthritis. Median C-reactive protein (CRP) concentration in erosive arthritis was 14.5 mg/L (IQR, 6.6-19.4), but only 0.8 (0.45-7.37, p = 0.01) in non-erosive. Anti-cyclic citrullinated peptide antibodies (anti- CCP) were also associated with erosive arthritis (60 vs. 0% , p = 0.02; OR = 18.2, 0.66-495). Serum IL-6, IFNgamma, IL-4 and IL-10 tended to be higher in erosive arthritis, although none attained statistical significance. A negative correlation between IL-6 and CRP was found in non-erosive arthritis ( r-0.60). High CRP and anti-CCP may be useful serological markers for an erosive arthritis pattern among SLE patients.
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Anticuerpos , Artritis , Proteína C-Reactiva/metabolismo , Lupus Eritematoso Sistémico , Péptidos Cíclicos/inmunología , Adulto , Anticuerpos/sangre , Anticuerpos/inmunología , Artritis/etiología , Artritis/inmunología , Artritis/patología , Femenino , Humanos , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/inmunología , Persona de Mediana Edad , Proyectos Piloto , Adulto JovenRESUMEN
OBJECTIVE: To explore the efficacy of prophylactic oral lipopolysaccharide (LPS) in sepsis induced by cecal ligation and puncture (CLP). MATERIAL: Male Balb/c mice. LPS serotype O55: B5 TREATMENT: Mice were treated every 4 days for a total of 5 times with 50 mug of LPS by intraperitoneal (IP) or oral (O) routes. Treatment was stopped one week prior to CLP. Control (C) groups received the vehicle orally, and sham (S) groups were used as reference. METHODS: Histopathology was performed to determine inflammation in liver and lung. Serum cytokines were measured by ELISA, and TNFalpha tissue expression by RTPCR. Antibodies against LPS were measured by ELISA. RESULTS: Administration of LPS by the oral route significantly increased survival (p<0.05) of mice in association with a reduction of Kupffer cells in liver, pulmonary edema in lung, shorter or delayed TNFalpha expression in target organs, a trend to decreased IFN gamma and increased IL-10 serum levels, and a notable increase in the production of specific IgM anti-LPS antibodies. CONCLUSIONS: LPS by oral route protected against CLP. The underlying mechanisms could be the modulation of the proinflammatory response and an increased production of IgM anti-LPS antibodies.
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Anticuerpos Antibacterianos/biosíntesis , Inmunoglobulina M/biosíntesis , Lipopolisacáridos/administración & dosificación , Sepsis/prevención & control , Administración Oral , Animales , Citocinas/biosíntesis , Ligadura , Lipopolisacáridos/inmunología , Masculino , Ratones , Ratones Endogámicos BALB C , Tasa de SupervivenciaRESUMEN
The skeleton is continuously remodelled throughout life, a process that is orchestrated by cells of the osteoblast lineage. Remodelling involves a complex network of cell-cell signalling involving systemic hormones, locally produced cytokines, growth factors and the mechanical environment of the cells. Here, we report on the effect of mechanically-induced strain on the synthesis by mouse calvarial osteoblasts in monolayer culture of IL-10 and IL-12, two cytokines that inhibit osteoclast formation in bone marrow cultures; IL-10 also suppresses osteoblast differentiation suggesting a role for both cytokines in bone physiology. A tensile strain was applied to the cells intermittently for 6s, every 90s, for 2-96h. After 2-h culture, supernatants from deformed cells contained significantly less IL-10 than control cultures. In contrast, mechanical deformation had a stimulatory effect on IL-12 synthesis; however, by 48h both had returned to control levels. These data suggest that IL-10 and IL-12 can be added to the growing list of mechanical stress-responsive genes. The down-regulation of IL-10 and stimulation of IL-12 further suggests that the initial response of the cells to mechanical deformation was an osteogenic one.
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Remodelación Ósea , Interleucina-10/biosíntesis , Interleucina-12/biosíntesis , Osteoblastos/fisiología , Cráneo , Animales , Animales Recién Nacidos , Células Cultivadas , Ensayo de Inmunoadsorción Enzimática , Interleucina-10/análisis , Interleucina-12/análisis , Ratones , Ratones Endogámicos BALB C , Osteoblastos/inmunología , Reología , Estrés MecánicoRESUMEN
Taenia crassiceps cysticerci develop in the peritoneal cavity of BALB/cAnN mice and, to a lesser extent, in C57BL/6J mice. The mechanisms involved in the immunity to this murine cysticercosis seem to be mainly mediated by T cells. To gain further insight into the mechanisms of cysticercal immunity, the susceptibility of mice deficient in different immunologically relevant genes was compared with that of the respective wild type. Mice were classified according to the parasite load and survival after infection: highly susceptible (HS), with an increased parasite load and mortality rate (CD4-/-, TCRalpha-/-, TCRbeta-/-, RAG1-/-), susceptible, with only increased parasite load (TCRdelta-/-, BALB/cAnN), and relatively resistant, with a lower number of parasites (CD8-/-, WT). Neither specific proliferative response nor Th2 cytokine or antibody responses were observed in HS mice. These data strongly suggest that CD4+TCRalphabeta+ T cells have a critical role in the control of T. crassiceps murine cysticercosis.
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Linfocitos T CD4-Positivos/inmunología , Cisticercosis/inmunología , Receptores de Antígenos de Linfocitos T alfa-beta/metabolismo , Taenia/inmunología , Animales , Anticuerpos Antihelmínticos/sangre , Linfocitos T CD8-positivos/inmunología , Cisticercosis/mortalidad , Cisticercosis/parasitología , Citocinas/biosíntesis , Eliminación de Gen , Activación de Linfocitos , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Receptores de Antígenos de Linfocitos T alfa-beta/genética , Receptores de Antígenos de Linfocitos T gamma-delta/genética , Receptores de Antígenos de Linfocitos T gamma-delta/metabolismo , Taenia/patogenicidadRESUMEN
This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation. The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist. The staff kept a computerized database for all patients seen and they were supervised once a month. During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%. Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child. Fifty-eight per cent of these mothers were evaluated as being properly trained. Eighty-five per cent of primary care physicians who worked for government institutions (n = 350) and 45% of private physicians (n = 90) were also trained in the recognition and proper management of AD and ARI. ARI mortality in children under 1 year of age in the catchment area (which included about 25,000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%. The corresponding figures for AD mortality reduction were 36.3% and 33.6%. In this same period, 11 clinical research protocols were written. In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians.
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Servicios de Salud del Niño/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Educación Médica Continua/organización & administración , Niño , Hospitales Públicos , Humanos , México , Modelos Educacionales , Servicio Ambulatorio en Hospital , Evaluación de Programas y Proyectos de SaludRESUMEN
In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands-on training courses thus seemed to be effective in improving the practice of physicians in both the private and public sectors.
PIP: This study evaluated the impact of an in-service training course for physicians on diarrhea and acute respiratory infection (ARI) management in children under age 5 in Tlaxcala, Mexico, between January 1993 and April 1994. The training consisted of a 5-day course of in-service practice, during which physicians diagnosed and treated sick children attending a center and conducted clinical discussions of cases under guidance. Each training course was limited to 6 physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counseling of mothers. The evaluation of ARI case management, on the other hand, covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counseling of mothers. The study revealed that the performance of public physicians before and after the intervention was better compared to those of private doctors. Most aspects of case management of children with diarrhea improved among both groups of physicians after the course. The proportion of private doctors who had 5 or 6 correct elements out of 6 increased from 14% to 37%, while for public doctors the corresponding increase was from 53% to 73%. As for the ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups. The proportion of private physicians with at least 3 correct elements out of 4 increased from 13% to 42%, while among the public doctors, the corresponding increase was from 43% to 78%.
Asunto(s)
Manejo de Caso/organización & administración , Competencia Clínica/normas , Diarrea/diagnóstico , Diarrea/terapia , Educación Médica Continua/organización & administración , Capacitación en Servicio/organización & administración , Médicos de Familia/educación , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/terapia , Enfermedad Aguda , Adulto , Anciano , Preescolar , Femenino , Unidades Hospitalarias/organización & administración , Humanos , Lactante , Recién Nacido , Masculino , México , Persona de Mediana Edad , Sector Privado , Evaluación de Programas y Proyectos de Salud , Sector PúblicoRESUMEN
In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute respiratory infections (ARI) in 1992-1993 received medical care; in more than 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and public GPs to children under five years of age with diarrhoea and ARI. During the clinical observation, the treatment and counselling given to the mother were assessed with the WHO guidelines as reference standard. A total of 41 private and 40 public GPs were evaluated for the management of diarrhoea, and 59 private and 40 public GPs for the management of ARI. For diarrhoea, half of the private GPs gave inadequate rehydration therapy, 63% gave incorrect advice on diet, 66% and 49% made an incorrect correct decision in the prescription of antimicrobial and symptomatic drugs, respectively. Public GPs generally performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the prescription of symptomatic drugs and 28% gave a wrong decision in antimicrobial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared to 30% and 20% of public GPs, respectively. Counselling to the mother given by both private and public GPs was considered inadequate in most cases of diarrhoea and ARI. These results clearly show that private doctors, as important providers of medical care, need to be included in the strategies to improve the quality of care of children with diarrhoea and ARI. Future research needs to address the determinants of the clinical practice of private doctors in countries like Mexico.
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Servicios de Salud del Niño/normas , Diarrea/terapia , Medicina Familiar y Comunitaria/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Infecciones del Sistema Respiratorio/terapia , Niño , Preescolar , Diarrea/mortalidad , Medicina Familiar y Comunitaria/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , México/epidemiología , Práctica Privada/normas , Práctica Privada/estadística & datos numéricos , Administración en Salud Pública/normas , Administración en Salud Pública/estadística & datos numéricos , Infecciones del Sistema Respiratorio/mortalidadRESUMEN
In early stages of experimental murine cysticercosis caused by Taenia crassiceps, there is a clear but transient Th1-type immune response (characterized by high levels of interleukin [IL]-2, interferon-gamma, concanavalin A, and antigen specific response, delayed-type hypersensitivity, and immunoglobulin [Ig]G2a antibodies) that associates with a low rate of parasite reproduction. As time of infection progresses an energic and more permanent Th2-type response follows (characterized by high levels of IL-4, IL-6, IL-10, IgG2b, and IgG1 antibodies) that in turn associates with an increment in the rate of parasite reproduction. The sequential activation of Th1-type and Th2-type responses in murine cysticercosis would appear to favor progressively parasite reproduction, explaining the long time residence and the massive parasite intensity reached in chronic infections.
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Cisticercosis/inmunología , Cysticercus/inmunología , Citocinas/biosíntesis , Células TH1/inmunología , Células Th2/inmunología , Animales , Anticuerpos Antihelmínticos/biosíntesis , Antígenos Helmínticos/inmunología , Cysticercus/crecimiento & desarrollo , Femenino , Hipersensibilidad Tardía , Inmunoglobulina G/biosíntesis , Inmunofenotipificación , Interferón gamma/biosíntesis , Interleucina-10/biosíntesis , Interleucina-2/biosíntesis , Interleucina-4/biosíntesis , Interleucina-6/biosíntesis , Activación de Linfocitos , Masculino , Ratones , Ratones Endogámicos BALB C , Caracteres Sexuales , Bazo/citologíaRESUMEN
In developing countries, antibiotics are the most common drugs sold, and some data suggest that they are frequently misused. In order to describe the pattern of antibiotic use in a periurban community in Mexico City, 1659 randomly-selected households were visited and an interview with the housewife was carried out. Six local drugstores also were selected at random. A social worker made six visits to each pharmacy, observed the events during the purchase of the drug and applied a structured questionnaire to the customer immediately after the transaction. Of 8279 individuals, 425 (5%) said that they had used at least one antimicrobial in the preceding 2 weeks and antibiotics were the majority (29%) of the drug sales. The main perceived reasons for drug use were acute respiratory tract ailments and gastroenteritis. Interviewees reported that antibiotic therapy was given in 27% of respiratory diseases and in 37% of all diarrheal episodes. The drugs most commonly reported were: penicillins, erythromycin, metronidazole, neomycin, cotrimoxazole and tetracyclines. While self-medication and drug purchases without medical prescription were common, the majority of antibiotics were prescribed by a physician. Approximately two thirds of individuals using an antibiotic said they had used it for less than 5 days and 72% of the purchases were for insufficient quantities of drugs. Our data suggest that antibiotics are frequently misused and they support the need to assess the determinants of self-medication, health-seeking behavior and physician prescribing practices. The need for effective educational programs to improve prescribers' decisions is stressed.
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Antibacterianos/provisión & distribución , Países en Desarrollo , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Salud Urbana , Adolescente , Adulto , Anciano , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Niño , Preescolar , Prescripciones de Medicamentos/estadística & datos numéricos , Revisión de la Utilización de Medicamentos , Femenino , Gastroenteritis/tratamiento farmacológico , Gastroenteritis/epidemiología , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Automedicación/estadística & datos numéricosRESUMEN
There is currently a very active research on the mechanisms that give rise to the cell selection of lymphocyte precursors by the thymus. This selection is basic for the process of formation of the repertoire of T cells with which an organism is potentially capable of developing an immune response to a foreign antigen, and not doing so when encountering its own antigens. This work pretends to detail some recent advances in the knowledge of the process by which cells are positively or negatively selected by the thymus, to give rise to the T cell repertoire of an individual.
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Tolerancia Inmunológica , Inmunidad Celular , Timo/fisiología , HumanosRESUMEN
A survey of 1659 households in a periurban community in Mexico City was carried out to assess the frequency of and risk factors for inappropriate antimicrobial therapy in acute diarrhea. The housewife was interviewed to obtain information of the occurrence of diarrhea or use of an antibiotic in the previous 2 weeks by any member of the family. An antibiotic was used in 37% or 287 diarrheal episodes although only in 5% of all episodes was this therapy indicated, based on the presence of gross blood in stools. Patients seen by a physician were 6 times more likely to be treated with an antibiotic compared to those who did not consult a physician (p < 0.001). Self-medication was associated with a higher risk of using an inadequate drug or dose (in 72% of treated episodes) and of following treatment for less than 5 days (in 66% of treated episodes). Other risk factors significantly and independently associated with antibiotic misuse were: an increased number of stools (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 1.04, 1.41), bloody diarrhea (OR = 19.04; 95% CI = 2.52, 160.90) and family crowding (OR = 2.07; 95% CI = 1.17, 3.63). These findings support future community-oriented educational interventions aimed at improving physician prescribing practices and patient compliance behavior in order to achieve a more rational use of antibiotics.
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Antibacterianos/uso terapéutico , Diarrea/tratamiento farmacológico , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Aglomeración , Diarrea/complicaciones , Utilización de Medicamentos , Composición Familiar , Femenino , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/tratamiento farmacológico , Humanos , Lactante , Masculino , México , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Automedicación , Índice de Severidad de la Enfermedad , Población SuburbanaRESUMEN
In developing countries, antibiotics are the most common sales of drugs and it has been suggested that their irrational use leads to the emergence of resistant bacteria. In order to assess the purchase of antimicrobials in a peri-urban community in Mexico City six local drug stores were randomly selected. A social worker made five visits to each pharmacy and she observed the events during the purchase of the drug and applied a structured questionnaire to the customer immediately after the transaction. Antibiotics were the majority (29%) of the drug sales. Of all purchasers of an antibiotic 43% did it without medical prescription and 72% answered that a physician had influenced on the purchase. Duration of the antibiotic therapy was specified in one out of three prescriptions that were examined and only in 28% of the sales the purchase was enough for a treatment duration of more than four days. More information, from similar surveys in drug stores in other settings, is needed to support the reinforcement of actions to control the sales of antibiotics in the community.
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Antibacterianos/administración & dosificación , Utilización de Medicamentos , Farmacias , Servicio de Farmacia en Hospital , Humanos , MéxicoRESUMEN
Based on previous community-oriented studies an irrational use of antibiotics, particularly in developing countries, has been suggested. In order to describe the pattern of antibiotic use in a periurban community in Mexico City, 1659 randomly selected households were visited and an interview to the housewife was carried out. Of 8279 individuals 425 (5%) had used at least one antimicrobial in the preceding two weeks. Main perceived reasons for drug use were: respiratory tract ailments (58%) and acute diarrhea (25%). Antibiotic therapy was given in 27% of respiratory diseases and in 37% of all diarrheal episodes. Most commonly used drugs were: penicillins (43%), erythromycin (13%), metronidazole (9%), neomycin (6%), cotrimoxazole (6%) and tetracyclines (6%). While self-medication was common (19%) the majority of antibiotics were prescribed by a physician (81%). Approximately two thirds of individuals using an antibiotic did it for less than five days. Our data suggest a frequent misuse of antibiotics and support the future assessment, in this community, of physician prescribing practices, the determinants of self-medication as well as the impact of this drug use on the selection of resistant bacterial strains.
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Antibacterianos/uso terapéutico , Población Suburbana , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Prescripciones de Medicamentos/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , México/epidemiología , Persona de Mediana Edad , Autocuidado/estadística & datos numéricos , Automedicación/estadística & datos numéricos , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología , Población Suburbana/estadística & datos numéricosRESUMEN
A seroepidemiological study of a household cohort, using both clinical observational and molecular criteria was conducted in a periurban area endemic for E. histolytica infection. This longitudinal study was undertaken to determine the risk of asymptomatic cyst carriers to develop invasive illness. Zymodeme patterns of strains isolated from these patients were correlated both with the clinical presentation of disease and with the serological response against the M-17 ameba antigen and further compared with that found in 16 proven cases of amebic liver abscess. From a total of 163 housewives screened, 39, (24%) were asymptomatic cyst carriers; 31 of them (index cases) and 114 members of their households remained in the study over an 8 month follow-up period to detect ameba infection and illness. Of the household members at risk, 46 (40%) became infected within 6 weeks. None of the index or secondary cases developed ameba-related symptoms and cyst excretion followed a chronic persistent, intermittent, or transient pattern over the period of the study. Amebas were recovered and zymodemes determined in 19 of 71 (27%) cyst carriers. Ameba shed from each of these 19 carriers exhibited nonpathogenic zymodeme 1, except for one index case where zymodeme 2 was recovered in one sampling, and returned to zymodeme 1 in subsequent samples. Of 48 of 71 cyst carriers studied, antibodies to crude E. histolytica antigen were detected by ELISA in 16 (31%); antibodies to the M-17 fusion protein were found in 8 (16%) by ELISA and in 2 (4%) by Western-Blot (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Portador Sano/parasitología , Entamoeba histolytica/aislamiento & purificación , Entamebiasis/epidemiología , Animales , Antígenos de Protozoos/genética , Antígenos de Protozoos/inmunología , Estudios de Cohortes , Entamoeba histolytica/genética , Entamoeba histolytica/inmunología , Heces/parasitología , Estudios de Seguimiento , Humanos , Epítopos Inmunodominantes/inmunología , Estudios Longitudinales , México/epidemiología , Factores de Riesgo , Salud UrbanaRESUMEN
A cohort of 179 children under 5 years of age from a low-income urban community was followed up for a year to determine the incidence of symptom-producing and of diarrhoea-free campylobacter intestinal infections, and thus their illness-to-infection ratio. 66% of all children had at least one campylobacter infection, one-third of these being associated with diarrhoea. The annual incidence of all campylobacter infections was 2.1 episodes per child. The incidence was inversely related to age (r = -0.78 p less than 0.02). The illness-to-infection ratio, which in infants younger than 6 months was 1:2, was negatively associated with age (r = -0.7, p less than 0.02). Only symptom-producing infections occurring early in life seemed to protect against subsequent infections.