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Resumen: Los ejercicios tradicionales de rehabilitación de extremidades superiores tienen como objetivo principal recuperar la fuerza o rango de movimiento del área lesionada de los pacientes. Una opción alternativa que se ha presentado en los últimos años es el uso de interfaces hápticas, las cuales han mostrado ser herramientas potenciales en el apoyo de las terapias de rehabilitación. En este artículo se presenta un sistema de rehabilitación háptico de movimientos finos en extremidades superiores, cuya característica principal es que los usuarios del sistema pueden interactuar de forma visual y táctil con objetos virtuales mezclados con escenarios reales logrando con ello un ambiente de realidad aumentada. El sistema fue probado en dos etapas, ambas con sujetos que presentaban un grado de discapacidad en extremidades superiores. Los datos recopilados fueron trayectorias seguidas, errores de seguimiento y la actividad muscular obtenida por medio de electromiografía; esta información recolectada permitió analizar de forma cuantitativa el grado de avance de los pacientes. Además, se consideraron las valoraciones hechas por fisioterapeutas, concluyendo que el sistema propuesto puede ser utilizado como una herramienta viable que complementa a las terapias de rehabilitación convencionales.
Abstract: Traditional upper limb rehabilitation exercises are primarily aimed at regaining the strength or range of motion of the patients' injured area. An alternative option that has been presented in the last years is the use of haptic interfaces, which have shown their potential as tools that support rehabilitation therapies. This article presents a haptic system of rehabilitation for fine upper limb movements, whose main characteristic is that users of the system can interact in a visual and tactile fashion with virtual objects mixed with real scenarios, thereby achieving an augmented reality environment. The system was tested in two stages, both with subjects who had a degree of disability in upper limbs. The data collected were followed trajectories, follow-up errors and the muscular activity obtained by means of electromyography; the collected information enabled the analysis, in a quantitative way, of the degree of progress of the patients. In addition, the assessments made by physiotherapists were considered, concluding that the proposed system can be used as a viable complementary tool for conventional rehabilitation therapies.
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Resumen: Las quemaduras son un escenario especial de trauma grave que condiciona osteopenia, alteraciones del metabolismo del calcio, miopatía e inmunosupresión, entre otras. Los pacientes quemados tienen elevado riesgo de hipovitaminosis D debido a que condicionan incremento en la pérdida de calcio, disminución de su captación en hueso e importantes alteraciones en la síntesis de vitamina D. En este contexto la suplementación con vitamina D en el paciente con quemaduras pudiera compensar su deficiencia y los efectos nocivos secundarios. El objetivo de este trabajo es revisar los conceptos actuales relacionados con el metabolismo de la vitamina D y el efecto de su deficiencia en los enfermos con quemaduras.
Abstract: Severe burn injury represents a special trauma leading to major systemic dysfunctions such a bone loss, mineral disruptions, myopathy and immunosuppression. Burn patients are at high risk of hypovitaminosis D. Burn injury gives rise to calcium wasting, failure of bone to take up calcium, and vitamin D insufficiency. In this context vitamin D supplementation could help counteract post-burn sequelae. The aim of this paper is to review the current concepts on vitamin D metabolism with special focus in burn patients.
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Most people with diabetes suffer some deterioration of the feet. Diabetic foot syndrome causes ulceration in about 15% of cases and such deterioration leads to amputation in about 2.5% of diabetic patients, diminishing their quality of life and generating extraordinary costs for patients and public health systems. Currently, there is no objective method for the detection of diabetic foot syndrome in its early stages. We propose terahertz imaging as a method for the evaluation of such deterioration. This screening method could aid the prevention and medical treatment of this condition in the future.
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Pé Diabético/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imagem Terahertz/métodos , Adulto , Amputação Cirúrgica/estatística & dados numéricos , Estudos de Casos e Controles , Pé Diabético/economia , Pé Diabético/psicologia , Pé Diabético/cirurgia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida/psicologia , Fatores de Risco , Síndrome , Imagem Terahertz/instrumentaçãoRESUMO
The effect of LiCl additions on the in vitro bioactivity, hemolysis, cytotoxicity, compressive strength and setting time of calcium aluminate cements was studied. Calcium aluminate clinker (AC) was obtained via solid state reaction from reagent grade chemicals of CaCO3 and Al2O3. Calcium aluminate cements (CAC) were prepared by mixing the clinker with water or aqueous LiCl solutions (0.01, 0.0125 or 0.015M (M)) using a w/c ratio of 0.4. After 21days of immersion in a simulated body fluid (SBF) at physiological conditions of temperature and pH, a Ca-P rich layer, identified as hydroxyapatite (HA), was formed on the cement without LiCl and on the cement prepared with 0.01M of LiCl solution. This indicates the high bioactivity of these cements. The cements setting times were significantly reduced using LiCl. The measured hemolysis percentages, all of them lower than 5%, indicated that the cements were not hemolytic. The compressive strength of the cements was not negatively affected by the LiCl additions. The obtained cement when a solution of LiCl 0.010M was added, presented high compressive strength, appropriated bioactivity, no cytotoxicity and low setting time, making this material a potentially bone cement.
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Compostos de Alumínio/farmacologia , Cimentos Ósseos/farmacologia , Regeneração Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Compostos de Cálcio/farmacologia , Cloreto de Lítio/farmacologia , Animais , Líquidos Corporais/química , Contagem de Células , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Força Compressiva , Hemólise/efeitos dos fármacos , Humanos , Camundongos , Soluções , Espectrometria por Raios X , Estresse Mecânico , Temperatura , Fatores de Tempo , Difração de Raios XRESUMO
Cuando una necrosis pulpar se instala en dientes jóvenes que aún no han completado el cierre apical o no han terminado el desarrollo radicular, la apexificacion es el tratamiento indicado, el cual induce la formación de una barrera calcificada que oblitere el orificio apical 0 que permita el desarrollo radicular completo. La mezcla del hidróxido de calcio Ca(OH)2 con suero fisiológico es la forma más deseable y sencilla de inducir la apexificacion con pronóstico exitoso. El caso clínico que se presenta es un paciente masculino de 10 años de edad, al cual se diagnostica necrosis pulpar en O.D.36, radiográficamente con zona radiohicida en ápices y furca, retracción pulpar y falta de cierre apical al cual se realiza el tratamiento de apexificacion con hidroxido de calcio, mostrando en el control radiográfico disminución de la lesión en furca y ápices, lográndose el cierre apical permitiendo el tratamiento de endodoncia con gutapercha y finalmente la rehabilitación con corona de acero cromo...
When a pulp necrosis it's established in young teeth that have not developed an apical seal or the incomplete development of the root, an apexitication is the election treatment, because it inducts the formation of a calcified barrier that obliterates the apical foramen or allows the complete radicular development. The mixture of Calcium Hydroxide with physiological serum is the most simple technique of inducting apexification. The case report presents a 10 year old male, with necrotic pulp in O.D 36, in the x-ray can be observed radiolucent zone in apex and furcation, pulp retraction and lack of apical seal; in this teeth apexification was performed with calcium hydroxide, and it shows a correct evolution in decrasing of lesion in furcation and seal in apex; that permits the obturation or radicular system and finally the rehabilitation with a steel crown...
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Humanos , Masculino , Criança , Apexificação , Hidróxido de Cálcio/uso terapêutico , Necrose da Polpa Dentária/terapiaRESUMO
INTRODUCTION: Chronic hypoperfusion in rats produces memory and learning impairments due to permanent occlusion of commun carotid arteries (POCCA). Molecular mechanisms leading to behavioural disorders have been poorly studied. For this reason, the aim of the present study was to characterise oxidative metabolism disorders and their implications in memory and learning impairments. METHODS: Superoxide dismutase (SOD) and catalase (CAT) activities were determined in cortex, hippocampus and striatum homogenates at 24 hours and at 22 days after the lesion. Haematoxylin-eosin staining and glial fibrillary acidic protein (GFAP) immunoreactivity were performed on coronal sections. Behavioural impairments were explored using the Morris water maze (MWM). Escape latencies were determined in all behavioural studies. RESULTS: The lesion induced a significant increase (P<.01) in CAT activity in the cortex at 24 hours, while SOD activity was significantly higher (P<.01) in the cortex and hippocampus at 22 days. An intense vacuolization was observed in the cortex and striatum as a result of the lesion. A neuronal loss in the striatum and hippocampus was observed. The glial reaction increased in the cortex and striatum. Visual alterations were observed in the lesion group with the lowest evolution time (P<.001). Escape latencies, corresponding to MWM schemes for long-term and short-term memory evaluation increased significantly (P<.05) in both groups of lesioned animals. CONCLUSION: It was concluded that changes in SOD and CAT activities indicate a possible implication of oxidative imbalance in the pathology associated with chronic cerebral hypoperfusion. In addition, the POCCA model in rats is useful for understanding mechanisms by which cerebral hypoperfusion produces memory and learning impairments.
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Isquemia Encefálica/metabolismo , Isquemia Encefálica/psicologia , Aprendizagem/fisiologia , Memória/fisiologia , Animais , Artéria Carótida Primitiva/patologia , Estenose das Carótidas/metabolismo , Estenose das Carótidas/psicologia , Masculino , Aprendizagem em Labirinto/fisiologia , Motivação/fisiologia , Proteínas do Tecido Nervoso/efeitos dos fármacos , Oxirredução , Ratos , Ratos Sprague-Dawley , Superóxido Dismutase/metabolismoRESUMO
Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48 percent males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39 percent of the patients, hypertension in 45 percent and seizures in 17 percent. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78 percent). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9 percent in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p <0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC >20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.
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Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Injúria Renal Aguda , Anuria/etiologia , Síndrome Hemolítico-Urêmica/complicações , Injúria Renal Aguda , Anuria/epidemiologia , Anuria/terapia , Serviços de Saúde da Criança/estatística & dados numéricos , Chile/epidemiologia , Seguimentos , Síndrome Hemolítico-Urêmica/mortalidade , Síndrome Hemolítico-Urêmica/terapia , Hospitalização , Modelos Logísticos , Prognóstico , Diálise Renal , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. AIM: To describe the characteristics of patients with the diagnosis of HUS in Chile, and to identify the most reliable early predictors of morbidity and mortality. MATERIAL AND METHODS: The clinical records of patients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. RESULTS: A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and peritoneal dialysis was used in the majority of cases (78%). The most frequently isolated etiological agent was Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC)>20.000/mm3 and requirements of renal replacement therapy (p<0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC>20.000/mm3, seizures and hypertension. CONCLUSIONS: The present study emphasizes important clinical and epidemiological aspects of HUS in a Chilean pediatric population.
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Injúria Renal Aguda/etiologia , Anuria/etiologia , Síndrome Hemolítico-Urêmica/complicações , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Anuria/epidemiologia , Anuria/terapia , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Chile/epidemiologia , Feminino , Seguimentos , Síndrome Hemolítico-Urêmica/mortalidade , Síndrome Hemolítico-Urêmica/terapia , Hospitalização , Humanos , Lactente , Modelos Logísticos , Masculino , Prognóstico , Diálise Renal , Estudos Retrospectivos , Fatores de RiscoRESUMO
Usual and acute alcohol consumption are important risk factors for injury. Although alcohol-dependent people are thought to be at increased risk of injury, there are few reports suggesting that their risk is greater than that of nondependent alcohol users in a given episode of alcohol use. The authors conducted a case-crossover analysis of data on 705 injury patients from a hospital emergency department in Mexico City, Mexico, collected in 2002. The majority of the sample was male (60%) and over 30 years old (51%). With use of a multiple matching approach that took into account three control time periods (the day prior to the injury, the same day in the previous week, and the same day in the previous month), the estimated relative risk of injury for patients who reported having consumed alcohol within 6 hours prior to injury (17% of the sample) was 3.97 (95% confidence interval: 2.88, 5.48). This increase in the relative risk was concentrated within the first 2 hours after drinking; there was a positive association of increasing risk with increasing number of drinks consumed. These data suggested that relative risk estimates were the same for patients with and without alcohol use disorders.
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Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/complicações , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto , Estudos de Casos e Controles , Estudos Cross-Over , Feminino , Humanos , Masculino , Análise por Pareamento , México/epidemiologia , RiscoRESUMO
Entre las complicaciones posibles de observar en un paciente con un Síndrome nefrótico, deben considerarse los fenómenos trombóticos tanto venosos como arteriales, incluyendo la trombosis de senos venosos cerebrales. Objetivo:Presentar la evolución de un niño que desarrolló una trombosis de seno longitudinal superior asociada a un Síndrome nefrótico, comparando la evolución de nuestro paciente con los 32 casos descritos en la literatura. Caso clínico: Varón de 14 años que ingresó por síndrome nefrótico descompensado y cefalea moderada, asociado a papiledema bilateral, en el cual el scanner cerebral y la angioresonancia mostraron una trombosis de seno longitudinal superior en etapa aguda. El hallazgo más significativo fue un aumento de la presión intracraneana de hasta 44 cm. de agua. El aumento progresivo de los anticuerpos IgM anticardiolipinas determinó una terapia anticoagulante permanente. Discusión:En el síndrome nefrótico un estado de hipercoagubilidad y otros factores como deshidratación o traumatismos menores, pueden causar trombos en diferentes vasos, incluyendo los senos cerebrales. El seno más frecuentemente comprometido es el seno longitudinal superior. La sintomatología puede ser escasa a pesar de una marcada hipertensión endocraneana, motivo por el cual esta condición puede ser subdiagnosticada si no se realiza una búsqueda dirigida.
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Humanos , Masculino , Adolescente , Pressão Intracraniana , Síndrome Nefrótica/complicações , Trombose do Seio Sagital/complicações , Trombose do Seio Sagital/diagnóstico , Trombose do Seio Sagital/tratamento farmacológico , Anticoagulantes , Diagnóstico por ImagemRESUMO
The aerobic riboflavin (Rf)-sensitized visible-light irradiation of Trolox (TX), a polar-solvent-soluble model for vitamin E, has been studied employing stationary photolysis, polarographic detection of oxygen uptake, stationary and time-resolved fluorescence spectroscopy, and laser flash photolysis. Results indicate that in methanolic solution, no dark complexation exists between Rf and TX. The latter quenches singlet and triplet states of Rf, with rate constants of 6.2 x 10(9) M(-1) s(-1) and 4.7 x 10(9) M(-1) s(-1), respectively. The photodecomposition of Rf, a known process taking place from triplet Rf, has been found to depend on the concentration of dissolved TX: at >/=30 mM very slight Rf photodecomposition occurs due to the massive quenching of excited singlet Rf, while at TX concentrations < or =1 mM triplet Rf is photogenerated and subsequently quenched either by oxygen, giving rise to O(2)((1)Delta(g)), or by TX, yielding semireduced Rf through an electron transfer process. Complementary experiments performed in pure water employing superoxide dismutase and sodium azide inhibition of the oxygen uptake, in coincidence with flash photolysis data, indicate that superoxide anion and singlet molecular oxygen are generated, likely by the reaction of the anion radical from Rf with dissolved oxygen, also yielding neutral, ground state Rf or by energy transfer from triplet Rf to ground-state oxygen, respectively. The final result is that both TX and Rf are photodegraded, likely through oxidation with activated oxygen species. In the absence of oxygen no degradation of TX can be detected, but Rf photodegradation is favoured because Rf regeneration is avoided.
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Antioxidantes/química , Cromanos/química , Fármacos Fotossensibilizantes/química , Riboflavina/química , Vitamina E/análogos & derivados , Escuridão , Lasers , Fotólise , Solubilidade , Solventes , Espectrometria de FluorescênciaRESUMO
La Sala de Situación de Salud es un concepto que la OPS está diseminando en nuestro continente, como instrumento más para la gestión institucional. La Sala de Situación es un espacio físico y virtual, en el que la información de diferentes fuentes es concentrada, condensada, organizada, expuesta y analizada con prontitud, con el fin de posibilitar recomendaciones y decisiones oportunas, además de permitir un amplio conocimiento de especialistas, como de los medios de comunicación y de la sociedad en general. Funciona, también, como un punto de encuentro para los diferentes segmentos del sector interesado, permitiendo discusiones, reuniones y encuentros que llevan a la identificaciín de problemas, debilidades y demandas, fortalezas y ofertas, negociaciones y movilización de recursos, acciones de coordinación, monitoreo y evaluación de intervenciones, y particularmente difusión de información para la comunidad.
Trabajo presentado en el Seminario Internacional sobre la Comunicación Social como Herramienta para Fortalecer lo Mecanismos Sensoriales de los Sistemas de Información y Vigilancia Epidemiológica. Coordinado por el Centro Panamericano de Fiebre Aftosa (PANAFTOSA - OPS/OMS); 24-26 abril 2000.
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Saúde Pública Veterinária , Monitoramento Epidemiológico , Meios de ComunicaçãoRESUMO
UNLABELLED: Our objective was to compare the neurologic and psychological sequelae of children with acute lymphoblastic leukemia (ALL) after three or more years without antineoplasic treatment who underwent cranial irradiation plus intrathecal methotrexate (Group 1) or just intrathecal methotrexate (Group 2). In both groups, a neurologic evaluation, electroencephalogram (EEG) and cranial computed tomography (CCT) were performed. Intellectual quotient and the Bender test were done for the psychological evaluation. Investigators did not know the kind of treatment of each patient. STATISTICS: Fisher's exact test and Mann-Whitney U. There were fourteen patients in group 1 and eight patients in group 2. Intellectual quotient was statistically lower in the first group (median 83.5) than in the second (90.5). Neurologic impairments were found in one patient of each group, alterations of the EEG were found in 6 and 4 in group 1 and 2, respectively, and in the CCT of two patients in group 2 without statistical difference. Children with ALL after cranial irradiation have a greater alteration of intellectual performance than children with intrathecal methotrexate. Neurologic alterations were seen in both groups.
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Antimetabólitos Antineoplásicos/administração & dosagem , Encéfalo/efeitos da radiação , Inteligência , Metotrexato/administração & dosagem , Doenças do Sistema Nervoso/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Radioterapia/efeitos adversos , Adolescente , Fatores Etários , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Interpretação Estatística de Dados , Eletroencefalografia , Feminino , Humanos , Lactente , Injeções Espinhais , Inteligência/efeitos dos fármacos , Inteligência/efeitos da radiação , Testes de Inteligência , Masculino , Exame Neurológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Testes Psicológicos , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios XRESUMO
La hemodiálisis crónica en pediatría comenzó a ser empleada en la década de los años de 1970 y en Chile en la siguiente. Desde entonces cada vez más pacientes con insuficiencia renal terminal utilizan este procedimiento de sustitución. En este artículo se revisan los fundamentos fisiopatológicos básicos de la hemodiálisis y su aplicación en forma de sugerencias y algunos aspectos técnicos del procedimiento, sin pretender una descripción exhaustiva de las técnicas y equipamientos actuales utilizados en el procedimiento
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Humanos , Criança , Diálise Renal/métodos , Insuficiência Renal/terapia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/instrumentação , Equipamentos e Provisões , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação , Heparina/uso terapêutico , Hipertensão/etiologiaRESUMO
Background: The final objective of every children that is admitted to a program o hemodialysis or peritoneodialysis is to receive a renal graft. Aim: To report the experience in pediatric hemodialysis in two pediatric hospitals in Chile that are reference centers for renal transplantation. Patients and methods: Sixty patients, 55 percent female, aged 2 to 15 years old, admitted to the dialysis and transplant program since 1987, with a creatinine clearance of less than 20 ml/min/l.73 m2, were studied. Results: Twenty percent of children were less than 5 years old at the moment of admittance to the program and 3.3 percent weighed less than 10 kg. Etiologies of end stage renal disease were glomerulopathies in 33.4 percent, reflux nephropathy in 27.7 percent, obstructive uropathy in 13.3 percent, hypoplasia/dysplasia in 10 percent, hereditary problems in 8.3 percent and vascular disorders in 5 percent. Eighty six percent of patients were dialyzed less than 2 years and 5 percent more than 4 years. Fifty percent had received prior medical treatment, 5 percent bad been treated with intermittent peritoneal dialysis, 5 percent with chronic ambulatory peritoneal dialysis and 20 percent presented as a terminal renal failure. Sixty two percent received a renal graft, 25 percent is still on hemodialysis, 3.3 percent switched to chronic ambulatory peritoneal dialysis, 3.3 percent had a recovery of renal function and 6.7 percent died being on hemodialysis. Arterio-venous fistulae were the vascular accesses in 75 percent of patients, double lumen catheters in 50 percent and vein grafts in 5 percent. Malfunctioning or infections were the main complications of arterio-venous fistulae, accounting for 30 percent of hospital admissions. Conclusions: The availability of new vascular accesses and new hemodialysis machines specially designed for chndren, along with specially trained health care personnel, should reduce the mortality and complication rates of hemodialysis in this age group
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Humanos , Masculino , Feminino , Adolescente , Diálise Peritoneal/métodos , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia , Cateteres de Demora/efeitos adversos , Estado Nutricional , Transtornos do Crescimento/etiologia , Composição Corporal , Diálise Renal/efeitos adversos , Hospitalização/estatística & dados numéricos , Transplante de RimRESUMO
The prevalence of asthma among schoolchildren in Costa Rica is very high -- at the level of 20-30% -- and the reason is still unknown. A group of children from our previous epidemiologic study was randomly selected in order to establish the relation between asthma symptoms and allergy sensitization to common allergens. Serum samples from children with and without asthma were analyzed for the presence of IgE antibodies to 36 different allergens, for the presence of IgE antibodies to a pool of 10 common allergens, and for total serum IgE. The most prevalent IgE antibodies were those to mite, cockroach, dog, and house-dust allergens with MAST pipettes for the serologic measurements. Positive reactions to house dust, mite, cat, and the two molds (Alternaria and Cladosporium), and food allergens such as egg white, peanut, and shellfish were significantly more prevalent among the asthmatics than the nonasthmatics. Sensitization was equally prevalent at different ages, but the house-dust, mite, cat, dog, cockroach, Alternaria, and egg-white allergens had sensitized boys more often than girls (P < 0.01). The result of the analysis of IgE antibodies to a pool of 10 common allergens by Phadiatop supported the MAST pipette results, showing allergen sensitization in 57.7% of the asthmatic children and 42.3% in the nonasthmatic group. The concentration of IgE was significantly higher among the asthmatic children (372.2 kU/l) than among the nonasthmatic children (249.1 kU/l) (P < 0.00001). Parasitic infestations were not examined in this study, but in most of Costa Rica these have largely been eliminated and could not explain the high total IgE levels. Our data indicate that the very high prevalence of bronchial asthma in Costa Rican schoolchildren can be related to sensitization, especially to airborne indoor allergens such as those of mites, cockroaches, and dogs.
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Alérgenos/imunologia , Asma/imunologia , Imunização , Alérgenos/análise , Animais , Anticorpos/análise , Gatos/imunologia , Criança , Baratas/imunologia , Costa Rica , Cães/imunologia , Poeira/análise , Feminino , Hipersensibilidade Alimentar/imunologia , Humanos , Imunoglobulina E/análise , Masculino , Ácaros/imunologia , Valores de Referência , Instituições AcadêmicasRESUMO
The prevalence of asthma in children between the ages of 5 and 17 years in Costa Rica was determined using a large sample (n = 2682). The definition of asthma was based on a combination of a physician's diagnosis and a symptom score, using information from a questionnaire given to the parents. An overall asthma prevalence as high as 23.4% was found. Sex, age, urban/rural location, or rain precipitation did not show any association with the diagnosis of asthma. The presence of smokers in the home was found to be an important risk factor (odds ratio = 1.6). Another identified risk factor was a high yearly average outside temperature, i.e. above 25 degrees C (odds ratio = 1.8). Furthermore, the proportion of children with more than four upper respiratory infections during the preceding year was found to be significantly increased in children with asthma (odds ratio = 4.3). The non-asthma group seemed to use equal amounts of drugs for the treatment of asthma as the asthma group. For a country like Costa Rica with limited economic resources the current work indicates two important issues for consideration in the future; firstly, to try to define the cause(s) of asthma and secondly, to continuously inform the physicians about the best way of diagnosing and treating asthmatic patients to ensure optimal handling of this large patient group.
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Asma/epidemiologia , Adolescente , Criança , Pré-Escolar , Costa Rica/epidemiologia , Feminino , Temperatura Alta , Humanos , Masculino , Prevalência , Doenças Respiratórias/epidemiologia , Fatores de Risco , População Rural , Fumar/epidemiologia , Inquéritos e Questionários , População UrbanaRESUMO
In a Mexican village in which Taenia solium infection was known to be endemic, we selected a cluster sample of 368 households (21% of the total) for demographic, environmental, and diagnostic surveys, and medical histories for taeniasis and cysticercosis. Coproparasitologic studies of 1,531 participants revealed infection by Taenia sp. in four (0.3%) individuals; however, 5.8% of the respondents reported a history of having passed tapeworm proglottids in feces. Of 1,552 human serum specimens, 10.8% tested positive in the cysticercosis immunoblot assay. Seropositivity increased with age and reached a maximum in subjects ages 46-55 years. Risk factors associated with seropositivity included a history of passing tapeworm proglottids, frequent consumption of pork, and poor personal and household hygiene (P less than 0.05). A history of seizures was also significantly associated with seropositivity (P less than 0.05); approximately one-third of persons with such histories were seropositive. Of 571 pigs examined by tongue inspection, 23 (4.0%) had cysticerci; infection rates increased with the age of pigs, and were higher in pigs that habitually ran loose or were fed human feces (P less than 0.05). Goodness of fit analysis confirmed that seropositive persons (but not infected pigs) were significantly clustered within households, particularly, in households in which a member reported a history of having passed tapeworm proglottids. The results of this study have identified community behavioral and environmental practices that must be modified to prevent continued transmission of cysticercosis and taeniasis.