RESUMO
BACKGROUND: The del22q11 syndrome patients present immunological abnormalities associated to thymus alterations. Up to 75% of them present cardiopathies and thymus is frequently removed during surgery. The thymectomy per se has a deleterious effect concerning lymphocyte subpopulations, and T cell function. When compared to healthy controls, these patients have higher infections propensity of variable severity. The factors behind these variations are unknown. We compared immunological profiles of del22q11.2 Syndrome patients with and without thymectomy to establish its effect in the immune profile. METHODS: Forty-six del22q11.2 syndrome patients from 1 to 16 years old, 19 of them with partial or total thymectomy were included. Heart disease type, heart surgery, infections events and thymus resection were identified. Immunoglobulin levels, flow cytometry for lymphocytes subpopulations and TREC levels were determined, and statistical analyses were performed. RESULTS: The thymectomy group had a lower lymphocyte index, both regarding total cell count and when comparing age-adjusted Z scores. Also, CD3+, CD4+ and CD8+ lower levels were observed in this group, the lowest count in those patients who had undergone thymus resection during the first year of life. Their TREC level median was 23.6/µL vs 16.1µL in the non-thymus group (p=0.22). No differences were identified regarding immunoglobulin levels or infection events frequencies over the previous year. CONCLUSION: Patients with del22q11.2 syndrome subjected to thymus resection present lower lymphocyte and TREC indexes when compared to patients without thymectomy. This situation may be influenced by the age at the surgery and the time elapsed since the procedure.
Assuntos
Subpopulações de Linfócitos T/fisiologia , Linfócitos T/fisiologia , Timectomia , Timo/cirurgia , Adolescente , Criança , Pré-Escolar , Deleção Cromossômica , Cromossomos Humanos Par 22/imunologia , Feminino , Citometria de Fluxo , Humanos , Lactente , Contagem de Linfócitos , Masculino , Receptores de Antígenos de Linfócitos T/genéticaRESUMO
INTRODUCTION AND OBJECTIVES: Although the prevalence of sensitization to fungi is not precisely known, it can reach 50% in inner cities and has been identified as a risk factor in the development of asthma. Whereas the prevalence of allergic diseases is increasing, it is unclear whether the same occurs with sensitization to fungi. PATIENTS AND METHODS: A retrospective study was performed at the "Hospital Infantil de México Federico Gómez". From skin tests taken between 2004 and 2015, information was gathered about Alternaria alternata, Aspergillus fumigatus, Candida albicans, Cladosporium herbarum, Mucor mucedo and Penicillium notatum. The participating patients were 2-18 years old, presented some type of allergic condition, and underwent immediate hypersensitivity tests to the fungi herein examined. Descriptive analysis and chi-squared distribution were used. RESULTS: Of the 8794 patients included in the study, 14% showed a negative result to the entire panel of environmental allergens. The remaining 7565 individuals displayed sensitization to at least one fungus, which most frequently was Aspergillus, with a rate of 16.8%. When the patients were divided into age groups, the same trend was observed. The highest percentage of sensitization (58%) toward at least one type of fungus was found in 2014, and the lowest percentage (49.8%) in 2008. CONCLUSION: The rate of sensitization to at least one type of fungus was presently over 50%, higher than that detected in other medical centers in Mexico. This rate was constant over the 11-year study, and Aspergillus exhibited the greatest frequency of sensitization among the patients.
Assuntos
Alérgenos/imunologia , Antígenos de Fungos/imunologia , Asma/epidemiologia , Fungos/imunologia , Hipersensibilidade/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Imunização , Masculino , México/epidemiologia , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: Cow's milk protein allergy (CMPA) affects between 0.6 and 0.9% of the general population, and its treatment implies the total elimination of the intake of this protein. Camel's milk has been suggested as an alternative for patients over one year of age who suffer from CMPA due to the difference in the amino acid sequence from that of cow's milk. The objective of this study was to evaluate the safety and tolerability of camel's milk in children with CMPA. METHODS: Crossed clinical trial for the use of camel's milk vs. amino acid formula, carried out at the Dr. Federico Gómez Children's Hospital of Mexico (HIMFG) on patients between one and 18 years of age with diagnosed CMPA confirmed through double-blind, placebo-controlled food challenges (DBPCFCs). Only those whose allergies were confirmed were randomly placed into two groups: those to be administered camel's milk and those to be administered the amino-acid formula for two weeks, followed by a six-week wash-out period, and then a group crossing for a further two weeks. RESULTS: 49 patients with suspected CMPA were included in the study; the diagnosis was confirmed through DBPCFCs in 15 patients, who were those who participated in the study. After having been administered camel's milk, none of the patients presented adverse effects. CONCLUSIONS AND CLINICAL RELEVANCE: Camel's milk is safe and tolerable in patients above one year of age with CMPA and can be considered as a good alternative given the benefit of its taste compared to other formulas.
Assuntos
Alérgenos/imunologia , Hipersensibilidade a Leite/imunologia , Proteínas do Leite/imunologia , Adolescente , Animais , Camelus , Bovinos , Criança , Pré-Escolar , Reações Cruzadas , Estudos Cross-Over , Dietoterapia , Ingestão de Alimentos , Feminino , Humanos , Lactente , Masculino , Hipersensibilidade a Leite/tratamento farmacológicoRESUMO
BACKGROUND: House dust mites are a ubiquitous air allergen in the human habitat. It has been shown that exposure to them is a fundamental factor in sensitisation and development of atopic disease. The objective of the study was to analyse changes in sensitisation to Dermatophagoides pteronyssinus (Der p.) in children treated in a tertiary level care hospital in Mexico City for a period of 11 years and compare with other studies carried out in Mexico. METHODS: A retrospective study was performed at the Hospital Infantil de México Federico Gómez (HIMFG). Information was gathered from skin tests for Der p. performed in the Allergy Laboratory from January 2004 to April 2015. Patients 2-18 years old who presented for examination of some type of allergic condition and who had immediate hypersensitivity tests to Der p. were included in the study. Results were compared with prior reports from other institutions. Descriptive analysis and χ2 statistics were used. RESULTS: A total of 8794 patients were included in the study; 49.3% of the tests (95% CI 48-50) were positive for Der p. The percentage of monosensitised to mites was 2.7% for Der p. (95% CI 2-3). A significant difference was found between the results of older patients and those <6 years old. The frequency of sensitisation had a tendency to decrease during the 11 years analysed in all age groups. CONCLUSIONS AND CLINICAL RELEVANCE: The frequency of sensitisation to Der p. increased with age until reaching adolescence. In the last 11 years a decrease in sensitisation to this air allergen was observed.
Assuntos
Antígenos de Dermatophagoides/imunologia , Dermatophagoides pteronyssinus/imunologia , Hipersensibilidade/epidemiologia , Adolescente , Animais , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipersensibilidade/imunologia , Imunização , Masculino , México , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de TempoRESUMO
Though exposure to air pollution has a detrimental effect on respiratory health, few studies have examined the association between elemental carbon exposure and lung function among schoolchildren. The aim of the present study was to present the association between short-term elemental carbon exposure and lung function in schoolchildren from Mexico City. 55 asthmatic and 40 non-asthmatic children were followed for an average of 22 weeks. A spirometry test was performed every 15 days during follow-up. Portable air samplers collected particulate matter onto Teflon filters. Gravimetric analysis was conducted and elemental carbon was quantified using transmission densitometry. The association between the main variables was analysed using linear mixed effects models. The mean ± sd of elemental carbon light absorption was 92.7 ± 54.7 Mm(-1). An increase of one interquartile range in the 24-h average of elemental carbon (100.93 Mm(-1)) was associated with a significant negative impact on forced expiratory volume in 1 s (FEV(1)) (-62.0 (95% CI -123.3- -1.2) mL) and forced expiratory flow at 25-75% of forced vital capacity (FVC) (FEF(25-75%)) (-111 (95% CI -228.3- -4.1) mL) among asthmatic children, equal to 3.3% and 5.5%, respectively; and on FEV(1) (-95.0 (95% CI -182.3- -8.5) mL) and FVC (-105.0 (95% CI -197.0- -13.7) mL) among non-asthmatic children. Exposure to elemental carbon resulted in an important negative effect on lung function in atopic schoolchildren, regardless of asthma status.
Assuntos
Asma/epidemiologia , Carbono/toxicidade , Pulmão/efeitos dos fármacos , Adolescente , Poluição do Ar , Asma/induzido quimicamente , Criança , Cidades , Densitometria/métodos , Exposição Ambiental , Feminino , Humanos , Pulmão/patologia , Masculino , México , Testes de Função Respiratória , Espirometria/métodosRESUMO
BACKGROUND: Adolescent obesity is associated with an increased risk of adult obesity and subsequent cardiovascular diseases. The present study aimed to assess the effect of weight loss after 6-month lifestyle intervention in obese adolescents on biomarkers of endothelial activation and fibrinolytic system. METHODS: Eighty-five obese adolescents aged 10 to 16 years were assigned to a 6-month lifestyle intervention and 61 completed the programme. We examined the effect of the intervention on adhesion molecules (selectin E, soluble intercellular adhesion molecule 1 and soluble vascular adhesion molecule 1) and fibrinolytic parameters [plasminogen activator inhibitor-1 (PAI-1) and fibrinogen]. Thirty-six lean adolescents were studied only at baseline as a comparison group. RESULTS: Compared with lean participants, obese adolescents at baseline demonstrated significantly higher levels of triglycerides, glucose, insulin, homeostasis model assessment, soluble intercellular adhesion molecule 1, PAI-1 and fibrinogen. After 6-month lifestyle intervention, those obese adolescents with decreased standard deviation score-body mass index (SDS-BMI) displayed significant decreases in insulin (19.2 ± 11.2 vs. 26.8 ± 13.2 mU/L, P≤ 0.01), homeostasis model assessment (4.24 ± 3.19 vs. 6.58 ± 4.08, P≤ 0.01), selectin E (100.2 ± 60.9 vs. 116.0 ± 69.0 ng/mL, P≤ 0.01) and PAI-1 (39.6 ± 38.0 vs. 51.8 ± 25.6 ng/mL, P≤ 0.05) with respect to the baseline levels. No changes in these parameters were observed in the obese adolescents with stable or increased SDS-BMI. The changes of triglycerides after intervention in subgroup with decreased SDS-BMI were significantly greater than those in subgroup with stable SDS-BMI. CONCLUSIONS: The present study demonstrated increased endothelial activation and impairment of the fibrinolytic system in early life, which is in part reversible by a 6-month lifestyle intervention.
Assuntos
Dieta Redutora , Exercício Físico/fisiologia , Fibrinólise/fisiologia , Obesidade/sangue , Redução de Peso/fisiologia , Adolescente , Amina Oxidase (contendo Cobre)/sangue , Aterosclerose/sangue , Aterosclerose/prevenção & controle , Biomarcadores/sangue , Estudos de Casos e Controles , Moléculas de Adesão Celular/sangue , Criança , Selectina E/sangue , Feminino , Humanos , Estilo de Vida , Masculino , Obesidade/terapia , Inibidor 1 de Ativador de Plasminogênio/sangueRESUMO
OBJECTIVE: To establish the relationship between the use of acetaminophen and the frequency of asthma in Mexican children in 3 Mexican cities. METHODS: Ours was a multicenter, observational, descriptive, cross-sectional study. Patients from 6 to 7 years of age participating in Phase Three B of the ISAAC (International Study of Asthma and Allergies in Children) living in the north of Mexico City, Victoria City, and Merida were included. After adjusting for confounders, we calculated the odds ratios (OR) for the presence of wheezing ever, wheezing in the last 12 months, asthma ever, and the use of acetaminophen in the first year of life and during the last 12 months. RESULTS: The ORs for wheezing ever, wheezing in the last year, and asthma ever with respect to use of acetaminophen in the first year of life were not statistically significant (P > .05) in Mexico City, but they were significant in Victoria City (P < .05) and Merida (P < .05). The ORs (95% confidence intervals) for wheezing ever, wheezing in the last year, and asthma ever with respect to use of acetaminophen in the last year were 3.44 (2.96-4.0), 7.97 (5.89-10.78), and 6.10 (3.30-8.81) (P < .05) in Mexico City. Values forVictoria City were 1.36 (1.13-1.63), 3.80 (2.88-5.05), and 2.18(1.57-3.01) (P < .05). Those for Merida were 1.61 (1.40-1.85), 2.07 (1.73-2.48), and 1.53 (1.29-1.82) (P < .05). CONCLUSION: The use of acetaminophen is associated with the presence of wheezing and asthma in 3 different cities in Mexico.
Assuntos
Acetaminofen/uso terapêutico , Asma/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Saúde da População UrbanaRESUMO
G-protein-coupled receptor for asthma susceptibility (GPRA or GPR154) was identified as an asthma and atopy candidate gene by positional cloning. Some subsequent studies suggest associations of GPRA single nucleotide polymorphisms (SNPs) and haplotypes with asthma or atopy susceptibility. However, the associated SNPs or haplotypes vary among studies. The role of GPRA genetic variation in asthma and atopy remains unsolved. Published data on GRPA variants and asthma come exclusively from Caucasian and Asian populations. We examined whether GPRA SNPs and haplotypes are associated with asthma and atopy in a Mexican population. We genotyped and analyzed 27 GPRA SNPs in 589 nuclear families consisting of asthmatic children aged 4-17 years of age and their parents in Mexico City. Atopy was determined by skin prick tests to 25 aeroallergens. The 27 SNPs examined provided excellent coverage of the GPRA gene. GPRA SNPs and haplotypes were not associated with childhood asthma and the degree of atopy to aeroallergens in a Mexican population. Our review of studies of GPRA variants in relation to asthma phenotypes shows considerable heterogeneity. Accordingly, our results suggest that GPRA variants are not an important contributor to childhood asthma and atopy susceptibility in a Mexican population.
Assuntos
Asma/genética , Predisposição Genética para Doença/genética , Variação Genética , Hipersensibilidade Imediata/genética , Receptores Acoplados a Proteínas G/genética , Adolescente , Criança , Pré-Escolar , Clonagem Molecular , Genótipo , Haplótipos/genética , Humanos , México , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire allows users to find factors associated with allergic diseases, but thus far most of the studies on risk factors for allergic diseases have been devoted to asthma and not to rhinitis. OBJECTIVE: To determine the main factors associated with symptoms of allergic rhinitis and rhinoconjunctivitis in school children and adolescents in northern Mexico City. PATIENTS AND METHODS: A cross sectional, multicenter survey was conducted in northern Mexico City, in children aged 6-7 and 13-14 years. The survey instrument was the Phase Three B ISAAC questionnaire, which was validated and standardized in Spanish. RESULTS: There were 4106 6-7-year-olds and 6576 13-14-year-olds. The total prevalence of diagnosis of allergic rhinitis was 4.6%. The prevalence of cumulative and current symptoms of rhinitis was considered high (>29%), but the prevalence of the diagnosis of allergic rhinitis was considered low (ranging from 3.4% to 5.6%). The prevalence of symptoms of rhinitis with conjunctivitis had intermediate values (ranging from 20.3% to 30.2%). Cumulative symptoms of allergic rhinitis, current symptoms of allergic rhinitis, and rhinoconjunctivitis were related to symptoms of current or cumulative asthma, symptoms of current or cumulative atopic eczema, and current use of paracetamol (odds ratio > 1, P < .05). CONCLUSION: The present results support the concept of rhinitis and asthma as common chronic respiratory diseases, and this study also found a relation between paracetamol use and rhinitis in children.
Assuntos
Acetaminofen/imunologia , Asma/epidemiologia , Rinite Alérgica Perene/epidemiologia , Acetaminofen/efeitos adversos , Adolescente , Asma/imunologia , Criança , Estudos Transversais , Dermatite Atópica/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , México/epidemiologia , Rinite Alérgica Perene/imunologia , Fatores de RiscoRESUMO
BACKGROUND: Acute respiratory tract infections (ARTIs) are a major cause of childhood morbidity and mortality. Immunostimulants (IS) may reduce the incidence of ARTIs. OBJECTIVES: To determine the efficacy and safety of IS in preventing ARTIs in children. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2005); MEDLINE (January 1966 to January 2006); and EMBASE (January 1990 to January 2006); PASCAL (up to January 2006); SciSearch (up to January 2006); and IPA (up to January 2006) for reports of trials. Investigators in the field were also contacted. Ongoing studies were searched in the trial registration web site, metaRegister of Controlled Trials. SELECTION CRITERIA: All comparative trials which enrolled patients less than 18 years of age were included. The intervention of interest was the use of an IS medication administered by any method for preventing ARTIs. Clinical trials using random or quasi-random allocation and comparing IS medication or medications to placebo were included. DATA COLLECTION AND ANALYSIS: The outcome on ARTIs was analyzed both as the mean number of ARTIs by group and as a percent change in the rate of ARTIs. Meta-analysis was undertaken using a random-effects model and results were presented as weighted mean differences (WMD) with 95% confidence intervals (CI). The trials search, quality assessment and data extraction were undertaken independently by two authors. A funnel plot suggested there may be publication bias in the trials identified. MAIN RESULTS: Thirty-four placebo controlled trials (3877 participants) provided data in a form suitable for inclusion in the meta-analysis. When compared with placebo, the use of IS was shown to reduce ARTIs measured as the total numbers of ARTIs (WMD -1.27; 95% CI -1.58 to -0.97) and the difference in ARTIs rates (WMD -39.68%; 95% CI -47.27% to -32.09%). The trial quality was generally poor and a high level of statistical heterogeneity was evident. The subgroup analysis of bacterial IS studies produced similar results, with lower heterogeneity. No difference in adverse events was evident between the placebo and IS groups AUTHORS' CONCLUSIONS: This review showed that IS reduces the incidence of ARTIs in children, by 40% on average. However, due to significant heterogeneity and the poor quality of the trials this positive result should be interpreted with caution. The safety profile of IS appears to be good. Further high-quality trials are needed and we encourage national health authorities to conduct large, multicenter, double-blind, placebo-controlled trials on the role of IS in the prevention of ARTIs.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Infecções Respiratórias/prevenção & controle , Adolescente , Criança , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Asthma is an important childhood disease. Recent surveys of the International Study of Asthma and Allergies in Childhood (ISAAC) suggest that the prevalence of asthma is increasing but these surveys do not include any pulmonary tests to confirm the possible diagnosis of asthma. OBJECTIVE: To compare bronchodilator reversibility with the albuterol test in symptomatic and asymptomatic 6-7-year-old children with asthma participating in the ISAAC survey and living in Mexico City. PATIENTS AND METHODS: We performed an observational, descriptive, comparative, cross sectional study in children participating in phase 3b of the ISAAC study. According to the ISAAC questionnaire children were classified as asthma symptomatic or asymptomatic. Both groups had bronchodilator reversibility with the albuterol test, using the guidelines of the American Thoracic Society to confirm or rule out the diagnosis of asthma. RESULTS: The asymptomatic group had a baseline FEV1 of 1.70 +/- 0.34 l/sec (mean +/- SD) and an endpoint FEV1 of 1.76 +/- 0.42 l/sec; in the symptomatic group the respective values were 1.51 +/- 0.41 l/sec and 1.57 +/- 0.44 l/sec (p < 0.05). A positive reversibility test was found in 13/136 (9.6 %) children in the asymptomatic group and in 22/112 (19.6 %) children in the symptomatic group (p < 0.05). CONCLUSION: Because of its low sensitivity, bronchodilator reversibility cannot be considered a diagnostic tool to confirm diagnosis of asthma.
Assuntos
Albuterol , Asma/diagnóstico , Broncoconstrição/efeitos dos fármacos , Broncodilatadores , Albuterol/farmacologia , Asma/epidemiologia , Asma/fisiopatologia , Broncodilatadores/farmacologia , Criança , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , México/epidemiologia , Valor Preditivo dos Testes , Sons Respiratórios/efeitos dos fármacos , Sensibilidade e Especificidade , Inquéritos e Questionários , População UrbanaRESUMO
BACKGROUND: In addition to the increased incidence of asthma, obesity in asthmatic children is also on the rise. Several studies have been performed to determine whether obesity could be a risk factor for asthma, but this association has not been demonstrated in all patients. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is a standardized and validated tool for use in the pediatric population, which evaluates the effect of asthma on patients' daily activities. METHODS AND RESULTS: To determine the effect of obesity and overweight on quality of life, the PAQLQS was applied to 100 pediatric patients with intermittent asthma and mild persistent asthma and obesity, overweight and normal weight. The results of the three dimensions evaluated in the questionnaire (emotions, symptoms and limitation of activities) showed significant differences in quality of life in the obese asthmatic group only (p < 0.000). No differences were found when the groups with and without overweight were compared. CONCLUSIONS: The PAQLQ revealed a significant difference in the quality of life in obese asthmatic patients. Overweight and normal weight had no effect quality of life.
Assuntos
Asma/psicologia , Obesidade/psicologia , Qualidade de Vida , Atividades Cotidianas , Adolescente , Asma/complicações , Criança , Emoções , Feminino , Humanos , Masculino , México , Obesidade/complicações , Projetos Piloto , Estudos Prospectivos , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: We recently reported that antioxidant supplementation with vitamins C and E mitigated ozone related decline in forced expiratory flow (FEF(25-75)) in 158 asthmatic children in an area with high ozone exposure in Mexico City. METHODS: A study was undertaken to determine whether deletion of glutathione S-transferase M1 (GSTM1 null genotype), a gene involved in response to oxidative stress, influences ozone related decline in FEF(25-75) and the benefit of antioxidant supplementation. RESULTS: GSTM1 null children receiving placebo had significant ozone related decrements in FEF(25-75) (percentage change per 50 ppb of ozone 2.9 (95% CI -5.2 to -0.6), p=0.01); GSTM1 positive children did not. Conversely, the effect of antioxidants was stronger in children with the GSTM1 null genotype. CONCLUSIONS: Asthmatic children with a genetic deficiency of GSTM1 may be more susceptible to the deleterious effects of ozone on the small airways and might derive greater benefit from antioxidant supplementation.
Assuntos
Antioxidantes/administração & dosagem , Asma/dietoterapia , Suplementos Nutricionais , Glutationa Transferase/genética , Ozônio/toxicidade , Polimorfismo Genético/genética , Asma/genética , Asma/fisiopatologia , Criança , Método Duplo-Cego , Exposição Ambiental/efeitos adversos , Feminino , Fluxo Expiratório Forçado/fisiologia , Deleção de Genes , Genótipo , Humanos , Masculino , México , Estresse Oxidativo/genéticaRESUMO
BACKGROUND: Previous studies have revealed the relationship between asthma and obesity, but the relationship with other markers of overweight and obesity has not yet been investigated. OBJECTIVE: To establish the relationship between asthma symptoms and simple anthropometric indexes (BMI, waist circumference (WC), and waist-to-hip ratio (WHR)) as markers of overweight in an adult Hispanic population. METHODS: The data were obtained from the PRIT (Prevalence of Cardiovascular Risks in General Hospital Workers) 2001 survey. The participants were workers at the Hospital General de México in Mexico City and included 135 men and 398 women aged 43.8 +/- 11.9 and 43.0 +/- 10.5, respectively. Odds ratios for asthma symptoms at different BMI, WC, and WHR cutoff points associated with excessive weight were calculated. The likelihood ratios for having asthma symptoms in participants with various cutoff values of BMI, WC, and WHR also were calculated. RESULTS: Asthma symptoms were not related to anthropometric markers of overweight or obesity in men, while they were associated in women with WC cutoff levels of 80 and 85 cm, and BMI of 25 and 27 kg/m2. No level of WHR was related to asthma symptoms in women. In women, the likelihood ratio for asthma symptoms increased proportionally from WC levels of 73.5 cm up to 86 cm, while this risk increased significantly from BMI levels of 22 up to 29 kg/m2. CONCLUSION: Overweight as assessed by BMI and WC (but not WHR) was related to asthma symptoms in women in the studied population.
Assuntos
Antropometria , Asma/complicações , Obesidade/complicações , Adulto , Constituição Corporal , Índice de Massa Corporal , Hispânico ou Latino , Humanos , Masculino , México , Razão de Chances , Fatores SexuaisRESUMO
BACKGROUND: Recurrent acute respiratory tract infections (RARTIs) in children are related to IgG subclass deficiencies. The aim of the trial was to evaluate the effect of OM-85 BV in the number of RARTIs as well as in the IgG subclass levels. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial. Patients of ages three to six years, having three or more documented ARTIs during the last six months with subnormal IgG subclass levels were included. Patients took either one capsule of OM-85 BV (3.5 mg) or placebo orally every day for ten consecutive days per month during three consecutive months. Patients were followed three further months without drug intake. IgG subclass levels were determined before and after treatment. RESULTS: IgG4 levels diminished after the OM-85 BV treatment (-3 [-8.0, -1.0] median difference [95 % CI] p < 0.05 by Wilcoxon test). No other significant changes in IgG subclasses were observed. After six months the patients in the OM-85 BV group (n = 20) experienced 2.8 1.4 (mean SD) ARTIs, while the patients in the placebo group (n = 20) suffered 5.2 1.5 ARTIs (-2.4 [3.3, -1.5] mean difference [95 % CI] p < 0.001 by Student's t test). Three patients with OM-85 BV had gastrointestinal events related to drug administration, as well as three placebo patients. CONCLUSION: This study demonstrated the clinical benefit of OM-85 BV in patients suffering from RARTIs and subnormal levels of IgG subclasses. This trial opens new perspectives in the research of the mechanism of action of OM-85 BV.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Bactérias , Extratos Celulares , Deficiência de IgG/complicações , Imunoglobulina G/sangue , Infecções Respiratórias/prevenção & controle , Adjuvantes Imunológicos/efeitos adversos , Pré-Escolar , Método Duplo-Cego , Feminino , Gastroenteropatias/induzido quimicamente , Humanos , Deficiência de IgG/sangue , Deficiência de IgG/terapia , Imunoglobulina G/classificação , Lactente , Masculino , México , Polissacarídeos Bacterianos/imunologia , Estudos Prospectivos , Recidiva , Infecções Respiratórias/etiologia , Infecções Respiratórias/imunologia , População UrbanaRESUMO
BACKGROUND: Development of latex hypersensitivity type 1 response mediated by IgE depends on exposition intensitivity and genetic predisposition. Clinical manifestations are urticaria, rhinoconjunctivitis, asthma and anaphylaxis. OBJECTIVE: The aim of the study was to determine the frequency of latex immediate skin reactivity on allergy patients from 1-15 yr old from Hospital Infantil de México. METHODS: A clinical, prospective trial was performed between november 1998 and april 1999. During the study we documented 629 patients with allergy. Of them 30 had positive skin prick test (SPT) to latex according to Aas classification and 30 with negative SPT were randomly chosen as control group. Both groups were similar with respect to diagnosis, age, and sex characteristics. RESULTS: 629 children's with SPT, 30 had positive skin princk test (4.76%), 15 men and 15 women, with an average age of 8.9 years. For groups 1-5 years of age. The group age 6-10 years 6.21% and that of age 11-15 8.9%. Atopia antecedent 73.3%. For rhinitis and asthma diagnostic 63%, rhinitis 13%, asthma 20%, conjunctivitis 20%, atopic dermatitis and anaphylaxis 3.3%, urticaria 6.6%. Surgery antecedent 30%. 100% used a sucking, 93% used a latex toy the relationship of symptoms with the use of latex was 6.6%. Statistica1 ana1ysis was performed using: Nonparametric correlations the Kendall's tau-b: 0.329 and Spearman's rho 0.348 correlation is significant. CONCLUSION: It does exist a correlation between SPT and test for latex-especific IgE antibodies, the older the patient, the higher frequency of latex reaction, history of atopy is the mayor risk factor.
Assuntos
Hipersensibilidade Imediata/diagnóstico , Imunoglobulina E/análise , Hipersensibilidade ao Látex/diagnóstico , Testes Cutâneos , Adolescente , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Projetos Piloto , Estudos ProspectivosRESUMO
Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 micrograms per puff) or Ibe + Isal (B 2 puff/12 hr, 100 micrograms per puff and S 2 puff/12 hr, 25 micrograms per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 +/- 2.18 (mean +/- SD) years, baseline K was 4.57 +/- 0.43 mEq/l, after B K 4.38 +/- 0.39 IU and after BS K 4.38 +/- 0.40. The CPK-MB level were baseline 14.75 +/- 4.5, after B 20.10 +/- 6.9 and after BS 21 +/- 8.05 (p < 0.05). Baseline QTc was 0.416 +/- 0.02 msec, after B 0.425 +/- 0.027, and after BS 0.415 +/- 0.029. We conclude that the treatment of children with asthma with 400 micrograms per day of Ibec or concomitantly with 100 micrograms of Isal for 6 weeks does not alter the serum K+ or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased.
Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Albuterol/análogos & derivados , Albuterol/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/tratamento farmacológico , Beclometasona/efeitos adversos , Creatina Quinase/sangue , Eletrocardiografia/efeitos dos fármacos , Coração/efeitos dos fármacos , Isoenzimas/sangue , Potássio/sangue , Adolescente , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/uso terapêutico , Albuterol/administração & dosagem , Albuterol/uso terapêutico , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Asma/sangue , Asma/fisiopatologia , Beclometasona/administração & dosagem , Beclometasona/uso terapêutico , Criança , Creatina Quinase Forma MB , Estudos Cross-Over , Quimioterapia Combinada , Feminino , Humanos , Masculino , Estudos Prospectivos , Xinafoato de SalmeterolRESUMO
BACKGROUND: Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients. PATIENTS: A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin. METHODS: Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles. RESULTS: The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin. DISCUSSION: The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.
Assuntos
Dessensibilização Imunológica , Diabetes Mellitus Tipo 1/tratamento farmacológico , Insulina/imunologia , Adolescente , Diabetes Mellitus Tipo 1/imunologia , Toxidermias/etiologia , Toxidermias/terapia , Feminino , Humanos , Insulina/administração & dosagem , Insulina/efeitos adversos , Insulina/genética , Insulina/uso terapêutico , Prurido/induzido quimicamente , Prurido/terapia , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/uso terapêutico , Testes Cutâneos , Urticária/induzido quimicamente , Urticária/terapiaRESUMO
The asthma is one of the most frequent chronic illnesses in the children. It is characterized by hyperreactivity from the air roads to inspecific stimuli (metacholin and histamin) and specific (allergens). The broncodynamics tests determines the broncolability asthmatic boy's and they help to settle down the I diagnose functional. They should be carried out with antigenic extracts of high quality, lyophilized watery and standardized; you can use an open or closed circuit and a dosimeter, the initial dose of the allergen it is lower than with the one that the positive cutaneous reactivity was obtained, carrying out successive increments until the VEF-1 descend 15% or more. The patient's security is fundamental, they should be carried out for specialized personnel.
Assuntos
Alérgenos , Asma/diagnóstico , Testes de Provocação Brônquica/métodos , Administração por Inalação , Alérgenos/administração & dosagem , Criança , HumanosRESUMO
AIMS: The exercise-induced bronchoespasm, also called asthma for exercise, it corresponds to a frequent clinical entity that commonly accompanies the asthmatic patient. Their frequency is of around the 80 to 90% for the patients with asthma; it is presented among 40 to 50% of the children with allergic rhinitis, in the athletes 14% and in the population's 12% in general. OBJECTIVE: To determine the effectiveness of a heating routine like preventive agent of the exercise-induced bronchoespasm. METHOD: 30 patients were included of between 10 and 16 years of age, asthmatic and with exercise-induced bronchoespasm by diagnosed by means of challenge test to the exercise. All the patients carried out an exercise routine with duration of 20 minutes during which movements of elasticity, calisthenics and light activity were made directed to the exercise to develop, taking as objective parameter 60% of the frequency heart submax. Did all the patients carry out challenge at once, again to the exercise, in which a band numberless was used, with speeds that were increased progressively from 1 to 8 km/h and with inclination of 0? 10 0. The spirometrics registrations was made before the challenge and at the 2, 5, 10, 15, 20, 25, 30 and 60 minutes after the same one. RESULTS: The average of the patient's age was of 12.8 +/- 2 years with size of 157 +/- 10 cm. CONCLUSION: The heating in children with broncoespasmo induced by exercise acts as a protective agent against the decrement of the VEF-1. Although the heating can be a good control method in the asthmatic patient, it is necessary to keep in mind that not all the patients have a benefit of this protection. This can only be used in patient with programmed physical activity, since in the preschoolers it is not possible to implant a heating routine for the characteristics characteristic of their activity.