Drug-induced anaphylaxis, elicitors, risk factors, and management in Latin America

Nonsteroidal anti-inflammatory drugs were the most frequent triggers of drug-induced anaphylaxis in Latín America, whereas antibiotics elicited faster onset and more scvere reactions. An improvement was observed in epinephrinc use and adherence to guidelines in the emergency department treatment of anaphylaxis in Latín America compared with our last report.Facultad de Ciencias Médica

Immunological evaluation during treatment of a case of borderline lepromatous leprosy

Background: Leprosy is a chronic granulomatous infection that affects skin and peripheral nerves. Its prevalence has declined, but is still observed mainly in poor rural areas. Case report: A male city dweller with photophobia and chronic dermatosis in the face: nodular and erythematous lesions, pustules, keratitis and entropion, partial eyebrows loss, and edema on eyelids, chin, and nose bridge. The rest of the body had no lesion or lymphadenopathy. Biopsy revealed Langhans giant cell proliferation in the superficial dermis without epidermal atrophy. BAAR staining for detection were positive, no Virschow cells were observed, and Fite-Franco staining (leprosy-specific) was negative. Cutaneous tuberculosis was diagnosed. Rifampicin/isoniazid/pyrazinamide and dialysate leukocyte extract were prescribed. A month later, the swelling had decreased significantly. Polymerase chain reaction (PCR) test was positive for Mycobacterium leprae. Flow cytometry showed CD4 count normalization. Long-term treatment with rifampicin, clofazimine, and dapsone was established. Conclusions: The host’s immune response determines the clinical features of the disease: if response is bad there will be vacuolated macrophages filled with bacilli (lepromatous leprosy). Clinical and histopathological findings help typing

Validation of a Diagnostic Questionnaire on Asthma in Children and Adults For Epidemiological Studies

Background: Asthma is a chronic airway in ammatory disease, for identification in the population epidemiological studies are required. Objective: To validate a questionnaire of asthma diagnosis in children and adults. Patients and method: A prolective, cross-sectional, homodemic and multicenter study was done in which a questionnaire of asthma for children and adults was subjected to a validation process was developed from November 2012 to February 2014, 300 patients, 150 children and 150 adults of both sexes, obtained from the Allergy department. The questionnaire was applied to adults from 13 years of age and to parents who have children age 12 and under. Each question was assigned a score as the sum of the points according to symptoms, when it reached a score equal to or greater than 0.75, asthma was diagnosed. Results: The questionnaire of asthma was applied in adult population 13-70 years of age and fathers with children was 2-12 years old. The tests applied to questionnaire responses showed adults and children in good agreement in the test and retest interobserver agreement, this being substantial to almost perfect. The tests applied to criterion validity for both questionnaires showed a sensitivity of 90% in > 12y, and 90 % in children, and speci city of 91% and 90%, respectively PPV 92% and NPV 90% in > 12y and 90% PPV and 90% NPV in children. The criteria for content validity and expression are properly met. The homogeneity test Cronbach’s alpha was 0.7. Conclusion: The questionnaire for diagnosis of asthma in adults and children has good intra- and interobserver agreement, with high sensi- tivity and specificity in the criterion validity

Prevalence of allergic diseases in children with secondary renal tubular acidosis attending a tertiary care pediatric center

Background: It has been suggested a high prevalence of allergic disease in children with RTA. Objectives: To describe the prevalence of allergic diseases in children with secondary RTA (renal tubular acidosis) in the nephrology department of the National Institute of Pediatrics (NIP), México. Methods: An observational, prospective, cross-sectional, descriptive study. Children with secondary RTA < 18 years who attended the outpatient nephrology service in the NIP for 24 months, were included. ISAAC questionnaire and the EAACI guidelines were applied. To prove a suspected allergy, skin tests, total and specific IgE, patch testing and food challenge were performed. Using SPSS 19, frequency of allergic diseases was described. Results: 113 patients were included. Age 8 to 168 months. Male: 53.9 %. RTA types: Distal (64.6 %), proximal (26.5 %), mixed (1.8 %) and undetermined (7 %). Age of onset between 1 and 96 months. Serum bicarbonate 10.1 to 20 mEq/L. Allergic diseases were found in 24.8 %: allergic rhinitis (18.4 %), food allergy (9.7 %), atopic dermatitis (8 %), asthma (8 %) and allergic conjunctivitis (6.1 %). Total IgE was increased in 9 patients. Positive skin tests in 14.2 %. Positive chemiluminescence in 18 children; positive open food challenge in 11 children and patch tests in 4. Conclusions: Secondary RTA is common in children attending tertiary care hospitals. The prevalence of allergic disease in children with secondary ATR, is similar to that described in the general population

Information and communication technology use in asthmatic patients: a cross-sectional study in Latin America

Rapid diffusion, low cost and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, communication and interventions in asthma. There is little information in Latin America about usage frequency of ICTs in asthmatic patients. The analysis undertaken consisted of an observational, cross-sectional study that aimed to identify the frequency and type of ICTs most often used by asthmatics. The Spanish version of the Michigan questionnaire was employed in five Latin American countries. Age and educational level was categorised. Logistic regression was performed among these groups concerning the frequency of ICT usage and the level of interest shown in seeking and receiving information about asthma. In total, 673 asthma patients were surveyed. The mean age was 43.44 years. Over two-thirds of the participants were female (68.4%). The most used ICT was the short message service (SMS) (69.9%). SMS and E-mail are useful tools for communicating (i.e. receiving and seeking information) with all asthma patients, irrespective of their age. WhatsApp (61.5%) and Facebook (32.0%) were rated as being the most interesting channels of communication for receiving information. Regression analysis showed that younger asthmatics and asthmatics with higher educational levels were most likely to use almost all forms of ICTs. ICTs are generally an attractive platform for managing care, communication and interventions to improve asthma care. SMS and E-mail were found to be the preferred ICT forms among users. However, social media forms such as WhatsApp and Facebook may also be appropriate for certain types of patient