Eficacia de la tintura de ajo al 20% en pacientes asmáticos. Policlínico 13 de Marzo. 2018 -2019 / Efficacy of 20% garlic tincture in asthmatic patients. Polyclinic March 13. 2018 -2019 / Eficácia da tintura de alho a 20% em pacientes asmáticos. Policlínica, 13 de março. 2018-2019

RESUMEN Se realizó un estudio prospectivo, con modelo cuasi experimental en los pacientes asmáticos pertenecientes del Policlínico 13 de Marzo, con el objetivo de evaluar la eficacia de la tintura de ajo al 20% en el tratamiento intercrisis del Asma Bronquial, en el período comprendido de enero de 2018 a mayo de 2019. El Universo estuvo representado por 88 pacientes asmáticos entre 20-59 años de edad dispensarizados en el consultorio 25. La muestra quedó constituida por 84 pacientes que cumplieron con los criterios de inclusión y de exclusión. Los pacientes fueron distribuidos de forma aleatoria, en dos grupos control y experimental, utilizando la tabla de números aleatorios computarizados, en una proporción pareada de 1:1. Se empleó la prueba de diferencia de proporciones para muestras independientes y se trabajó con un nivel de significación p=0,05. Con este proyecto se contribuyó al desarrollo de la medicina natural y tradicional en nuestro país. Se demostró la eficacia de la tintura de ajo en el 97.6 % de los pacientes. Los hombres fueron los más afectados por las crisis y se reportaron 3 efectos adversos de forma leve.

ABSTRACT A prospective study was carried out, with a quasi-experimental model in asthmatic patients belonging to the 13 de Marzo Polyclinic, with the aim of evaluating the efficacy of the 20% garlic tincture in the inter-crisis treatment of Bronchial Asthma, in the period from January from 2018 to May 2019. El universo was represented by 88 asthmatic patients between 20-59 years of age dispensed in the office 25. The sample consisted of 84 patients who met the inclusion and exclusion criteria. The patients were randomized into two control and experimental groups, using the table of computerized random numbers, in a paired ratio of 1: 1. The difference of proportions test was used for independent samples and the level of significance was p = 0.05. This project contributed to the development of natural and traditional medicine in our country. The efficacy of garlic tincture was demonstrated in 97.6% of patients. Men were the most affected by the seizures and 3 mild adverse effects were reported.

RESUMO Foi realizado um estudo prospectivo, com modelo quase experimental em pacientes asmáticos pertencentes à Policlínica 13 de Marzo, com o objetivo de avaliar a eficácia da tintura de alho a 20% no tratamento intercrises da Asma Brônquica, no período de janeiro de 2018 a maio de 2019. O El Universo foi representado por 88 pacientes asmáticos entre 20 e 59 anos dispensados ​​em consultório 25. A amostra foi composta por 84 pacientes que atenderam aos critérios de inclusão e exclusão. Os pacientes foram randomizados em dois grupos controle e experimental, utilizando a tabela de números aleatórios computadorizados, na proporção pareada de 1: 1. O teste de diferença de proporções foi utilizado para amostras independentes e o nível de significância adotado foi p = 0,05. Este projeto contribuiu para o desenvolvimento da medicina natural e tradicional em nosso país. A eficácia da tintura de alho foi demonstrada em 97,6% dos pacientes. Os homens foram os mais afetados pelas convulsões e três efeitos adversos leves foram relatados.

Correlation of age with Lung Function in Asthmatics

Background: Bronchial asthma has grown to be one of the major chronic health problem. The present study was conducted to assess correlation of age with lung function in asthmatics. Methods: The present study was conducted on 60 asthmatic patients of both genders. Patients were divided into 3 groups of 20 each. Group I were controlled asthmatics, group II had partly controlled and group III had uncontrolled asthmatics. In all patients, lung function tests were performed. Results: In age group 20-30 years had 12, group II had 10 and group III had 11 patients. Age group 30-40 years had 8 in group I, group II had 10 and group III had 9 patients. There was significant difference in FEV1 (L), FVC (L), FEV1/FVC and PEFR/Sec in all groups and in different age groups (P< 0.05). Conclusion: Authors found positive correlation of lung function test and age in uncontrolled asthmatics.

Microbial biotransformation of beclomethasone dipropionate by Aspergillus niger

In the present research, the steroidal anti-asthmatic drug beclomethasone dipropionate was subjected to microbial biotransformation by Aspergillus niger. Beclomethasone dipropionate was transformed into various metabolites first time from microbial transformation. New drug metabolites produced can act as new potential drug molecules and can replace the old drugs in terms of safety, efficacy, and least resistance. They were purified by preparative thin layer chromatography technique, and their structures were elucidated using modern spectroscopic techniques, such as 13C NMR, 1H NMR, HMQC, HMQC, COSY, and NOESY, and mass spectrometry, such as EI-MS. Four metabolites were purified: (i) beclomethasone 17-monopropionate, (ii) beclomethasone 21-monopropionate, (iii) beclomethasone, and (iv) 9beta,11beta-epoxy-17,21-dihydroxy-16beta-methylpregna-1,4-diene-3,20-dione 21-propionate.

Na pesquisa presente o fármaco esteróide antiasmático dipropionato de beclometasona foi submetido à biotransformação microbiana pelo Aspergillus niger. O dipropionato de beclometasona foi transformado, pela primeira vez, em metabólitos variados por biotransformação microbiana. Novos metabólitos do fármaco produzidos podem agir como novas moléculas potenciais e podem substituir os fármacos antigos em questão de segurança, eficácia e mínima resistência. Eles foram purificados por cromatografia em camada delgada preparativa e as suas estruturas foram elucidadas usando técnicas espectroscópicas modernas, como 13C NMR, 1H NMR; HMQC; HMQC; COSY, NOESY e espectrometria de massas, por exemplo, EI-MS. Purificaram-se quatro metabólitos, denominados (i) 17-monopropionato de beclometasona; (ii) 21-monopropionato de beclometasona: (iii) beclometasona e (iv) 21-propionato de 9beta,11beta-epoxi-17,21-diidroxi-16beta-metilpregna-1,4-dieno-3,20-diona.

Asma de difícil controle em pediatria: desafio presente e futuro / Hard-to-control asthma and pediatrics: current and future challenges

Objetivos: fazer revisão dos aspectos epidemiológicos, clínicos, propedêuticos e do manejo terapêutico da asma de difícil controle. Fonte dos dados: pesquisa não sistemática nas bases de dados Medline e LILACS. Síntese dos dados: a asma de difícil controle (ADC) constitui-se em síndrome definida na ausência de controle da asma com doses de budesonida, ou equivalente, iguais ou superiores a 800 ?g por dia. Apesar da simplicidade dessa definição clínica, o manejo propedêutico e terapêutico envolve multiplicidade de fatores e os pacientes devem ser acompanhados por pneumopediatra e equipe multidisciplinar em centros de referência. É necessário confirmar o diagnóstico de asma, avaliar diagnósticos alternativos e/ou fatores agravantes, verificar a adesão, a presença de causas psicossociais e estabelecer o fenótipo da asma a partir de marcadores inflamatórios (invasivos e não invasivos). As pesquisas revelam que os diferentes fenótipos requerem tratamentos específicos, entretanto, a aplicação na prática clínica desse conhecimento fenotípico ainda requer mais estudos. Conclusões: a asma de difícil controle em criança ou adolescente pode estar relacionada a múltiplas causas e à existência de diferentes subgrupos de ADC e com diferentes fisiopatologias de base.

Objectives: To review the epidemiological, clinical, propaedeutic aspects as well as the treatment of hard-to-control asthma. Source of data : Non-systematic research on Medline and LILACS databases. Data summary: Hard-to-control asthma (HCA) is a syndrome defined as the lack of asthma control despite daily doses of budesonide or equivalent that are equal to or higher than 800 ?g. This clinical definition may sound simple, but preliminary handling and treatment involve multiple factors and patients should be followed up by a pediatric pulmonologist and a multidisciplinary team at specialist care centers. It is necessary to confirm the diagnosis, to assess alternative diagnoses and/or aggravating factors, assess compliance and existence of psychosocial causes, and to define the asthma phenotype based on inflammatory markers (both invasive and non-invasive). Studies show that different phenotypes demand different treatments; however, further studies are needed to investigate the actual application of this knowledge in the clinical practice. Conclusions: Hard-to-control asthma in children or adolescents can be related to multiple causes and the existence of different HCA subgroups with different pathophysiological grounds

A study of autonomic nervous system status in children of asthmatic parents.

Asthmatic patients are known to have autonomic abnormalities. This study evaluated the status of autonomic nervous system in children of asthmatic parents for any occurrences of autonomic abnormalities that are known to occur in asthma. In this study autonomic function tests were conducted in children (5 to 10 years of age) divided into two groups: Group A had children from non-asthmatic parents as Control Group and Group B had children from asthmatic parents as Test Group. Both the groups had healthy children showing no clinical signs and symptoms of asthma, allergy or any illness known to affect autonomic nervous system. In response to various parasympathetic function tests (S/L ratio, 30:15 ratio, valsalva ratio and tachycardia ratio) and sympathetic function tests (handgrip test and cold pressor test) done, the two groups did not show any statistically significant dissimilarity for any of the parameters. The results of our study showed that there were no autonomic abnormalities found in the children of asthmatic parents. Thus this study indicates that the autonomic defects seen in asthmatics could be secondary to asthma and not because of autonomic aberrations inheritance in asthmatics as shown by earlier few studies supporting the possible role of inherited automatic reactivity in the pathogenesis and progression of asthma.

Assessment of personal exposure to ozone in asthmatic children residing in Mexico City / Evaluación de la exposición personal a ozono en niños asmáticos de la Ciudad de México

OBJECTIVE: A study was conducted to evaluate personal ozone exposure (O3p) among asthmatic children residing in Mexico City. MATERIAL AND METHODS: A total of 158 chil-dren were recruited from December 1998 to April 2000. On average, three O3p measurements were obtained per child using passive badges. Time-activity patterns were recorded in a diary. Daily ambient ozone measurements (O3a) were obtained from the fixed station, according to children’s residence. Levels of O3a and ozone, weighted by time spent in different micro-environments (O3w), were used as independent variables in order to model O3p concentrations using a mixed-effects model. RESULTS: Mean O3p was 7.8 ppb. The main variables in the model were: time spent indoors, distance between residence and fixed station, follow-up group, and two interaction terms (overall R²=0.50, p<0.05). CONCLUSIONS: The O3w concentrations can be used as a proxy for O3p, taking into account time-activity patterns and the place of residence of asthmatic Mexican children.

OBJETIVO: Realizamos este estudio para evaluar la exposición personal a ozono (O3p) en niños asmáticos de la Ciudad de México. MATERIAL Y MÉTODOS: Se incluyeron 158 niños entre diciembre de 1998 y abril de 2000. En promedio se obtuvieron tres mediciones por niño, utilizando filtros pasivos para medir O3p. Se caracterizaron los patrones de actividad y las concentraciones ambientales diarias de ozono (O3a) se obtuvieron de estaciones fijas cercanas a la residencia del niño. Los niveles promedio de O3a y las concentraciones ponderadas por el tiempo en diferentes microambientes (O3w) fueron usados como variables independientes para modelar las concentraciones de O3p, utilizando modelos de efectos mixtos. RESULTADOS: La media de O3p fue 7.8 ppb. Las principales variables en el modelo fueron: tiempo en exteriores, distancia, periodo de seguimiento y dos términos de interacción (R²=0.50, p<0.05). CONCLUSIONES: Las concentraciones de O3w pueden usarse como "proxi" de O3p, tomando en cuenta patrones de actividad y lugar de residencia.

Effects of Personal Exposure to Nitrogen Dioxide on Peak Expiratory Flow in Asthmatic Patients / 예방의학회지

OBJECTIVES: Nitrogen dioxide (NO2) has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of NO2 exposure in asthmatics by examining the association between changes in lung function and concentrations of NO2 which were personally measured. METHODS: Peak expiratory flow (PEF) and daily personal exposures to NO2 were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal NO2 exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. RESULTS: The personal NO2 exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for NO2 was 1.48. The personal NO2 exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. CONCLUSIONS: Among the asthmatic adults who participated in this study, we found no apparent impact of personal NO2 exposures on the peak expiratory flow.

Perception of Wheezing in the Elderly Asthmatics

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the important features. The main reason for underdiagnosis is thought to be a low frequency in complaining of symptoms due to the reduction of intellectual recognition and physical activity. Among the various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreased complaints for wheezing are also noted in elderly asthmatics. The objective of this study is to determine if less complaints of wheezing in elderly asthmatic is due to a decrease in the development of wheezing. METHODS: 61 young (20-39 years old), 68 middle-aged (40-59 years old) and 65 elderly (older than 60 years old) stable asthmatic subjects were studied (each group shall be called, hereafter, Young Group, Middle-aged Group and Old Group, respectively). During the methacholine induced airway narrowing, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted in 194 asthmatics. RESULTS: One hundred and sixty-nine patients (87%) developed wheezing during the methacholine induced airway obstruction. The frequency of wheezing during the methacholine challenge was found to be comparable among the groups. The methacholine concentration, % fall in FEV1, and FEV1 levels of the initial detection of wheezing were not different among the groups. Among the patients who developed wheezing, 47 patients (77%), 42 patients (61.8 %) and 26 patients (40%) complained of wheezing in Young, Middle and Old Group, respectively. CONCLUSION: In conclusion, the decreased perception of wheezing is a main factor for the low frequency of complaints of wheezing in elderly asthmatics.

Polymorphism of angiotensin I converting enzyme (ACE) gene according to the severity of asthma in Korean adult asthmatics / 천식및알레르기

BACKGROUND AND OBJECTIVE: Many chemical mediators such as histamine, prostaglandins, leukotrienes, bradykinin, angiotensisn II (A II), and even angiotensin converting enzyme (ACE) affect the pathophysiology of asthma. ACE exists in the epithelium, endothelium, neuroepithelium, plasma, and especially in high concentrations in human lung tissue. ACE converts A I to A II, which is highly vasoconstrictive, bronchoconstrictive, inflammatory substance, and can also inactivate bradykinin. ACE polymorphism determines the level of ACE such as DD, higher concentration of ACE, but II, lowest concentration of that, so in DD type, the level of A II increase, but that of bradykinin decrease. From that point we can speculate polymorphism of ACE gene anyhow affects asthma, so we carried out this study for evaluating relationships between the ACE genotype distribution and genesis and severity of asthma in Korean adult asthmatics. MATERIALS AND METHODS: The study population consisted of 150 asthmatics, 57 patients of non asthmatic lung diseases including lung cancer (n=10), pulmonary tuberculosis (n=27), empyema (n=3), pneumonia (n=11), bronchiectasis (n=5) and lung abscess (n=1) and 100 normal healthy subjects without hypertension, cardiovascular disease, diabetes mellitus and nephropathy which may bias the result. Bronchial asthmatics were classified into 3 groups according to the criteria of the NAPE. PCR (polymerase chain reaction) for ACE genotypes was performed. PCR products were electrophoresed in 1% agarose gels, and then DNA pattern was directly visualized under ethidium bromide staining. RESULTS: The frequency for II, ID, and DD genotypes were 46 (46%), 38 (38%), 16 (16%) in control group, 59 (39.6%), 74 (49.5%), 17 (10.9%) in asthma group and 28 (49.1%), 24 (42.1%), 5 (8.8%) in non-bronchial lung disease group, respectively. There was no signi- ficant difference in frequency of ACE genotype distribution among the 3 groups (p > 0.05). The frequency for II, ID, and DD genotypes in the 3 groups of asthmatics were 17 (34%), 27 (54%), 6 (12%) in mild subset, 13 (26%), 30 (60%), 7 (14%) in moderate subset, and 11 (22%), 33 (66%), 6 (12%) in severe subset. Even though there was also no significant difference among the 3 severity subsets in the asthma group, the frequency of non-DD subsets such as II and ID was higher in moderate and severe asthmatics. CONCLUSION: The results suggest that ACE gene polymorphism dose not affect the genesis but can progress asthma in Korean adult asthmatics. However, further mass studies on asthmatics will be needed to clarify the effect of ACE polymorphism on the severity of Korean adult asthmatics.

Food ( wheat flour ) dependent exerclse - induced anaphylaxis in asthmatics : related with the amont of wheat flour and exercise / 천식및알레르기

A 25-year-old male with asthma suffered from generalized urticaria, angioedema and syncope associated with exercise after ingestion of food made with wheat flour. Skin prick test with bread showed strong positive reaction(++++), but with wheat flour, a weak positive(+). Challenge test with wheat flour, and food made with wheat flour, without or with exercise, were done several times. Exercise such as 25 min of running on treadmill following 30 min after 50 grams of bread or 50 grams of hot pepper-stuffed rice cake only showed positive reaction such as generalized urticaria, angioedema and hypotension, but not with 15 grams of bread or 15 grams of hot pepper-stuffed rice cake. Ingestion of bread in such high amounts as 15 grams alone did not trigger reaction, not even with is min of exercise. This is the first clear case of food dependent exercise induced anaphylaxis (FDEIA) in which the allergic reaction depended on both the amount of food ingested and the amount of exercise was clarified.

The effects of nebulized salbutamol on serum potassium concentration in bronchial asthmatics / 천식및알레르기

BACKGROUND AND OBJECTIVE: The knowledge about the effects of the nebulized B2-agonist on serum potassium is limited. We aimed to assess the possible hypokalemia following nebulization of salbutamol. METHOD: Seven patients(mean age 60 +- 7.1years) with acute exacerbated asthma were treated with salbutamol nebulization(5mg nebulization at 1 hour interval, 3 times) without concomitant use of steroid or other bronchodilator such as theophylline. RESULTS: There was a significant increase in FEV1, from 46.41+-25.91% at baseline to 62.86+-22.38% at 3 hours after treatment. Serum potassium concentration was significantly decreased, from 3.93+-0.58mEq/L at baseline to 3.41+-0.62mEq/L and 3.46+-0.53mEq/L at 1 hour and 3 hours after third nebulization, repectively. There was a significant prolongation of the QTc interval in EKG from 454.36+-27.07msec at baseline to 479.41+-35.64msec and 505.09+-58. 69msec at 1 hour and 3 hours after third nebulization, respectively. Serum salbutamol concentration was 4.18+-3.39ng/ml at baseline, and increased to 7.69+-6.94ng/ml and 9.84+10.34ng/ ml at 1 hour and 3 hours after treatment, respectively. Magnitude of the hypokalemia and the degree of prolongation of the electrocardiographic QTc interval were significantly correlated with the level of serum salbutamol concenturation. CONCLUSION: The results suggest that cardiac complication could develop due to hypokalemia during repeated salbutamol nebulization. Caution should be done in monitoring of serum potassium concentration when using nebulized salbutamol repeatedly for the treatment of acute exacerbated bronchial asthma.