Risk factors for atopic dermatitis in southern Puerto Rico

BACKGROUND: Little is known about the risk factors and exposures to aeroallergens in subjects with atopic dermatitis (AD) in Southern Puerto Rico. The objective was to determine the prevalence of skin reactions to aeroallergens and to analyze self-reported risk factors in AD patients and a nonallergic control population. METHODS: A cross-sectional study was conducted which included 726 AD patients and 313 nonallergic control subjects. Skin tests were conducted and a questionnaire was self-applied to all participants. RESULTS: Seventy six percent of the AD patients showed at least one positive skin reactions to aeroallergens. Of these, half had positive skin reactions to dust mites, and one third to Periplaneta americana. A low prevalence of positive skin reactions to dog, cat, plant and fungal allergens was detected. Co-sensitivitity between mites and cockroaches was 30%. The maximum skin reactivity to mites was at 10-19 years of age declining thereafter while skin reactivity to dogs, and plants increased with age. No significant differences in the prevalence of skin reactions was observed between the male and female AD population. CONCLUSIONS. Of the aeroallergens tested, those derived from dust mites are the most frequent sensitizing agents in the AD patients. Data also showed that the mites B. tropicalis and E. maynei are also important sources of sensitization. Our study show that young patients specially those between the age of 10-19 age group are the most allergic. Being female, or having an asthmatic father are significant risk factors associated with allergen sensitivity in the AD population.

Transmission of Hansen's disease and unscreened household contacts.

INTRODUCTION: Leprosy household contact investigation has been recommended as an epidemiological surveillance strategy for more than 50 years. OBJECTIVE: The purpose of this study was to estimate the yield that could be achieved in case detection if four contacts could be examined for every case found. METHODS: For the estimation of the number of cases not detected (lost) and yield per contact investigation in Mato Grosso, the incidence rates and yield calculations from a cohort study conducted in Rio de Janeiro by Matos et al (1999) were applied to data from the state of Mato Grosso. Also, to identify high-risk groups for leprosy, a cross-sectional study was conducted in which leprosy cases found as a result of a contact investigation were compared with index cases detected by other means. RESULTS: The lost cases among household contacts were at least 4 per every 10 new cases detected. This is the result of insufficient contact investigations--it being 0.8 instead of 4 contact investigations per each case as recommended by the Brazilian Ministry of Health. Up to 60% of the incidence of leprosy could be explained by the high number of lost cases among household contacts not examined. Women and children are more likely to be contacts. CONCLUSION: The lost cases due to insufficient contact investigation represent lost opportunities in early detection and treatment, thus losing the opportunity to reduce leprosy transmission.

Alfa 1 antitrypsin and protease levels in Puerto Rican asthmatics: a pilot study

A cross-sectional pilot study was conducted on a population of 119 asthmatics who had been recruited from the Emergency Room Department of a major hospital in Ponce, Puerto Rico. The purpose of the study was to determine the frequency of the MM, MS, and SS a-i-antiprotease variants. Also, we analyzed the serum levels of the alpha-1-antiprotease inhibitor, quantified the levels of serine proteases in homes of the asthmatic volunteers, and determined whether environmental levels of proteases, regardless of their sources, had any association with either asthma symptoms or alpha-1-antiprotease inhibitor phenotypes. Our results do not support the role of the alpha-1-antiprotease as a risk factor for asthma in the study population as previously reported. Patients who had visited the ED due to asthma on 3 or more occasions had significantly higher trypsin levels than those who had done so 2 or fewer times. Of those asthmatic patients who had daily symptoms, 40had been exposed to high levels of elastase, and 33.3to trypsin. Similarly, 52.9of the patients with 2 or more hospitalizations a year had been exposed to high elastase levels, and 40.5of asthma patients who had nocturnal asthma more than 3 times a week had been exposed to high levels of elastase.

The onchocerciasis elimination program for the Americas: a history of partnership / Programa de Eliminación de la Oncocercosis para las Américas: historia de solidaridad

The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination of all morbidity from onchocerciasis from the Region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal. This partnership is embodied in the Onchocerciasis Elimination Program for the Americas (OEPA), which is supported by the River Blindness Foundation (RBF) and now by the Carter Center. OEPA was conceived as a means of maintaining a regional initiative to eliminate what is otherwise a low priority disease. Since its inception in 1993, the OEPA has provided more than US$2 million in financial, managerial, and technical assistance to stimulate and/or support programs in Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela, so as to take full advantage of the Merck donation. Now halfway into a five-year, US$ 4 million grant provided through the Inter-American Development Bank, the OEPA's capacity to support the regional initiative is assured through 1999

La decisión tomada en 1987 por la Merck & Co., fabricante de productos farmacéuticos, de proveer Mectizan® (ivermectina) gratuitamente a los programas de control de la oncocercosis ha obligado a la comunidad sanitaria internacional a buscar formas de distribuir el medicamento a las poblaciones rurales que se ven más afectadas por la enfermedad. En las Américas, la OPS respondió al reto con un llamado a eliminar de la Región toda morbilidad por oncocercosis para el año 2007 mediante la distribución de ivermectina al público. Desde 1991, una alianza multinacional de diversas entidades (la OPS, países con oncocercosis endémica, agencias de desarrollo no gubernamentales, los Centros para el Control y la Prevención de Enfermedades en Atlanta, Georgia, instituciones académicas y agencias de financiamiento) ha generado el apoyo político, económico y técnico necesario para tratar de alcanzar esa meta. Esta alianza está representada por el Programa de Eliminación de la Oncocercosis en las Américas (OEPA), subvencionado por la Fundación Ceguera de los Ríos y actualmente por el Centro Carter. El OEPA se creó como iniciativa de alcance regional destinada a eliminar una enfermedad que no merece atención prioritaria. Desde su aparición en 1993, el OEPA ha aportado más de US$ 2 millones en ayuda económica, administrativa y técnica para fomentar y subvencionar programas en Brasil, Colombia, Ecuador, Guatemala, México y Venezuela, logrando así aprovechar al máximo la donación de la Merck & Co. Ahora que hemos llegado a la mitad de una subvención de 5 años y US$ 4 millones aportada por el Banco Interamericano de Desarrollo, se sabe que el OEPA tiene la capacidad para apoyar la iniciativa regional hasta fines de 1999

Identification of the domestic mite fauna of Puerto Rico

This study was conducted to identify the domestic mite fauna of Puerto Rico. A total of 57 dust samples were collected from mattresses in homes of 11 cities on the Island. The analysis of the samples revealed that 73.70 percent of the mattress samples had at least one mite species. The identified species include: Dermatophagoides pteronyssinus (45.6 percent5), Blomia tropicalis (31.6 percent), Cheyletus sp. (19.3 percent), Dermatophagoides farinae (17.5 percent), Euroglyphus maynei (5.3 percent), Dermatophagoides sibonei (1.8 percent, Dermatophagoides sp. (1.8percent), Suidasia melanensis (1.8 percent) and mite species that were not identified (5.3 percent). Differences in the geographical distribution of mites showed that only Blomia tropicalis is more frequently in the northern (43 percent) than in the southern region (19 percent) of Puerto Rico (OR 3.36, p, 0.046). This finding can be explained by the fact that in the northern region the relative humidity is significantly higher that in the southern region (p < 0.001). No significant differences were observed for other species or in the total mite counts between the northern and southern regions. The small sample size of this study may explain the lack significance for some of the differences found. Nevertheless, our results indicate that the domestic mite fauna is composed of several clinically important species, their numbers are high enough to be considered in the sensitizing levels, and the diversity of these species is comparable to other observations in the Caribbean areas, and in the southern states in the continental US. Based upon our results, we recommend that when performing the skin test in Puerto Rico, extracts from the identified local domestic mite species be included in the allergen panel. This may prove useful in the aid for the diagnosis and management of atopic conditions

An estimate of the prevalence, severity and seasonality of asthma in visitors to a Ponce shopping center

To have an estimate of the prevalence of asthma in southern Puerto Rico, a cross-sectional study of a convenience sample of three thousand volunteers from southern Puerto Rico was conducted in a shopping center. Individuals were considered asthmatics when they indicated that had consulted their physicians during the previous 12 months for asthma, shortness of breath, accompanied wheezing, and medications had improved their condition. The crude point prevalence of asthma was 17.5 per 100 interviewees. The median age of the asthmatic population was 18 years while in the non-asthmatic it was 26 years of age (p < 0.0001). Males were 22 percent more likely to be asthmatics than females (p = 0.047). Twenty-six percent of the asthmatics reported hospitalizations at least one time, and 56 percent had received medical attention in emergency rooms due to asthma exacerbations. Analysis of the data strongly suggests that the asthma prevalence in southern Puerto Rico may be higher than in other parts of the United States and the rest of the world. This indicates that asthma probably is an important public health problem in the southern Puerto Rico and possibly, in the island

Morbilidad y mortalidad en el Servicio de Cirugía, Hospital San Juan de Dios, Bogotá, 1989 / Morbidity and mortality in the Department of Surgery, San Juan de Dios Hospital, Bogotá, 1989

Con el fin de conocer la patologia atendida y los resultados obtenidos en el servicio de cirugia del Hospital San Juan de Dios de Bogota, se desarrollo un estudio descriptivo retrospectivo, con base en una muestra probatoria. De las historias clinicas estudiadas se obtuvo la información sobre las variables de edad y sexo, tipo de patologia traumatica y no traumatica, dias de estancia, ingreso a la Unidad de Cuidado Intensivo, (UCI) y estado de salud al egreso. Como hallazgos mas importantes se encontró que el 64.0 por ciento del servicio lo utilizan los hombres; la patologia traumatica representó el 45.0 por ciento del total de los egresos; el arma cortopunzante fue el agente de la lesion en el 78.1 por ciento de los casos; la mortalidad ocurrió en el 7.7 por ciento de los pacientes. Con relación a la patologia no traumatica se encontró una mortalidad del 9.5 por ciento, en la cual los tumores y la patologia biliar aportaron el 44.8 por ciento del total de las muertes. Se destaca la necesidad de estudios mas profundos de tipo clinico y administrativo, asi como la urgencia de llegar hasta la prevención del trauma y el diagnostico temprano dentro de la comunidad, a traves del conocimiento de la causalidad, especialmente en lo relacionado con tumores de patologia biliar.