[Analysis of the incidence and epidemiology of non-tuberculous mycobacterial infections in the health area III of Aragón]. / Análisis de la incidencia y epidemiología de las infecciones por micobacterias no tuberculosas en el área de salud III de la comunidad autónoma de Aragón.

OBJECTIVE: The main objective of our investigation was to know the incidence and epidemiology of non-tuberculous mycobacteria (NTM) in our area and the prevalence of comorbidities in patients with MNT infection. As secondary objectives, we studied the distribution by species of MNT, the forms of disease and the type of sample used for its diagnosis. METHODS: A retrospective study was carried out in which all the isolates of mycobacteria carried out by the microbiology laboratory of the Hospital Clínico Universitario Lozano Blesa of Zaragoza during the period between January 1, 2011 and December 31, 2018 were included. RESULTS: A total of 533 mycobacteria were isolated, of which 295 (55.35%) were tuberculosis (MTB) and 238 (44.65%) were MNT. Of the whole MNT isolates, only 15.54% were considered clinically significant. Twenty-one species were identified being the most frequent: M. gordonae (26.89%), M. fortuitum (19.75%) and M. avium (16.39%). 32.72% of the MNT isolates were found in people over 70 years of age. CONCLUSIONS: We can confirm that the reported number of MNT isolates in our area is higher than in previous periods. MNT infection is more common in men and those older than 70 years. The epidemiology, especially the risk factors, of MNT disease is changing.

Influencia de la Vitamina D en la osteointegración de implentes dentales / Influence of vitamin D on the osseointegration of dental implants

OBJETIVO: Determinar la influencia de la vitamina D en la osteointegración de los implantes dentales. MATERIAL Y MÉTODOS: Se realiza una revisión de la bibliografía en las bases de datos online Pubmed, Cochrane y Google Académico sin restricción de fecha o idioma. RESULTADOS: Se seleccionaron un total de 25 artículos, tratándose en su mayoría de estudios de investigación en animales o estudios "in vitro". Tan sólo 4 de los artículos seleccionados son de investigación en humanos. Discusión: La vitamina D es una molécula liposoluble derivada del colesterol, es de gran importancia en el metabolismo óseo favoreciendo su mineralización. Los estudios al respecto, parecen indicar que los niveles de vitamina D suponen una importante influencia sobre el proceso de osteointegración, actuando en el metabolismo óseo y en la respuesta inmune periimplantaria. CONCLUSIONES: Estudios experimentales en animales han demostrado que existe una relación directa entre el déficit de vitamina D y las alteraciones en la osteointegración de los implantes en fases tempranas. En humanos también se asocia el déficit de dicha vitamina con el fracaso temprano de los implantes dentales, sin embargo, esta afirmación no ha podido ser aún demostrada. Por otro lado, se ha relacionado el uso de suplementos vitamínicos en personas con déficit de vitamina D con la supervivencia de los implantes dentales en este tipo de pacientes, así como también se ha observado que los niveles de vitamina D están relacionados con la aparición y avance de enfermedades periimplantarias

OBJECTIVE: To determine the infuence of vitamin D on the osseo integration of dental implants. MATERIAL AND METHODS: A comprehensive search of the literature databases (Pubmed, Cochrane and Google Scholar), along with cross-referencing published peer-reviewed articles, was conducted. The search include full text without restriction of date or language. RESULTS: A total of 25 articles were selected from the reviewed articles, most of them being animal research studies or "in vitro" studies. Only 4 of the selected articles are from human research. Discusión: Vitamin D is a fat-soluble molecule derived from cholesterol, is of great importance in bone metabolism, favoring bone mineralization. Studies in this regard seem to indicate that vitamin D levels are an important infuence on the osseointegration process, infuencing bone metabolism and peri-implant immune response. CONCLUSIONS: Experimental studies in animals have shown that there is a direct relationship between vitamin D defciency and alterations in the osseointegration of implants in early stages. In humans, the defcit of this vitamin is also associated with the early failure of dental implants, however this statement has not yet been proven. On the other hand, the use of vitamin supplements in people with vitamin D defciency has been related to the survival of dental implants in this type of patients, as well as it has been observed that vitamin D levels are related to the appearance and progress of peri-implant diseases

Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing.

BACKGROUND: Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed. OBJECTIVE: We aimed to evaluate the role of controlled challenge testing in skin test-positive IHR to ICM. PATIENTS AND METHODS: We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test-negative ICM; a further 2 patients underwent computed tomography with an alternative skin test-negative ICM. No premedication was administered. RESULTS: Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test-negative ICM. The 2 patients who underwent computed tomography with an alternative skin test-negative ICM tolerated the medium. CONCLUSIONS: Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test-positive reactions in order to identify an alternative non-cross-reactive ICM.

Skin Test–Positive Immediate Hypersensitivity Reaction to Iodinated Contrast Media: The Role of Controlled Challenge Testing

Antecedentes: Aunque clásicamente las reacciones de hipersensibilidad inmediatas (RHI) a medios de contraste iodados (MCI) se han considerado no alérgicas, la publicación creciente de pruebas cutáneas y test de activación de basófilos positivos, sugieren un mecanismo alérgico específico en algunos pacientes. Se han propuesto las pruebas cutáneas como una herramienta útil para el diagnóstico, aunque su sensibilidad y valores predictivos están aún por conocer. El papel de la prueba de provocación controlada no se ha determinado. Objetivo: El objetivo fue evaluar el papel de la prueba de provocación controlada en las RHI a MCI con prueba cutánea positiva. Pacientes y Métodos: Evaluamos 106 pacientes con RHI a MCI mediante prueba cutánea con el contraste que causó la reacción. Se seleccionaron los pacientes con resultado positivo: se ampliaron las pruebas cutáneas con una serie de 8 MCI; en 5 pacientes se realizó prueba de provocación controlada con un MCI alternativo con resultado negativo en la prueba cutánea; otros dos pacientes se sometieron a una tomografía computarizada con un MCI alternativo con resultado negativo en la prueba cutánea. No se administró ninguna premedicación. Resultados: Las pruebas intradérmicas fueron positivas al MCI que causó la reacción en 11 de 106 pacientes (10.4%). Cinco de ellos toleraron la prueba de provocación controlada con un MCI alternativo con resultado negativo en la prueba cutánea. Los otros 2 pacientes a los que se les realizó una tomografía computarizada con un MCI alternativo con prueba cutánea negativa, también lo toleraron. Conclusiones: Las pruebas cutáneas son útiles para la valoración diagnóstica en las RHI alérgicas a MCI. Dado que en muchos pacientes los MCI no pueden ser evitados al ser irremplazables para algunas técnicas diagnósticas o terapéuticas, es necesario identificar un MCI alternativo para ser utilizado con seguridad en procedimientos futuros. Proponemos el uso de la prueba de provocación controlada basada en los resultados de las pruebas cutáneas para resolver esta situación en estas reacciones con prueba cutánea positiva, para poder identificar un MCI alternativo sin reactividad cruzada (AU)

Background: Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed. Objective: We aimed to evaluate the role of controlled challenge testing in skin test–positive IHR to ICM. Patients and Methods: We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test–negative ICM; a further 2 patients underwent computed tomography with an alternative skin test–negative ICM. No premedication was administered. Results: Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test–negative ICM. The 2 patients who underwent computed tomography with an alternative skin test–negative ICM tolerated the medium. Conclusions: Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test–positive reactions in order to identify an alternative non–cross-reactive ICM (AU)

Anaphylaxis to oral iron salts. desensitization protocol for tolerance induction.

Allergies to iron salts are seldom reported. We studied a patient with iron-deficiency anemia who had suffered anaphylactic reactions caused by oral iron salts. An allergy study was performed using single-blind, placebo-controlled oral challenge and skin tests with various iron salts as well as excipients in commercial formulations. Oral challenges were positive for 2 of the commercial formulations of iron salts. Intradermal tests with ferrous sulphate and ferrous lactate also showed positive results. All of the cutaneous tests using the excipients were negative. A desensitization protocol was designed which enabled us to readminister ferrous sulphate, although antihistamines were necessary to guarantee good tolerance to iron salts. We report a patient with allergy to iron salts, positive skin tests, and positive controlled challenge. We highlight the desensitization protocol designed to complete the therapeutic management of the anemia.

Acoustic voice analysis in different phonetic contexts after larynx radiotherapy for T1 vocal cord carcinoma

INTRODUCTION: Radiotherapy for early vocal cord carcinoma affects quality of voice. Nevertheless, most patients refer to having a high satisfaction level with their voice. The few acoustic studies on quality of voice have been performed only in prolonged vowel production, which is not a usual speech situation. The present study has been done with the aim of establishing which phonetic situations reflect a greater alteration in voice production related to irradiation. MATERIAL AND METHODS: Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 non-irradiated subjects were included in a study of acoustic voice analysis. This analysis was performed one year after radiotherapy. Patients and control group voices were tape recorded in extended vowel production, oral reading of a standard paragraph, spontaneous speech and in a song. Acoustic analysis was performed by a Kay Elemetric's Computerized Speech Lab (model CSL #4300). Fundamental frequency, jitter, shimmer and harmonics-to-noise ratio were obtained in both groups. Statistical test: Lin concordance coefficient and Pearson's correlation coefficient, Student's t-test and ROC curves. RESULTS: Concordance and correlation studies did not allow selection of any subgroup in acoustic parameters and different acoustic situations. Acoustic parameters had higher median values in irradiated patients. Student's t-test showed significant differences for fundamental frequency in sustained vowel production and spontaneous speech; for jitter there was statistical significance in all the acoustic situations and for shimmer in oral reading and song. Jitter showed a cut-off of 2.02% with a sensitivity of 89% and specificity of 97% in classifying irradiated and non-irradiated groups. The ROC curve for jitter correctly classified 94% of subjects into irradiated or non-irradiated groups. CONCLUSIONS: The present study showed that jitter obtained from spontaneous speech was the most relevant parameter in discriminating voice in irradiated patients by acoustic analysis. Jitter in spontaneous speech is in need of more analysis in bigger series and in more advanced stages of larynx cancer as its relevance has been demonstrated (AU)

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Unilateral conjunctival chemosis as a unique symptom of nonsteroidal anti-inflammatory drug intolerance.

Patients with nonsteroidal anti-inflammatory drug (NSAID) intolerance usually have cutanous-mucosal or/and respiratory symptoms. We report the case of a patient who developed several episodes of left-eye conjunctivitis, manifested as conjunctival chemosis, with no other symptoms, after taking metamizole and other unidentified NSAIDs. We performed both a single blind placebo-controlled oral challenge test and conjunctival challenge test with different NSAIDs. The single blind placebo-controlled oral challenge was positive to ketoprofen and diclofenac. The conjunctival challenge with diclofenac and flurbiprofen was negative. The patient tolerated celecoxib and nabumetone. We believe this to be an exceptional case of NSAID intolerance as conjunctival chemosis has not hitherto been included in any of the classic types of pseudoallergic reactions.

Diagnosis and management of hypersensitivity reactions caused by oxaliplatin.

Hypersensitivity reactions to oxaliplatin have been increasing since its introduction at the end of the 1990s, but allergy tests with antineoplastic drugs are rarely used to aid diagnosis. We describe 5 cases in which hypersensitivity reactions to oxaliplatin after several courses of chemotherapy were managed by allergy testing and desensitization. Skin prick tests were negative at 1 mg/mL in all patients, positive at 10 mg/mL in 2 tested patients, and negative in 10 control subjects. Intradermal tests were positive and not irritant at 0.01 to 0.001 mg/mL concentrations. A desensitization protocol with increasing concentrations and flow rates was successfully completed in all patients. We conclude that prick and intradermal skin tests are useful in the diagnosis of hypersensitivity reactions to oxaliplatin and that the desensitization protocol performed avoided discontinuation of chemotherapy in all patients.

Hipersensibilidad a los nitrofuranos / Nitrofurane hypersensitivity

Antecedentes y objetivos: La nitrofurantoína y la nitrofurazona son antibacterianos de amplio espectro que se emplean como antinfecciosos urinario y dermatológico, respectivamente. Material y métodos: Presentamos dos casos de hipersensibilidad a los nitrofuranos, uno con una anafilaxia tras la ingestión de nitrofurantoína y otro con una reacción local de dermatitis de contacto tras la aplicación tópica de nitrofurazona. Resultados y conclusiones: El estudio alergológico con pruebas cutáneas y determinación de IgE frente a nitrofurantoína en el caso de la anafilaxia (mecanismo de hipersensibilidad del tipo I) y con pruebas epicutáneas a nitrofurazona en el caso de la dermatitis de contacto (mecanismo de hipersensibilidad del tipo IV) fue positivo; ambos pacientes toleraron otros nitrofuranos no implicados en la reacción. Encontramos pocos casos de alergia a estos fármacos en la literatura revisada. Aunque en el caso de nuestros pacientes no existió reactividad cruzada con otros fármacos que contienen el anillo furano, para poder confirmar esta observación se necesitan más estudios

Introduction: Nitrofurantoin and nitrofurazone are antibacterial agents used in urinary tract and cutaneous infections respectively. Material and methods: Two cases of hypersensitivity are presented, one with anaphylaxis after taking nitrofurantoin and another with a localized reaction of contact dermatitis after using nitrofurazone. Results and conclusions: In both cases the allergic examination including skin tests and IgE determinations with nitrofurantoin in the case of anaphilaxis and with epicutaneous tests for nitrofurazone in the case of contact dermatitis was positive; both tolerated other nitrofurans not involved in the reaction. We found few cases of allergy to these drugs in the revised literature. Although in our cases there was no cross reactivity among nitrofurans, more estudies are necessary in order to confirm that this is a general rule

Cross-reactivity among p-amino group compounds in sulfonamide fixed drug eruption: diagnostic value of patch testing.

We studied 28 patients with fixed drug eruption (FDE) caused by sulfonamide antibiotics to investigate cross-reactivity between sulfonamide derivatives and p-amino compounds and to explore the usefulness of patch testing, as an alternative to controlled oral challenge testing (COCT), in diagnosis within this clinical area. COCT with sulfamethoxazole (SMX), sulfadiazine (SDZ), sulfamethizole (SMZ), furosemide (FU), procaine (PRO) and glipizide (GPZ) was performed. Patch testing (PT) with SMX and SDZ was carried out. In all patients, the diagnosis of FDE was confirmed by positive COCT and allergy to trimethoprim ruled out by COCT. 42.8 and 31.8% of the SMX-induced FDE patients reacted to SMZ and SDZ, respectively. All patients (n = 28) tolerated FU, PRO and GPZ. COCT performed with the 3 sulfonamide antibiotics in 12 patients was positive in 2 subjects with the 3 drugs, in 2 patients only with SMX and SMZ and in the remaining 8, SMX was the only causative drug. PT was positive in 5 of 25 patients positive on COCT. The probability of obtaining a positive PT was higher among patients who had a residual lesion than that among those who lacked this. Cross-reactivity between different sulfonamide antibiotics is thus variable, being most likely between SMX and SMZ. We have found no cross-reactivity between sulfonamide antibiotics and other sulfonamide derivatives or p-amino drugs in FDE. PT is a useful tool in the diagnosis of FDE, especially if there are residual lesions, because it avoided the need for COCT in 20% of patients.

Characterization of allergens secreted by Anisakis simplex parasite: clinical relevance in comparison with somatic allergens.

BACKGROUND: Diagnostic methods for the study of allergic reactions to Anisakis simplex (A.s.) based on whole-body extracts of the larva are clearly insufficient. OBJECTIVES: To study the allergenicity of the proteins secreted by the parasite. Comparison with somatic antigens and determination of their clinical importance in allergic patients were also addressed. METHODS: An excretory/secretory (E/S) extract was produced by culturing third-stage A.s. larvae. It was used to perform immediate skin tests and to determine specific IgE in 10 patients diagnosed with allergy to A.s. Both tests were compared with the results obtained with the whole-body extract (somatic (S)). The molecular weight (MW) of their allergens was determined by immunoblotting, and a single-blind placebo-controlled oral challenge with E/S proteins was performed. Finally, allergens' resistance to gastric pepsin and acid pH was explored. RESULTS: A.s. larvae secreted allergens more potent than those present in the S extract. The skin prick test wheal area produced by E/S molecules and the absorbance obtained in the determination of specific IgE with these allergens (ELISA) were 5.8 times bigger than those obtained with S extract. MW allergens of 72 and 56 kDa in E/S extracts and those of 56, 48 and 43 kDa in S extract were recognized by more than 50% of the patients. Partial cross-reactivity between them was revealed by immunoblotting inhibition studies. Oral challenge with E/S extract (up to 479 microg) was negative in all the patients. Treatment of E/S proteins with gastric pepsin inhibited the binding of the E/S allergens for specific IgE. The acid pH did not affect the overall binding of IgE to E/S extract. It decreased by 15.23% and 19.96% at pH 4 and 2, but the difference was not statistically significant. CONCLUSION: A.s. secretes allergens more potent than somatic antigens and should be used in the diagnostic procedures. These allergens are inactivated by the pepsin, which supports the theory that live larva is necessary to induce an allergic reaction in most of the patients.

Dietary recommendations for patients allergic to Anisakis simplex.

BACKGROUND: Anisakis simplex, a fish parasite, causes allergic urticaria, angioedema and anaphylactic shock through an IgE-mediated hypersensitivity mechanism. Consensus on the dietary recommendations that should be given to allergic patients is lacking. Our objective was to evaluate the usefulness of different types of diets in preventing further reactions in patients allergic to A. simplex. METHODS: Twenty-eight adult patients, who had suffered an allergic episode caused by A. simplex were asked to follow one of the following three diets for a mean period of 13.16 months: a fish-free diet (diet 1; n = 19), a diet including fish frozen for more than 48 hours (diet 2; n = 9) and a diet with fresh fish (diet 3; n = 12). In all patients raw fish was excluded. Relapse rates and changes in total serum IgE and specific IgE to A. simplex were studied during the follow up. RESULTS: During the 13-month follow-up none of the patients developed anaphylaxis. Urticaria symptoms were present in 5.8 %, 11.1 % (n.s) and 33.3 % (p = 0.016) of patients following diets 1, 2 and 3, respectively. Total IgE decreased by 64 % (p < 0.05), 48 % (p < 0.05) and 39.4 % (p < 0.05), respectively. Specific IgE to A. simplex decreased by 50.7 % (p < 0.05), 54.1 % (p < 0.05) and 23.6 % (p < 0.05) after diets 1, 2 and 3, respectively. No statistically significant differences were found among the groups in variations in total and specific IgE. CONCLUSIONS: Patients allergic to A. simplex can eat fish that has been frozen at -20 C for 48 hours without risk of a severe allergic reaction. Long term decreases in specific and total IgE may not be good markers of eventual contact with A. simplex.

Dietary recommendations for patients allergic to Anisakis simplex

Background: Anisakis simplex, a fish parasite, causes allergic urticaria, angioedema and anaphylactic shock through an IgE-mediated hypersensitivity mechanism. Consensus on the dietary recommendations that should be given to allergic patients is lacking. Our objective was to evaluate the usefulness of different types of diets in preventing further reactions in patients allergic to A. simplex. Methods: Twenty-eight adult patients, who had suffered an allergic episode caused by A. simplex were asked to follow one of the following three diets for a mean period of 13.16 months: a fish-free diet (diet 1; n = 19), a diet including fish frozen for more than 48 hours (diet 2; n = 9) and a diet with fresh fish (diet 3; n = 12). In all patients raw fish was excluded. Relapse rates and changes in total serum IgE and specific IgE to A. simplex were studied during the follow up. Results: During the 13-month follow-up none of the patients developed anaphylaxis. Urticaria symptoms were present in 5.8 %, 11.1 % (n.s) and 33.3 % (p = 0.016) of patients following diets 1, 2 and 3, respectively. Total IgE decreased by 64 % (p < 0.05), 48 % (p < 0.05) and 39.4 % (p < 0.05), respectively. Specific IgE to A. simplex decreased by 50.7 % (p < 0.05), 54.1 % (p < 0.05) and 23.6 % (p < 0.05) after diets 1, 2 and 3, respectively. No statistically significant differences were found among the groups in variations in total and specific IgE. Conclusions: Patients allergic to A. simplex can eat fish that has been frozen at -20 °C for 48 hours without risk of a severe allergic reaction. Long term decreases in specific and total IgE may not be good markers of eventual contact with A. simplex (AU)

Antecedentes: Anisakis simplex, un parásito del pescado, causa urticaria alérgica, angioedema y choque anafiláctico a través de un mecanismo de hipersensibilidad mediado por IgE. No se ha llegado a un consenso claro sobre las recomendaciones dietéticas que se deben dar a los pacientes alérgicos. Nuestro objetivo fue evaluar la utilidad de distintos tipos de dietas para prevenir nuevas reacciones en pacientes alérgicos a A. simplex. Métodos: Se pidió a 28 pacientes adultos, que habían sufrido un episodio alérgico causado por A. simplex, que siguiesen una de tres dietas durante un promedio de 13,16 meses: dieta sin pescado (dieta1; n = 19), dieta con pescado congelado durante más de 48 h (dieta 2; n = 9) y dieta con pescado fresco (dieta 3; n = 12), pero evitando el pescado crudo en todos los casos. Durante el período de seguimiento se estudiaron las tasa de recaídas y las variaciones de la IgE total sérica y la IgE específica de A. simplex. Resultados: Durante los 13 meses de seguimiento ninguno de los pacientes experimentó anafilaxia. Se produjeron síntomas de urticaria en el 5,8, 11,1 (n.s.) y 33,3 por ciento (p = 0,016) de los pacientes tras llevar a cabo las dietas 1, 2 y 3, respectivamente. La IgE total disminuyó un 64 por ciento (p < 0,05), 48 por ciento (p < 0,05) y 39,5 (p < 0,05), respectivamente. La IgE específica de A. simplex descendió un 50,7 por ciento (p < 0,05), 54,1 por ciento (p < 0,05) y 23,6 por ciento(p < 0,05) tras las dietas 1, 2 y 3, respectivamente. No hubo diferencias estadísticas en las variaciones de la IgE total y específica entre los grupos. Conclusiones: Los pacientes alérgicos al parásito A. simplex pueden comer pescado que haya sido congelado a -20 °C durante 48 h sin riesgo de sufrir una reacción alérgica importante. Puede que las disminuciones a largo plazo de la IgE total y específica no sean buenos indicadores de posibles contactos con A. simplex (AU)