Ataxia-telangiectasia in Latin America: clinical features, immunodeficiency, and mortality in a multicenter study.

Ataxia-telangiectasia (AT) is a rare genetic disorder leading to neurological defects, telangiectasias, and immunodeficiency. We aimed to study the clinical and immunological features of Latin American patients with AT and analyze factors associated with mortality. Referral centers from 9 Latin American countries participated in this retrospective cohort study, and 218 patients were included. Median (IQR) ages at symptom onset and diagnosis were 1.0 (1.0-2.0)  and 5.0 (3.0-8.0) years, respectively. Most patients presented recurrent airway infections, which was significantly associated with IgA deficiency. IgA deficiency was observed in 60.8% of patients and IgG deficiency in 28.6%. T- and B-lymphopenias were also present in most cases. Mean survival was 24.2 years, and Kaplan-Meier 20-year-survival rate was 52.6%, with higher mortality associated with female gender and low IgG levels. These findings suggest that immunologic status should be investigated in all patients with AT.

Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

está disponible en el texto completo

Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.

Large hydropower projects increase stress despite compensation efforts: Evidence from the Brazilian Amazon.

Large hydropower projects continue to be built in developing nations, despite their known negative impacts. Large-scale energy projects strain local infrastructure and reduce access to infrastructure for households that live near them. Here we investigate the link between large-scale hydropower projects and stress. Our results suggest that these projects create stress through two mechanisms: strains on community resources and through the process of displacement. We also ask how compensation and resettlement programs condition these relationships. Using data from the Madeira river basin in the Brazilian Amazon, we find that hydropower projects increase stress by reducing access to energy, water, sanitation and land. Compensation provided was not sufficient to moderate this effect.

Analyzing group communication dynamics and content in a common-pool resource experiment.

We study costly communication in a common-pool resource (CPR) experiment as a proxy for two different forms of participatory processes: as a public good and as a club good. A public communication meeting, representing centralized participatory processes, occurs when all group members' monetary contributions reach a specified threshold. Club communication meetings, representing networked participatory processes, follow only among those members of the group who pay a communication fee. We test whether the way costly communication is provided affects the willingness of participants to contribute to communication, as well as the dynamics of such payments, and the content of communication. This is done by analyzing contributions to communication and communication content of 100 real-life resource users participating in a lab-in-field experiment. We find that contributions towards communication are higher when communication is public, and that club communication features more frequent but less inclusive communication meetings. Also, communication content is more oriented towards addressing the collective action problem associated with the management of the resource when communication groups are attended by all participants. The identified differences between the two ways to provide for communication can inform policies and the design of participatory processes in natural resource governance.

Large-scale hydropower impacts and adaptation strategies on rural communities in the Amazonian floodplain of the Madeira River.

Understanding social and environmental impacts and household adaptation strategies in the face of expansions in energy infrastructure projects is essential to inform mitigation and interventions programs that promote well-being. Here we conducted surveys in seven communities distributed across varying degrees of proximity to a hydropower dam complex in the Brazilian Amazon along about 250 km of the floodplain of the Madeira River. Based on interviews with 154 fishers from these communities, we examine how fishers perceived changes in fisheries yields, changes in the composition of fish species, and whether and how adaptation strategies had evolved 8-9 years after the dams' construction. Most respondents (91%) indicated declines in yields after the dams for both upstream and downstream zones. Multivariate analyses revealed statistically significant differences in the composition of species yields in pre-and post-dam periods for all communities and in both upstream and downstream zones (p < 0.001). The composition of yields diversified after the dams, with an apparent decline in yields of species of greatest market value (e.g., catfishes Brachyplatystoma spp., Pseudoplatystoma spp., and jatuarana Brycon spp.), and increases in yields of a set of other smaller bodied and faster growing species (e.g., 'branquinhas' Psectrogaster spp., Potamohinna spp., and sardines Triportheus spp.). Both downstream and upstream fishers indicated that fishing profits decreased since the dams' construction (76.8% and 67.9%, respectively). To cope with these changes, the majority of both upstream and downstream fishers (>70%) stated they have had to devote more time to fishing after the dams were built. The time fishers spend traveling to fishing locations also increased for upstream communities (77.1%), but not for downstream communities. Thirty-four percent of the interviewees changed the gear they use to fish after the dams construction, with twice as many mentioning uses of non-selective gear, such as gillnets, and declining use of traditional fishing gears such as castnets and a trap ("covi"). Fish consumption overall decreased: fish was consumed 'everyday' before the dams, but 1-2 times per week or rarely after the dams were built. Although the species that declined were those of high economic value, 53% of fishers stated fish prices have increased overall after the dams. These results shed light on the potential challenges faced by fishers and which adaptation strategies they have evolved to maintain livelihoods since the construction of the dams.

Advancing convergence research: Renewable energy solutions for off-grid communities.

Millions of people across the world live off-grid not by choice but because they live in rural areas, have low income, and have no political clout. Delivering sustainable energy solutions to such a substantial amount of the world's population requires more than a technological fix; it requires leveraging the knowledge of underserved populations working together with a transdisciplinary team to find holistically derived solutions. Our original research has resulted in an innovative Convergence Framework integrating the fields of engineering, social sciences, and communication, and is based on working together with communities and other stakeholders to address the challenges posed by delivering clean energy solutions. In this paper, we discuss the evolution of this Framework and illustrate how this Framework is being operationalized in our on-going research project, cocreating hybrid renewable energy systems for off-grid communities in the Brazilian Amazon. The research shows how this Framework can address clean energy transitions, strengthen emerging industries at local level, and foster Global North-South scholarly collaborations. We do so by the integration of social science and engineering and by focusing on community engagement, energy justice, and governance for underserved communities. Further, this solution-driven Framework leads to the emergence of unique approaches that advance scientific knowledge, while at the same time addressing community needs.

SARS-CoV-2 host prediction based on virus-host genetic features.

The genetic diversity of the Coronaviruses gives them different biological abilities, such as infect different cells and/or organisms, a wide spectrum of clinical manifestations, their different routes of dispersion, and viral transmission in a specific host. In recent decades, different Coronaviruses have emerged that are highly adapted for humans and causing serious diseases, leaving their host of unknown origin. The viral genome information is particularly important to enable the recognition of patterns linked to their biological characteristics, such as the specificity in the host-parasite relationship. Here, based on a previously computational tool, the Seq2Hosts, we developed a novel approach which uses new variables obtained from the frequency of spike-Coronaviruses codons, the Relative Synonymous Codon Usage (RSCU) to shed new light on the molecular mechanisms involved in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) host specificity. By using the RSCU obtained from nucleotide sequences before the SARS-CoV-2 pandemic, we assessed the possibility of know the hosts capable to be infected by these new emerging species, which was first identified infecting humans during 2019 in Wuhan, China. According to the model trained and validated using sequences available before the pandemic, bats are the most likely the natural host to the SARS-CoV-2 infection, as previously suggested in other studies that searched for the host viral origin.

[Skin and SARS-CoV-2 in pediatrics]. / Piel y SARS-CoV-2 en pediatría.

The clinical presentation, disease course, and outcome of SARS-CoV-2 infection in pediatrics differ from the presentation in adults. In a review by Hoang et al., the prevalence of dermatological manifestations was estimated in 0.25% of a total of 2,445 children with confirmed COVID-19. Similarly, the prevalence of skin manifestations was reported in 3% of 100 children in the Parri's study. A systematic review by Shah et al. analyzed 13 studies with 149 children who met eligibility criteria. The acral erythematous maculopapular lesion was the most common, as well as erythema multiforme, varicella rash, and presentations similar to Kawasaki disease. The duration of the skin lesion was one to two weeks in 43%. Skin biopsy of 18 cases complete superficial and deep perivascular and paracrine lymphocytic infiltrate and lymphocytic vasculitis were reported. RT-PCR was positive in 13.8 % of the cases. The serological markers of herpes simplex virus and parvovirus B19 analyzed were negative, except for Mycoplasma pneumoniae in two of 20 cases. The pathophysiological mechanism of skin lesions secondary to SARS-CoV-2 infection has not yet been explained; likely to be a combination of one or more complex mechanisms, direct skin damages induced by the virus, vasculitis-like reactions either indirect or secondary injuries as a consequence of a systemic inflammatory reaction. Publications from years 2019 to 2021 are reviewed in PubMed as the main search source, using key words.

La presentación clínica, curso de la enfermedad y resultado de la infección por SARS-CoV-2 en pediatría difieren de los observados en adultos. En una revisión de Hoang et al. se estimó que la prevalencia de las manifestaciones dermatológicas fue de 0.25 % de un total de 2445 niños con COVID-19 confirmada. Según Parri, se documentó 3 % en 100 niños. En la revisión sistemática de Shah et al.se analizaron 13 estudios que incluyeron 149 niños que cumplieron con los criterios de elegibilidad. La lesión maculopapular eritematosa acral fue la más común, también el eritema multiforme, el exantema de la varicela y las presentaciones similares a enfermedad de Kawasaki. La duración de las lesiones cutáneas fue de una a dos semanas en 43 %. La biopsia de piel de 18 casos reveló infiltrado linfocítico perivascular, infiltrado paracrino superficial y profundo y vasculitis linfocítica. La RT-PCR fue positiva en 13.8 %. Los marcadores serológicos analizados de virus de herpes simple y parvovirus B19 fueron negativos, y fueron positivos para Mycoplasma pneumoniae en dos de 20 casos. El mecanismo fisiopatológico de las lesiones en piel secundarias a infección por SARS-CoV-2 aún no se ha podido explicar; es probable que se trate de la combinación de uno o más mecanismos complejos, daños cutáneos directos inducidos por el virus, reacciones vasculíticas o lesiones indirectas o secundarias como consecuencia de una reacción inflamatoria sistemática. Se revisaron las publicaciones de 2019 a 2021 en PubMed como fuente principal de búsqueda, para lo cual se utilizaron palabras clave.

Feasibility of hybrid in-stream generator-photovoltaic systems for Amazonian off-grid communities.

While there have been efforts to supply off-grid energy in the Amazon, these attempts have focused on low upfront costs and deployment rates. These "get-energy-quick" methods have almost solely adopted diesel generators, ignoring the environmental and social risks associated with the known noise and pollution of combustion engines. Alternatively, it is recommended, herein, to supply off-grid needs with renewable, distributed microgrids comprised of photovoltaics (PV) and in-stream generators (ISG). Utilization of a hybrid combination of renewable generators can provide an energetically, environmentally, and financially feasible alternative to typical electrification methods, depending on available solar irradiation and riverine characteristics, that with community engagement allows for a participatory codesign process that takes into consideration people's needs. A convergent solution development framework that includes designers-a team of social scientists, engineers, and communication specialists-and communities as well as the local industry is examined here, by which the future negative impacts at the human-machine-environment nexus can be minimized by iterative, continuous interaction between these key actors.

[Autoimmune encephalitis-limbic encephalitis. A clinical case]. / Encefalitis autoinmune-encefalitis límbica. Caso clínico.

BACKGROUND: Autoimmune encephalitis occurs as a subacute condition with a strong infectious association in children. In the last 20 years, the frequency of non-infectious cases has increased significantly. CASE REPORT: A previously healthy eight-year-old male child with normal neurodevelopment, without a history of consanguinity, manifested progressive neurological deterioration with autoimmune encephalitis-limbic encephalitis up to hypothalamic dysfunction. CONCLUSION: In the mentioned case, it was documented that an inborn error of the immune system generated a severe neurological clinical picture, with permanent and irreversible damage, secondary to lack of immunological memory in the broad clinical context of a common variable immunodeficiency.

Antecedentes: La encefalitis autoinmune se presenta como un cuadro subagudo con fuerte asociación infecciosa en los niños. En los últimos 20 años, la frecuencia de casos no infecciosos ha aumentado de manera significativa Caso clínico: Niño del sexo masculino de ocho años de edad previamente sano con neurodesarrollo normal, sin antecedente de consanguinidad, en quien se manifestó deterioro neurológico progresivo, desde encefalitis autoinmune-encefalitis límbica hasta disfunción hipotalámica. Conclusión: En el caso referido se documentó un error innato del sistema inmunológico que generó cuadro clínico neurológico severo, con daño permanente e irreversible secundario a falta de memoria inmunológica en el contexto clínico amplio de una inmunodeficiencia común variable.

Sustainable hydropower in the 21st century.

Hydropower has been the leading source of renewable energy across the world, accounting for up to 71% of this supply as of 2016. This capacity was built up in North America and Europe between 1920 and 1970 when thousands of dams were built. Big dams stopped being built in developed nations, because the best sites for dams were already developed and environmental and social concerns made the costs unacceptable. Nowadays, more dams are being removed in North America and Europe than are being built. The hydropower industry moved to building dams in the developing world and since the 1970s, began to build even larger hydropower dams along the Mekong River Basin, the Amazon River Basin, and the Congo River Basin. The same problems are being repeated: disrupting river ecology, deforestation, losing aquatic and terrestrial biodiversity, releasing substantial greenhouse gases, displacing thousands of people, and altering people's livelihoods plus affecting the food systems, water quality, and agriculture near them. This paper studies the proliferation of large dams in developing countries and the importance of incorporating climate change into considerations of whether to build a dam along with some of the governance and compensation challenges. We also examine the overestimation of benefits and underestimation of costs along with changes that are needed to address the legitimate social and environmental concerns of people living in areas where dams are planned. Finally, we propose innovative solutions that can move hydropower toward sustainable practices together with solar, wind, and other renewable sources.

Efficacy, safety and quality of life in patients receiving subcutaneous IgG treatment: experience in Bogotá, Colombia.

AIM: Investigate efficacy, safety and quality of life of Gammanorm® 16.5% (subcutaneous immunoglobulin [SCIG]) in patients with primary immunodeficiencies (PIDs) and safety and to lesser extent efficacy in autoimmune diseases. PATIENTS & METHODS: Medical records were extracted from 31 pediatric and 12 adult patients who received SCIG as part of the Personalized Program at University Children's Hospital, Bogotá, Colombia. RESULTS: Mean SCIG dose was 28.7 g/month. Serious bacterial infections were observed in 7/33 patients in the PID group, most often bacterial pneumonia (3/33). There were no serious adverse events related to SCIG treatment. Drug-related adverse reactions were reported in 2/43 patients. CONCLUSION: Self-administration of SCIG provided effective protection, favorable tolerability and improved quality of life in patients with PIDs and autoimmune diseases from Colombia.

Future directions in human-environment research.

Human-environment research in the 21st century will need to change in major ways. It will need to integrate the natural and the social sciences; it will need to engage stakeholders and citizens in the design of research and in the delivery of science for the benefit of society; it will need to address ethical and democratic goals; and it will need to address a myriad of important theoretical and methodological challenges that continue to impede progress in the advance of sustainability science.

Imunoglobulina endovenosa em pacientes pediátricos e adultos em unidades de terapia intensiva com síndrome de resposta inflamatória sistêmica grave e/ou síndrome de disfunção de múltiplos órgãos / Intravenous immunoglobulin in pediatric and adult patients in intensive care units with systemic inflammatory response syndrome and/or multiple organ dysfunction syndrome

A literatura revela benefícios, em termos de sobrevivência, relacionados ao uso da imunoglobulina endovenosa em adultos com sepse hospitalizados em unidades de terapia intensiva, em comparação com pacientes tratados com placebo, ou com os que não sofreram intervenção. Em nossa prática clínica, alguns pacientes com sepse e/ou com síndrome de disfunção de múltiplos órgãos apresentam níveis de imunoglobulinas dentro das faixas utilizadas para interpretação do estado imunológico de indivíduos saudáveis. Desconhecemos se pacientes em estado crítico devido a infecção e inflamação poderiam ter a função das imunoglobulinas diminuída, a despeito de ter níveis de imunoglobulinas dentro da faixa de normalidade. O objetivo do presente artigo foi utilizar as informações dos resultados sobre segurança e eficácia publicados na literatura para intervenção com imunoglobulina humana endovenosa (IGIV), sobretudo em adultos com sepse e internados em unidades de terapia intensiva, numa tentativa de extrapolar os resultados para pacientes pediátricos com sepse e/ou com síndrome de disfunção de múltiplos órgãos, dando suporte ao seu uso durante as primeiras 12 e 24 horas em unidade de terapia intensiva pediátrica como coadjuvante, imunomodulador e anti-inflamatório, juntamente com a intervenção de rotina, em crianças com níveis "fisiologicamente normais" e/ou limítrofes baixos de IgG. Foram consultados os bancos de dados PubMed, MEDLINE e Cochrane de 1995 a 2011, com os seguintes termos: sepse, síndrome de disfunção orgânica múltipla, adultos, população pediátrica, unidade de terapia intensiva, e intervenção ou tratamento com imunoglobulina humana endovenosa.

The literature has described survival benefits associated with the use of intravenous immunoglobulin in adult patients admitted to intensive care units as compared to patients receiving placebo or no intervention. In our clinical practice, some patients with sepsis and/or multiple organ dysfunction syndrome show immunoglobulin levels within the normal ranges used to describe the immune status of healthy patients. It remains to be known whether a critically ill patient due to infection and inflammation could have an impaired immunoglobulin function despite showing normal immunoglobulin levels. The objective of this study was to review data on the safety and effectiveness of the use of intravenous immunoglobulin therapy in adult patients with sepsis admitted to intensive care units, in an attempt to extrapolate results to pediatric patients with sepsis and/or multiple organ dysfunction syndrome. The review focused on data supporting the use of intravenous immunoglobulin in the first 12-24 hours in the pediatric intensive care unit as an adjuvant, immunomodulatory, and anti-inflammatory agent, in addition to the routine intervention in children with “physiologically normal” or borderline low IgG levels. The PubMed, MEDLINE, and Cochrane databases were searched for articles published between 1995 and 2011, using the terms sepsis, multiple organ dysfunction syndrome, adult, pediatric population, intensive care unit, and intervention or treatment with human intravenous immunoglobulin.

El arte de la medicina: entre lo místico y la ciencia / The art of medicine: between the mystical and science

La medicina como ciencia y arte se complementan en la práctica cotidiana. Cuando se entienda la propiedad “plástica” de sistemas como el inmunológico, se estará en capacidad de inclinarnos respetuosos y reverentes ante el concepto de la creación...

Medicine as a science and art it complement each other in everyday practice. When we comprehend the attribute of “plasticity” of the immune system, we will be able to incline with respectful and reverential when we think in the concept of Creation...

Alergia a anestésicos locales y generales y a otros medicamentos durante procedimientos quirúrgicos / Allergy to local and general anesthetics and to other drugs during surgical procedures

Las reacciones de choque e hipersensibilidad a los anestésicos locales y generales y a otros medicamentos utilizados durante los procedimientos quirúrgicos, continúan siendo un reto en la práctica clínica. Las reacciones de hipersensibilidad alérgica pueden variar en su presentación e intensidad, y pueden producir desde síntomas leves en la piel hasta la muerte.

Shock and hypersensitivity reactions to local and general anesthetics and to other drugs used during surgical procedures continue being a challenge in clinical practice. Allergic hypersensitivity can vary in presentation and intensity and might manifest itself from mild cutaneous symptoms to death.

Contaminação bacteriana e fúngica de canudos de refrigerantes e seus recipientes em lanchonetes de município do interior de São Paulo / Fungal and bacterial contamination of drinking straws and their containers in snack bars in a municipality of São Paulo state, Brazil

OBJETIVO: Avaliar o nível de contaminação bacteriana e fúngica de canudos de refrigerantes e seus recipientes em 30 lanchonetes do Município de Ibiúna (SP), correlacionando com as condições de higiene, processos e métodos de desinfecção destes estabelecimentos. MÉTODOS: Foram colhidas três amostras por estabelecimento nas embalagens fechadas, em recipientes e swab em toda a superfície de contato. Foi aplicado um questionário a fim de avaliar: a empresa fornecedora dos canudos, higienização, freqüência e desinfecção, e foram efetuadas inspeções sanitárias nos estabelecimentos. Para as análises microbiológicas foi utilizada a técnica de lavagem superficial e semeadura em meios, para contagem de bactérias mesófilas. As amostras turvas foram semeadas em meios de cultura para: Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Enterococcus, coliformes totais e/ou termotolerantes. RESULTADOS: Dentre os microorganismos isolados nas amostras dos canudos nos recipientes foi detectado Bacillus cereus em 36,6 por cento, Enterococo spp. em 3,3 por cento. O Bacillus cereus foi isolado em 46,6 por cento nos swabs dos recipientes, e em 13,3 por cento, Enterococos. Na análise de associação do nível de contaminação microbiana de canudos de refrigerantes e seus recipientes com as condições de higiene, os processos de higienização e a desinfecção dos estabelecimentos, não foi identifica significância estatística (p>0,05). CONCLUSÃO: O Bacillus cereus foi o microorganismo que prevaleceu nas embalagens íntegras dos canudos, nos seus recipientes e no swab das superfícies. Não foi comprovada a associação de fatores de risco de contaminação bacteriana e fúngica.

OBJECTIVE: The objective of this study was to evaluate the fungal and bacterial contamination level of drinking straws and their containers of thirty snack bars at the municipality of Ibiuna (SP, Brazil) and to correlate these data with conditions of hygiene and the processes and methods of disinfection of these establishments. METHODS: Three samples of closed packages, containers and contact surface swabs were collected in each establishment. A questionnaire was administered to identify the straws supplier, hygiene methods, frequency and disinfection. Sanitary inspections were also performed in these establishments. Microbiological analyses were done using the superficial washing technique and seeding plates to count mesophilic bacteria, mold and yeasts. Turbid samples were seeded in culture media for: Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Enterococcus, total and/or thermotolerant coliforms. RESULTS: Microorganisms isolated from samples of drinking straws were Bacillus cereus 36.6 percent, Enterococcus spp and Molds/yeasts 3.3 percent. Swabs of containers revealed 46.6 percent of Bacillus cereus and 13.3 percent of Enterococcus. Association analyses of the microbial contamination level of drinking straws and their containers with conditions of hygiene, hygiene processes and disinfection of the establishments did not show statistical significance (p>0.05). CONCLUSION: Bacillus cereus was the most prevalent microorganism in closed packages, containers and surface swabs. No statistical association of risk factors for bacterial or fungal contamination was found.

Asma, una patología de interés / Asthma, an important pathology

El asma bronquial se considera una enfermedad de interés en salud pública. Latinoamérica tiene una de las prevalencias mas elevadas del mundo; en Colombia se encontró una prevalencia global de 10,4/100. Por tanto es pertinente revisar su definición, epidemiología, clínica, factores de riesgo, diagnóstico, clasificación y tratamiento para realizar el mejor y más adecuado enfoque y seguimiento de los pacientes que la padecen.

Rinitis alérgica: un hecho / Allergic rhinitis: a fact

La rinitis alérgica es una enfermedad de alta prevalencia. En la población infantil, infortunadamente el diagnóstico se hace en forma tardía, alrededor de los seis años. En el presente artículo se intenta estimular al lector a buscar los signos clínicos más sensibles para su diagnóstico y tratamiento tempranos.