BRCA1 and TP53 codeficiency causes a PARP inhibitor-sensitive erythroproliferative neoplasm.

Mutations in the BRCA1 tumor suppressor gene, such as 5382insC (BRCA1insC), give carriers an increased risk for breast, ovarian, prostate, and pancreatic cancers. We have previously reported that, in mice, Brca1 deficiency in the hematopoietic system leads to pancytopenia and, as a result, early lethality. We explored the cellular consequences of Brca1-null and BRCA1insC alleles in combination with Trp53 deficiency in the murine hematopoietic system. We found that Brca1 and Trp53 codeficiency led to a highly penetrant erythroproliferative disorder that is characterized by hepatosplenomegaly and by expanded megakaryocyte erythroid progenitor (MEP) and immature erythroid blast populations. The expanded erythroid progenitor populations in both BM and spleen had the capacity to transmit the disease into secondary mouse recipients, suggesting that Brca1 and Trp53 codeficiency provides a murine model of hematopoietic neoplasia. This Brca1/Trp53 model replicated Poly (ADP-ribose) polymerase (PARP) inhibitor olaparib sensitivity seen in existing Brca1/Trp53 breast cancer models and had the benefits of monitoring disease progression and drug responses via peripheral blood analyses without sacrificing experimental animals. In addition, this erythroid neoplasia developed much faster than murine breast cancer, allowing for increased efficiency of future preclinical studies.

Pediatric asthma treatment: What to do when international guideline recommendations do not agree.

BACKGROUND: There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs. OBJECTIVE: To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part. RESULTS: Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma. CONCLUSION: For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.

[Mexican Asthma Guidelines: GUIMA 2017]. / Guía Mexicana del Asma: GUIMA 2017.

BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

Consenso para las prácticas de alimentación complementaria en lactantes sanos / Guidelines for complementary feeding in healthy infants

Resumen: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial de cada ser humano; actualmente se reconoce que este periodo es una ventana crítica para la promoción de un crecimiento y desarrollo óptimos y un buen estado de salud. Por tanto, cumplir con una alimentación adecuada en esta etapa de la vida tiene impacto sobre la salud, estado de nutrición, crecimiento y desarrollo de los niños; no sólo en el corto plazo, sino en el mediano y largo plazo. El presente trabajo ofrece recomendaciones de alimentación complementaria (AC) que se presentan en forma de preguntas o enunciados que consideran temas importantes para quienes atienden niños durante esta etapa de la vida; por ejemplo: inicio de la alimentación complementaria a los 4 o 6 meses de edad; exposición a alimentos potencialmente alergénicos; introducción de bebidas azucaradas; uso de edulcorantes artificiales y productos light; secuencia de introducción de alimentos; modificaciones de consistencia de alimentos de acuerdo a la maduración neurológica; número de días para probar aceptación y tolerancia a los alimentos nuevos; cantidades por cada tiempo de comida; prácticas inadecuadas de alimentación complementaria; mitos y realidades de la alimentación complementaria; hitos del desarrollo; práctica del "Baby Led Weaning" y práctica de vegetarianismo.

Abstract: A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

Immunization with a heat-killed preparation of the environmental bacterium Mycobacterium vaccae promotes stress resilience in mice.

The prevalence of inflammatory diseases is increasing in modern urban societies. Inflammation increases risk of stress-related pathology; consequently, immunoregulatory or antiinflammatory approaches may protect against negative stress-related outcomes. We show that stress disrupts the homeostatic relationship between the microbiota and the host, resulting in exaggerated inflammation. Repeated immunization with a heat-killed preparation of Mycobacterium vaccae, an immunoregulatory environmental microorganism, reduced subordinate, flight, and avoiding behavioral responses to a dominant aggressor in a murine model of chronic psychosocial stress when tested 1-2 wk following the final immunization. Furthermore, immunization with M. vaccae prevented stress-induced spontaneous colitis and, in stressed mice, induced anxiolytic or fear-reducing effects as measured on the elevated plus-maze, despite stress-induced gut microbiota changes characteristic of gut infection and colitis. Immunization with M. vaccae also prevented stress-induced aggravation of colitis in a model of inflammatory bowel disease. Depletion of regulatory T cells negated protective effects of immunization with M. vaccae on stress-induced colitis and anxiety-like or fear behaviors. These data provide a framework for developing microbiome- and immunoregulation-based strategies for prevention of stress-related pathologies.

[Guidelines for complementary feeding in healthy infants]. / Consenso para las prácticas de alimentación complementaria en lactantes sanos.

A proper nutrition during the first two years of life is critical to reach the full potential of every human being; now, this period is recognized as a critical window for promoting optimal growth, development, and good health. Therefore, adequate feeding at this stage of life has an impact on health, nutritional status, growth and development of children; not only in the short term, but in the medium and long term. This paper provides recommendations on complementary feeding (CF) presented as questions or statements that are important for those who take care for children during this stage of life. For example: When to start complementary feedings: 4 or 6 months of age?; Exposure to potentially allergenic foods; Introduction of sweetened beverages; Use of artificial sweeteners and light products; Food introduction sequence; Food consistency changes according to neurological maturation; Number of days to test acceptance and tolerance to new foods; Amounts for each meal; Inadequate complementary feeding practices; Myths and realities of complementary feeding; Developmental milestones; Practice of "Baby Led Weaning" and practice of vegetarianism.

[Risk factors related to allergic diseases at Mexico City]. / Factores de riesgo relacionados con enfermedades alérgicas en la Ciudad de México.

BACKGROUND: Several studies suggest that the prevalence of allergic diseases has been increasing worldwide in recent years; then it is very important to identify some risk factors that could be related. OBJECTIVE: To know some hereditary and environmental risk factors that could be related to the development of allergic diseases in open population from Mexico City. PATIENTS AND METHOD: It was an open-population, cross-sectional trial, in two phases with a random sample size of 4272 individuals in 214 public health centers. A questionnaire was applied by health workers. Statistical analysis was made with Excel 97-2004 using the Mann-Whitney U test for continuous variables and chi-square-test for discrete variables. p < 0.001 was considered statistically significant. RESULTS: The prevalence of allergic diseases in Mexico City was 42.6%, allergic rhinitis was the most frequent. The most important risk factors for allergic diseases were: family history of atopy in first and second degree; early consumption of cow's milk; early weaning with cereal, egg, beef, fish and pulses; living with some animals, indoor plants, active and passive smoking, to keep stuffed toys in the rooms, as well as living in dwellings with dust, cold temperatures, wall saltpeter and with dampness (mold growth). CONCLUSION: Because genetic factors can not be modified, it is important to identify environmental factors related to the development of allergic diseases in order to promote preventive measures.

[Prevalence of allergic diseases in Mexico City]. / Prevalencia de las enfermedades alérgicas en la Ciudad de México.

BACKGROUND: There is a considerable variation in the prevalence of allergic disorders in developing countries. These differences may be attributable to different methodological problems and to the lack of operational definitions. Several studies suggest that the prevalence of allergic diseases has been increasing worldwide in recent years. However, in Mexico, there is no data in open population. OBJECTIVE: To know in open population the prevalence of allergic diseases in the counties of Mexico City, the frequence of symptoms in each allergic disease, the therapeutic modalities that patients seek, the school and work annual absences and the amount of money that each patient spends in antiallergic drugs. PATIENTS AND METHODS: It was an open-population, cross-sectional trial, in two phases with a random sample size of 8,000 individuals from 214 public health centers. Statistical analysis was made with Excel 97-2004: Mann-Whitney U test for continuous variables and chi-square-test for discrete variables, p < 0.05 was considered statistically significant. RESULTS: The prevalence of allergic diseases in Mexico City was 42.6%, allergic rhinitis was the most frequent. Children are the largest age group affected. The highest prevalence was found in Tlahuac county. Coexistence of allergic diseases was found in 19.9%. The 44.2% of allergic patients attended to their general practitioner. 20.4% of all patients spent 10-20% of their income in medicines and 26% do not have money to buy antiallergic drugs. School and work annual absences are 3.37 +/- 3.86 and 6.2 +/- 12.84 days, respectively. CONCLUSION: Allergic diseases must be considered a public-health problem in Mexico City.

Identification of influenza, parainfluenza, adenovirus and respiratory syncytial virus during rhinopharyngitis in a group of Mexican children with asthma and wheezing.

BACKGROUND: Viral infections can promote allergic sensitization in genetically susceptible individuals. Besides, they are the main cause of wheezing in children. OBJECTIVE: To assess the frequency with which influenza, parainfluenza, adenovirus and respiratory syncytial virus (RSV) cause rhinopharyngitis in patients with asthma and wheezing. PATIENTS AND METHODS: Longitudinal, prospective study in which 168 patients with asthma and wheezing, who attended the outpatient allergy clinic of the National Institute of Pediatrics, Mexico, during the spring (from April through June), with clinical signs and symptoms of rhinopharyngitis were included. Samples of nasal secretions were taken with a long swab, and identification of RSV, adenovirus, infuenza A and B and parainfluenzae 1, 2 and 3 by means of direct immunofluorescence (DI) was carried out. RESULTS: Samples of nasal secretions were taken in 100 children with asthma and 68 with wheezing, aged 2-17 years. Viral identification was positive in 75% and 44.1% of the patients, respectively. By age group, RSV predominated among children in preschool age; and influenza A among children in school age and adolescents. Influenza A, adenovirus and parinfluenza 3 were identified more frequently in asthmatic children, whereas influenza A and RSV in patients with wheezing. Coinfection of two viruses was found in 17.1% of all patients with positive DI; the most frequent association was parainfluenza 1 and 2. CONCLUSIONS: Viral identification by means of DI is a fast and non-invasive technique that could favor the early beginning of antiviral treatments in children with asthma and wheezing.

[Allergic disease with IgE hypersynthesis. Proposal of a new denomination for an allergic disease confused with immunodeficiency]. / Enfermedad alérgica con hiperproducción de IgE. Propuesta de nueva denominación para una enfermedad alérgica confundida con inmunodeficiencia.

Within the variety of diseases in which there is an excessive production of immunoglobulin E (IgE), clinicians have the dilemma to establish a differential diagnosis between allergy, immunodeficiency and even autoimmunity. In the present study the clinical manifestations of allergic patients who presented very high levels of IgE and who were taken care of in the Allergy Service of the National Institute of Pediatrics and did not show criteria to be identified as carriers of some non-atopic immunological disease (eg. Hyper-IgE syndrome), are described. In addition, the regulation and synthesis of IgE is presented. The authors propose that the presence of an allergic entity with or without skin manifestations without any history of recurrent infections or cutaneous abscesses, should be named allergic disease with hypersynthesis of IgE, in which the levels of IgE are greater than 2,000 UI/mL.

[Hypoacusis in pediatric patients with allergic rhinitis]. / Hipoacusia en pacientes pediátricos con alergia respiratoria.

Currently, allergic disorders represent an important problem of public health. Besides having high prevalence they begin their clinical manifestations at early ages, in 75% of the cases before five years old. When they do not receive the proper treatment, they have systemic affectation, with a repercussion in the quality of life. The great comorbidity can cause a late and wrong diagnosis. In this article we review the relationship between hypoacusis and allergic rhinitis, with a description of their epidemiology, pathophysiology and clinical manifestations.

[Indications for sunflower oil concentrate in the treatment of atopic dermatitis]. / Indicación del destilado oleico de girasol en el tratamiento de la dermatitis atópica.

The treatment of atopic dermatitis, as other diseases that present a sensible skin, includes a series of therapeutic measures initiating with the general cares of the skin and application of elements that allow to preserve the functionality through relipidization and the inhibition of some components of the inflammation. This article includes a series of concepts that justify the use of sunflower oil concentrated like a weapon of forward edge in the treatment of these morbidities.

[Efficacy and safety of astemizole in the treatment of allergic rhinitis and urticaria: a systematic review with meta-analysis]. / Eficacia e inocuidad del astemizol en el tratamiento de la rinitis alérgica y la urticaria: revisión sistemática con metaanálisis.

OBJECTIVE: To compare astemizole with other first or second generation antihistaminics in the treatment of allergic rhinitis or urticaria. DESIGN: Systematic revision of clinical, controlled and randomized tests. MATERIAL AND METHODS: 36 controlled, randomized, clinical, double or simple blind tests were made in 6,446 patients; 4,513 of them were assigned to astemizole and 1,933 to other first or second generation antihistaminics. Analyzed outcomes: Rate of global success; global scoring improvement of rhinitis; ocular, nasal or pharingeal pruritus; watering; nasal obstruction; sneeze; urticaria; cutaneous response to histamine; time to get a satisfactory improvent; frequency of sedation and headache. RESULTS: In connection to global success there were significant differences in favor of astemizole (OR 6.72, CI95% 5.36 to 8.41, p 0.0001); alike global scoring improvement of rhinitis (SMD -0.82, CI95% -1.70 to 0.06, p 0.04); rhinorrhea (SMD of -0.70, CI95% -1.47 to -0.03, p 0.02); nasal, pharingeal or ocular pruritus (SMD -0.64, CI95% -1.63 to 0.35, p 0.03); urticaria (SMD of -3.53, CI95% -4.11 to -2.94, p 0.0001), and reduction of cutaneous response to histamine (SMD -2.02, CI95% -2.47 to -1.57, p 0.0001). Differences for watering, nasal obstruction or sneeze were not observed. Finally, the safety area was analyzed considering the existence of sedation and headache; it was demonstrated less sedation (OR 0.23, CI95% 0.18 to 0.30, p 0.0001) and less headache (OR 0.58, CI95% 0.40 to 0.85, p 0.005) in the group treated with astemizole. CONCLUSIONS: The available evidence shows a therapeutic superiority of astemizole versus other antihistaminics in relation to the percentage of global success and the global scoring improvement of rhinitis, rhinorrhea, pruritus in general, urticaria symptoms and of the reduction of response to histamine, with a smaller frequency of headache or sedation.

[Relation between Helicobacter pylori and atopic diseases]. / Relación entre la infección por Helicobacter pylori y las enfermedades atópicas.

The rise in the incidence of atopic diseases in the last years is associated to a greater prevalence of viral and bacterial infections. The infections facilitate a chronic inflammatory process that is directly related to the sensibilization of mast cells which favors manifestations of allergic diseases. Within the proposed bacteriological agents as causes of is Helicobacter pylori. This work is a bibliographical revision and concludes that there is not evidence of the direct causal relation between infection by Helicobacter and allergic diseases; however, it can play an indirect role. Controlled and randomized studies are necessary to know accurately this relation because the eradication treatment could be a real alternative in these patients handling.

[Allergens and risk factors in pediatric patients with allergic seasonal conjunctivitis]. / Alergenos y factores de riesgo en pacientes pediátricos con conjuntivitis alérgica estacional.

BACKGROUND: The seasonal allergic conjunctivitis is an inflammatory disease of the ocular surface that affects mainly children, with predominance of male sex. It is an immunological disease with a typical reaction of hypersensitivity type 1 (IgE), resulted from several biological reactions (antigen-antibody) and it's associated to several risk factors. OBJECTIVE: To determine the more frequently identified allergens and the associated risk factors to the seasonal allergic conjunctivitis in children living in Mexico City. MATERIAL AND METHODS: Ophthalmologic clinical study done to 50 patients with diagnosis of seasonal allergic conjunctivitis, during the months of March to October, 2001, at the Ophthalmology Department of the National Pediatric Institute. A control group was integrated by 50 patients of the consultation of ophthalmology with non-allergic ocular pathology, and percutaneous skin tests were made. A direct interrogation was applied to both groups to investigate associated risk factors of atopy. RESULTS: The associated risk factors to the development of allergic conjunctivitis are: family atopic background, negative antecedent of breast feeding, asthma o rhinitis (statistically significant). The most frequently identified allergens were Dermatophagoides pteronissinus, Dermatophagoides farinae, Lolium perenne and Atriplex bacteosa, of the group of dust mites and pollen, respectively. CONCLUSION: It is important to see our patients in an integral way. In the case of patients with seasonal allergic conjunctivitis, it should not be forgotten to make an interrogation of the factors associated to atopy and, if it is possible, to inform to the patient and their relatives about these, in order to prevent them.

Teofilina en asma / Teophylline in asthma

La teofilina ha sido uno de los medicamentos más ampliamente utilizados e intensivamente estudiado para el tratamiento del asma. La teofilina es una xantina metilada, relacionada con las xantinas de la dieta, cafeína, y teobromina. Tradicionalmente utilizada como broncodilatador, su uso actual es predominante como medicamento de mantenimiento para el asma crónica. Para el tratamiento del asma aguda, la teofilina es menos efectiva que los ß-2 agonistas inhalados o inyectados y permanece como una importante medicación en el manejo de síntomas nocturnos refractarios a tratamietno antiinflamatorio; es también útil como manejo de primera línea en pacientes que no cumplen o sin apego al tratamiento antiinflamatorio inhalado. El beneficio y toxicidad de la teofilina está en estrecha relación a las concentraciones séricas, y óptimos beneficios se obtienen a concentraciones de 10µg/mL y la toxicidad es frecuente a concentraciones que exceden 20 µg/mL. El rango de eliminación varía entre individuos, pero generalmente permanece estable en el paciente, excepto cuando cursa con alteraciones fisiológicas o con interacciones medicamentosas. Su uso clínico requiere cuidadosas consideraciones, de las características de absorción, individualización de la dosis, guiada por las concentraciones séricas y educación al paciente sobre los potenciales efectos secundarios y de las interacciones con medicamentos. Recientemente, parece renovarse el entusiasmo por el uso de la teofilina para el tratamiento del asma por sus propiedades antiinflamatorias y efecto inmunomodulador

Frecuencia entre la asociación de dermatitis atópica con infección de vías urinarias en pacientes de edad pediátrica / Frequency between association of atopic dermatitis and urinary tract infection in pediatric subjects

Objetivo. Existen en la literatura reportes clínicos que apoyan la asociación entre enfermedad alérgica e infección de vías urinarias, tanto por sintomatología, como por cambios anatomopatológicos e inmunológicos. Este estudio se realizó para evaluar la frecuencia de asociación de dermatitis atópica alérgica e infección de vías urinarias en sujetos pediátricos de nuestro medio. Metodología. Se incluyeron 86 sujetos preescolares, mayores de un mes y menores de cinco años 11 meses, con diagnóstico de dermatitis atópica; tomándoseles a todos examen general de orina, urocultivo, pruebas cutáneas, IgE total e IgE específica, para confirmar etiología alérgica de la dermatitis. Resultados. De los 86 sujetos estudiados, 55.8 por ciento fueron el sexo femenino. Se encontró atopia familiar en primer grado en el 52.3 por ciento y antecedentes personales de atopia en el 65.1 por ciento del grupo problemas. En cuanto a criterios diagnósticos de dermatitis atópica, se detectó morfología típica en el 84.9 por ciento; prurito en el 82.6 por ciento; exacerbación crónica en 65.1 por ciento; ojeras en el 78.9 por ciento y pliegues de Dennie-Morgan en el 62.8 por ciento. Las pruebas cutáneas resultaron positivas en el 13.95 por ciento; con PRIST de 17.45 por ciento y RAST de 5.8 por ciento. Entre los síntomas urinarios encontramos: disuria, nicturia, poliaquiuria, tenesmo vesical, enuresis, fiebre, dolor abdominal y vómito, obteniéndose sólo un urocultivo positivo para E. Coli. Conclusiones: En este estudio no se observó la asociación de dermatitis atópica alérgica e infección de vías urinaria. Se cuantificó la prevalencia de criterios menores y mayores en la población estudiada

Uso de furosemida inhalado en pacientes con crisis asmática / Inhaled furosemide in patients with asthmatic crisis

Estudio prospectivo de 53 pacientes de ambos sexos, en edades entre 6 y 17 años con crisis asmática leve o moderada, durante los meses de junio de 1993 a febrero de 1994. Se separaron en grupo, A de 33 pacientes que recibió furosemida inhalado y el grupo B, control, con 20 pacientes que recibió salbutamol inhalado. Todos los pacientes fueron sometidos a valoración clínica y pruebas de función respiratoria pre y posterior a la inhalación de uno u otro medicamento. En el grupo A, cuatro pacientes incrementaron el 20 por ciento o más posterior a la inhalación en el FVC, siete en el FEVI, 21 en el VEF 25-75 por ciento y ocho en PEF. En el grupo B, dos pacientes incrementaron el 20 por ciento o más, posterior a la inhalación en el FVC, cuatro en el FEVI, 17 en el VEF 25-75 por ciento y seis en el PEF. En VEF 25-75 por ciento es el indicador que con mayor frecuencia se incrementó en los dos grupos. De acuerdo a las PFR, el furosemida tiene efectos similares al salbutamol