[Treatment with high doses of intravenous immunoglobulin in a case of complicated pemphigus vulgaris]. / Tratamiento con dosis altas de inmunoglobulina intravenosa en un caso de pénfigo vulgar complicado.

A case of a young woman with recalcitrant pemphigus vulgaris involving skin and mucosae, with multiple side effects due to the chronic use of corticosteroids and azathioprine related myelosuppression is presented. She received high doses of intravenous immunoglobulin for five consecutive days and showed a rapid disease control, with healing in three weeks. Remission observed in this patient supports the idea that intravenous immunoglobulin is a good alternative of treatment for patients with pemphigus vulgaris, when there is no response to it or when significant adverse effects appear as a result of its prolonged use.

Clinical factors predicting a rapid response to short-acting beta2 agonists in mild and moderate asthma exacerbations.

BACKGROUND: The need for establishing criteria that facilitate decision-making has lead to search for factors that could predict prognosis and response to treatment for asthma exacerbations. OBJECTIVE: To assess which clinical factors are associated with a rapid response to short-acting beta2 agonists during asthma exacerbations. PATIENTS AND METHODS: Two hundred and twenty consecutive adults with mild to moderate asthma crisis were included. Their medical history and physical examinations were completed and closely monitored: heart rate, respiratory rate, SO2, and FEV-1. They were initially treated with O2 and micronebulized albuterol (2.5 mg every 20' x 4). A FEV-1 > or = 80% of predicted and an improvement at 90' were considered as good response. RESULTS: One hundred and forty-four (65.5%) patients had a good response to micronebulized albuterol, while 76 (34.5%) required steroids and hospitalization. Early relapse rate (72 hours) in this study was low (3.4%) and it was associated to other factors, such as: upper airway infection (40%) and history of oral steroids usage in the previous year (80%). The variables associated to a good response were: < 6 hours since crisis started, no hospitalization or steroid use during a crisis in the last year, initial SO2 > or = 90% and initial FEV-1 > or = 60%. CONCLUSIONS: These variables are easily measured and predict a therapeutic response in asthma patients when first seen in the emergency room.

Utilidad de la prueba cutánea a la coccidioidina en personas con diabetes mellitus tipo 2 en una zona endémica / Clinical useful of coccidioidin skin test in subjects with type 2 diabetes mellitus in an endemic area

Objetivo: Existen pocos estudios que evaluen la respuesta cutánea a antígenos micóticos en personas con diabetes, por lo que analizamos la posible diferencia de la reactividad cutánea a la coccidioidina en sujetos con y sin diabetes mellitus. Material y metodo: Mediante un diseño transversal se estimó la prevalencia de la reactividad cutánea a coccidioidina en una muestra poblacional de 1651 sujetos en una zona endémica de coccidioidomicosis. Se identificaron los portadores de diabetes mellitus, validándose el diagnóstico por criterios clínicos y de laboratorio. Para determinar el grado de asociación de la reactividad con el antecedente de diabetes mellitus se contrastaron los datos crudos y mediante regresión logística ajustada por edad, sexo y zona geográfica de residencia. Se obtuvo razón de momios (RM) e intervalos de confianza al 95 por ciento. Resultados: En el estudio poblacional hubo 665 positivos a la coccidioidina (tasa 40.28 por ciento). Se identificaron 76 casos con diabetes mellitus, 23 positivos a la prueba (tasa 30.26 por ciento), con una RM para este grupo de 0.63 (IC 95 por ciento 0.37-1.07), disminuyendo a 0.52 (IC95 por ciento 0.31 - 0.88, p=0.014) al analizar mediante regresión logística ajustada por variables confusoras. Conclusion: La reactividad a la coccidioidina fue significativamente menor en los casos con diabetes mellitus que en la población general. Se sugiere interpretar con cautela la respuesta de esta prueba en personas con DM tipo 2.

Prevalance of skin reactivity to coccidioidin and associated risks factors in subjects living in a Northern City of Mexico

Background. Coccidioidomycosis is a reemerging fungal disease seen mainly in the states located at the Mexican-U.S: border. The finding of advanced cases of the disease are now more frequent. Methods. A cross-sectional study was conducted to determine the prevalence of skin reactivity to coccidioidin in the city of Torreón, Coahuila, Mexico, located in the northern region of the country. A multifactorial association of environmental, social, and health conditions was analyzed. A total of 1,653 coccidioidin skin tests was applied in male and female subjects older than 8 years of age. Results. The overall rate of positive reactivity in this city was 40.2 percent, with a 95 percent confidence interval of 37.8-42.5. This was related to time/life exposure risk and to the habitat of unpaved streets. No statistically significant difference regarding gender, socioeconomic level, and working activities was found. the highest reactivity was observed in subjects between 30 and 65 years of age. Conslusions. Positive results were related to exposure risk and habitat, principally in the sputheast region of the city. These results were applied both to residents and outsiders with no differences between the groups. Of the total, 87.5 percent were considered high-risk subjects. It is recommended that future surveys be carried out in other northern cities of Mexico to obtain more useful data concerning the extent of the infection and mainly to establish preventive measures, such as appropriate reforestation and urbanization procedures