Ariá (Goeppertia allouia) Brazilian Amazon tuber as a non-conventional starch source for foods.

Ariá (Goeppertia allouia) is a tuber from the arrowroot's family widely found in the Brazilian Amazon. The tuber has a flavor similar to corn, besides high retrogradation when cooked, differing from other commercial starches. To enhance its added value, the Ariá starch was extracted to evaluate its potential as a food ingredient. The Ariá starch was compared to the commercially available corn and potato starches regarding their physicochemical, thermal, structural, and rheological properties based on the Duncan's test (p-value <0.05). The Ariá starch presented high amylose content (~38% w/w). Furthermore, the X-ray diffraction pattern confirmed its Type-C crystalline structure. The rheological properties showed that the starch gels presented high hardness and retrogradation as other studied starches. Ariá has great potential as a source of starch with low digestibility, increasing the satiety of food products.

[MASK (Mobile Airways Sentinel Network), a mobile App with ARIA's comprehensive solution in Spanish-speaking countries]. / MASK (Mobile Airways Sentinel Network), una app móvil con la solución integral de ARIA en países de habla hispana.

Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

Aunque existen guías clínicas de alta calidad sobre rinitis alérgica, numerosos pacientes reciben tratamiento deficiente, en parte debido al alto grado de automedicación. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS; en ella, los pacientes indican diariamente cuánto les molestan los síntomas a través de cinco pantallas con una escala visual análoga; recientemente se agregaron dos pantallas más (afectación del sueño). La aplicación también permite descargar los datos del "Diario de alergias" en la computadora del médico en el momento de la consulta a través de un código QR. En este artículo reseñamos el primer año de experiencia en España, México y Argentina, que utilizan la versión española.

[MASK (Mobile Airways Sentinel Network). ARIA's comprehensive solution for mobile app for the multimorbidity of allergic rhinitis and asthma]. / MASK (Mobile Airways Sentinel Network). La solución integral de ARIA por app móvil para la multimorbilidad de rinitis alérgica y asma.

The vast majority of patients with allergic rhinitis (AR) do not receive the proper management which is recommended by the guidelines, but they frequently self-medicate. MASK (Mobile Airways Sentinel Network) is an integral part of a project that is supported by the European Union against chronic diseases and focused on active and healthy aging. MASK represents the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma), in which, by using a mobile application in a smart device, the objective is to guide the patient in the control of his/her multi-morbidity, AR and/or allergic conjunctivitis (AC) and/or asthma. The mobile app Allergy Diary by MACVIA-ARIA is free and it is available for both Android and iOS platforms. After it is downloaded to the patient's cell phone, it first requests some information about the patient's profile, allergic pathologies and medication; afterwards, through a visual analog scale, the patient is invited to determine the degree of affectation in the nose, eyes, and bronchi, and its influence on their productivity at work / school. After analyzing the data generated by filling the Allergy Diary, it became clear there is a new clinical entity: allergic rhinitis+ allergic conjunctivitis +asthma, with greater effect; in addition to a high level of self-medication: in general, the patient takes medication on days when symptoms are present. The app has already been deployed in 23 countries, including several Spanish-speaking countries.

La mayoría de los pacientes con rinitis alérgica no recibe el manejo idóneo, sino que se automedica. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS. Al descargarla al celular del paciente, a este se le piden datos de su perfil, patologías alérgicas y medicación; posteriormente, mediante una escala visual analógica se le invita a determinar el grado de afectación en nariz, ojos y bronquios y su influencia sobre su productividad laboral/escolar. Con los datos del Diario de Alergia se observa que existe un nuevo patrón de presentación: rinitis alérgica + conjuntivitis alérgica + asma, con mayor afectación, así como un alto nivel de automedicación: en general, el paciente toma medicación cuando presenta síntomas. La app se ha desplegado en 23 países, incluyendo varios países hispanohablantes.

[Executive Summary of ARIA 2019: Integrated care pathways for allergic rhinitis in Argentina, Spain and Mexico]. / Resumen ejecutivo de ARIA 2019: Vías integradas de atención para la rinitis alérgica en Argentina, España y México.

The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.

El impacto sanitario y económico de las enfermedades alérgicas está aumentando rápidamente y se necesitan cambios en las estrategias para su manejo. Su influencia reduce al menos en un tercio la capacidad de desempeño laboral y escolar. Los ICP (Vías Integradas de Atención) de las enfermedades de las vías respiratorias son planes de atención estructurados y multidisciplinarios, que promueven las recomendaciones de las guías en protocolos locales y su aplicación a la práctica clínica. En este documento se presenta un resumen ejecutivo para Argentina, México y España. Se desarrollan las guías ARIA de próxima generación para el tratamiento farmacológico de la rinitis alérgica (RA) utilizando las pautas basadas en GRADE para RA, probadas con evidencia de la vida real proporcionada por tecnología móvil basada en escalas visuales analógicas. Se concluye que en el tratamiento de la RA, los antihistamínicos anti-H1 son menos efectivos que los corticoides intranasales (CINS), que en la rinitis gravelos CINS representan la primera línea de tratamiento, y que la combinación intranasal de CINS + anti-H1 es más eficaz que la monoterapia. Sin embargo, según el estudio MASK observacional en vida real, los pacientes tienen pobre adherencia al tratamiento y frecuentemente se automedican de acuerdo con sus necesidades.

[Primary care physicians' knowledge about allergic rhinitis and its impact on asthma (ARIA guidelines): a comparative Brazilian/Paraguayan/Uruguayan pilot study]. / Conocimiento de médicos de atención primaria sobre Rinitis Alérgica y su Impacto en el Asma (ARIA): estudio piloto comparativo Brasil, Paraguay, Uruguay.

BACKGROUND: Allergic Rhinitis and its Impact on Asthma (ARIA) establishes guidelines for the treatment of allergic rhinitis (AR) and its comorbidities. OBJECTIVE: To assess and compare the level of knowledge about AR and ARIA guidelines among primary care physicians (PCP) of Brazil, Paraguay and Uruguay. METHODS: 336 PCPs (Brazil 109, Paraguay 127, Uruguay 100) answered a questionnaire about personal and professional data and knowledge on RA and the ARIA guidelines; the Google Forms tool was used. RESULTS: There was a predominance of females (73, 50.4 and 70 % in Brazil, Paraguay and Uruguay, respectively); 124 worked in the community and 75 in emergency departments. Brazil and Uruguay PCPs recognized AR symptoms; 67 % of those from Uruguay did not ask about a history of AR diagnosis, 93 % about an asthma diagnosis and 90 % about rhinitis interference with daily activities. Intranasal corticosteroids use: 78, 92 and 54 % of Brazilian, Paraguayan and Uruguayan doctors; 100, 73.4 and 78 % of Paraguayan, Brazilian and Uruguayan PCPs, respectively, did not refer the patient to a specialist; 26.6, 62 and 6 % of PCPs in Brazil, Paraguay and Uruguay, respectively, knew the ARIA guidelines. CONCLUSIONS: AR is commonly looked after by PCPs, but the recognition of symptoms and knowledge about ARIA guidelines are low and treatment is not always optimal.

Antecedentes: En ARIA se establecen directrices para el tratamiento de la rinitis alérgica y sus comorbilidades. Objetivo: Evaluar y comparar el nivel de conocimiento sobre rinitis alérgica y la guía ARIA en médicos de atención primaria (MAP) de Brasil, Paraguay y Uruguay. Métodos: 336 MAP (Brasil 109, Paraguay 127, Uruguay 100) respondieron un cuestionario sobre datos personales, profesionales y conocimiento en rinitis alérgica y ARIA; se utilizó Google Forms. Resultados: Predominaron las mujeres (73, 50.4 y 70 % en Brasil Paraguay Uruguay); 124 trabajaban en la comunidad y 75 en servicios de urgencias. Los MAP de Brasil y Uruguay reconocieron los síntomas de rinitis alérgica; 67 % de Uruguay no preguntaba sobre antecedentes de diagnóstico de rinitis alérgica, 93 % sobre diagnóstico de asma y 90 % sobre la interferencia de la rinitis con las actividades diarias. Uso de corticosteroides intranasales: 78, 92 y 54 % de los médicos de Brasil Paraguay y Uruguay; 100, 73.4 y 78 % de Paraguay, Brasil y Uruguay no derivaban el paciente al especialista; 26.6, 62 y 6 % de Brasil, Paraguay y Uruguay conocían ARIA. Conclusiones: La rinitis alérgica frecuentemente es atendida por el MAP, pero el reconocimiento de los síntomas y el conocimiento sobre ARIA son reducidos y el tratamiento no siempre es óptimo.

[ARIA 2016 executive summary: Integrated care pathways for predictive medicine throughout the life cycle in Argentina]. / Resumen ejecutivo de ARIA 2016: vías integradas de atención para la medicina predictiva a lo largo del ciclo de vida en Argentina.

The ARIA initiative was started during a World Health Organization workshop in 1999. The initial goals were to propose a new classification for allergic rhinitis, to promote the concept of multi-morbidity in asthma and rhinitis and to develop guidelines with stakeholders for world-wide use. ARIA is now focused on the implementation of emerging technologies for individualized and predictive medicine. MASK: MACVIA-Aria Sentinel Network uses mobile technology to develop care pathways that enable management by a multidisciplinary group or by patients themselves. An App for iOS and Android uses a visual analogue scale to assess symptom control and work productivity, as well as a clinical decision support system; it is associated with an interoperable tablet for health professionals. The escalation strategy uses recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of ARIA's new approach is to provide an active and healthy life to people affected by rhinitis, regardless of age, gender or socioeconomic status, in order to reduce social and health inequalities caused by the disease.

La iniciativa ARIA (Rinitis Alérgica y su Impacto en el Asma) se inició durante un taller de la Organización Mundial de la Salud en 1999. Los objetivos iniciales fueron proponer una nueva clasificación de rinitis alérgica, promover el concepto de multimorbilidad en asma y rinitis y desarrollar guías con todas las partes interesadas para su en todos los países y poblaciones. ARIA, difundida e implementada en más de 70 naciones, ahora se centra en la implementación de tecnologías emergentes para la medicina individualizada y predictiva. MASK (MACVIA [Contre les Maladies Chroniques pour un Vieillissement Actif] Aria Sentinel Network) utiliza la tecnología móvil para desarrollar vías de atención que permitan el manejo de la rinitis y del asma por un grupo multidisciplinario o por los propios pacientes. Una aplicación (app) para iOS y Android está disponible en 20 países y 15 idiomas; utiliza una escala analógica visual para evaluar el control de los síntomas y la productividad del trabajo, así como un sistema de apoyo para las decisiones clínicas. Se asocia con una tabla interoperable (que permite intercambiar información) para médicos y otros profesionales de la salud. La estrategia de escalamiento utiliza las recomendaciones de la Asociación Europea de Innovación para el Envejecimiento Activo y Saludable. El objetivo del nuevo enfoque ARIA es proporcionar una vida activa y saludable a las personas afectadas por la rinitis, cualquiera que sea su edad, sexo o condición socioeconómica, con el fin de reducir las desigualdades sociales y de salud causadas por la enfermedad.

Relación entre sensibilización alérgica por pruebas cutáneas y grados clínicos de rinitis / Relationship between allergic sensitization by skin test and severity of rhinitis

INTRODUCCIÓN: La rinitis alérgica (RA) es una enfermedad inflamatoria de la mucosa nasal mediada por IgE. Existen controversias en los diferentes estudios acerca de la relación entre la gravedad de los síntomas de RA y la magnitud de la sensibilización medidas por pruebas cutáneas con alergenos. OBJETIVOS: Relacionar la magnitud de sensibilización alérgica con los grados clínicos de la RA. POBLACIÓN Y MÉTODO: Estudio Observacional, analítico y transversal, que incluyó pacientes de ambos sexos, entre 6 y 18 años con diagnóstico de RA. Se clasificaron según el grado clínico establecido por Allergic rhinitis and its impact on asthma (ARIA). La sensibilización alérgica se midió a través de pruebas cutáneas por puntura con aeroalergenos y se determinó su magnitud según: PC1 (número de alérgenos positivos), PC2 (sumatoria de milímetros de pápulas) e Índice de atopía (relación entre PC2/PC1). Se dividieron según la presencia de monosensibilización y/o polisensibilización. ANÁLISIS ESTADÍSTICO: Se realizó estadística descriptiva y analítica utilizando prueba de Wilcoxon Mann Withney y prueba de Kruskal Wallis. Se consideró un valor significativo a una p<0,05. RESULTADOS: Se incluyeron 156 pacientes con una mediana de edad de 11,18 años (5-18,66 años). No se encontró diferencia en los valores de PC1, PC2 ni en el índice de atopía entre los cuatro grados clínicos de rinitis (p=0,3370, p=0,2222 y p=0,8774 respectivamente). Tampoco se observó diferencia en el índice de atopia entre los pacientes monosensibilizados y polisensibilizados (p=0,5493). Al comparar la rinitis según la frecuencia no se encontró diferencia en los valores de PC1, PC2 ni en el índice de atopía entre los grupos intermitente y persistente (p=0,0810; p=0,0587 y p=0,5705). Con respecto a la gravedad de la rinitis no se encontró diferencia en los valores de PC1, PC2 ni en el índice de atopía entre los grupos leve y moderado/grave (p=0,5693; p=0,1653 y p=0,4613). CONCLUSIONES: Las pruebas cutáneas por puntura de lectura inmediata no son un método diagnóstico capaz de diferenciar los grados clínicos de rinitis. (AU)

INTRODUCTION: Allergic rhinitis (RA) is an inflammatory disease of nasal mucosal mediated by IgE. There are controversies in the different studies about the relationship between the severity of RA symptoms and the magnitude of sensitization measured by skin tests with allergens. OBJECTIVE: Relate the magnitude of allergic sensitization to the clinical grades of AR. PATIENTS AND METHODS: In a observational, analytical and crosssectional study, we included patients aged 6 to 18 years with diagnosis of allergic rhinitis (RA). Were classified according to the clinical grade established by Allergic Rhinitis and its Impact on Asthma (ARIA) guide. Allergic sensitization was measured through skin prick test with aeroallergens and their magnitude was determined according to: PC1 (Number of positive allergens), PC2 (sum of millimeters of papules) and index of atopy (relation between PC2/PC1). The patients were divided in two groups according to the presence of monosensitization and/or polysensitization. RESULTS: We included 156 patients with a median age of 11,18 years (5-18,66 years). There were no difference in the values of PC1, PC2 or in the index of atopy between the clinical grades of rhinitis (p=0,337; p=0,2222 and p=0,8774 respectively). There was no difference in the index of atopy between monosensitized and polysensitized patients (p=0,5493). When comparing rhinitis according to the frequency, no difference was found in the values of PC1, PC2 or the index of atopy between the intermittent and persistent groups (p=0,0810; p= 0,0587 and p= 0,5705). Regarding the severity of rhinitis, no difference was found in the values of PC1, PC2 or in the index of atopy between the mild and moderate/severe groups (p=0,5693; p=0,1653 and p= 0,4613). CONCLUSIONS: Skin prick tests with aeroallergens are not a diagnostic method capable of differentiating the clinical grades of rhinitis. (AU)

United airway disease: current perspectives.

Upper and lower airways are considered a unified morphological and functional unit, and the connection existing between them has been observed for many years, both in health and in disease. There is strong epidemiologic, pathophysiologic, and clinical evidence supporting an integrated view of rhinitis and asthma: united airway disease in the present review. The term "united airway disease" is opportune, because rhinitis and asthma are chronic inflammatory diseases of the upper and lower airways, which can be induced by allergic or nonallergic reproducible mechanisms, and present several phenotypes. Management of rhinitis and asthma must be jointly carried out, leading to better control of both diseases, and the lessons of the Allergic Rhinitis and Its Impact on Asthma initiative cannot be forgotten.

Impacto de la frecuencia y la gravedad de la rinitis sobre la función pulmonar en niños y adolescentes sin asma / Impact of frequency and severity of rhinitis on lung function in children and adolescents without asthma

Introducción. Se han observado alteraciones espirométricas en pacientes con rinitis, sin asma, proporcionales al grado clínico de la rinitis establecido por la guía Allergic Rhinitis and its Impact on Asthma (ARIA). Recientemente se ha validado una nueva clasificación de la rinitis como ARIA modificada (ARIAm), que disocia la forma moderada de la grave. Se desconoce el impacto de la rinitis sobre la función pulmonar considerando su frecuencia y gravedad por separado. Objetivos. Determinar las posibles alteraciones de la función pulmonar y su potencial reversibilidad al broncodilatador en niños y adolescentes con rinitis alérgica y no alérgica sin asma, de acuerdo a su frecuencia (intermitente y persistente) y gravedad (leve, moderada y grave) establecida según ARIAm. Población y métodos. Estudio observacional, analítico de corte transversal, que incluyó pacientes de ambos sexos, entre 5 y 18 años, con rinitis alérgica y no alérgica, sin asma. Se realizó espirometría por curva flujo-volumen y se analizó la existencia de anormalidades en la función pulmonar y la respuesta broncodilatadora en relación con el grado de rinitis por ARIAm ajustando un modelo logístico. Se consideró un valor de p<0,05 para establecer significación estadística. Resultados. Se incluyeron 189 pacientes. En 42 (22,2%) se observó al menos un parámetro alterado en la función pulmonar. Los pacientes con rinitis persistente exhibieron mayor afectación de la función pulmonar que los de grado intermitente (p=0,0257). El defecto funcional fue más frecuente en las formas grave y moderada que en el grado leve (p=0,0052) y fue independiente de la condición de atopia (p=0,1574 para frecuencia y p =0,5378 para gravedad). No se encontró diferencia en la reversibilidad al broncodilatador entre los grupos (p=0,1859 y p=0,0575, respectivamente). Conclusiones. La alteración de la función pulmonar se asoció con rinitis persistente. Fue más prevalente en las formas moderada y grave pero no existieron diferencias significativas entre ambas. El defecto funcional se demostró tanto en rinitis alérgica como no alérgica. (AU)

Background: Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, proportional to the clinical grade established by Allergic Rhinitis and Its Impact on Asthma (ARIA) guideline. Recently has been validated a new criteria of rhinitis classification designed as ARIA modified (ARIAm), which allow to discrimination moderate to severe grades. Rhinitis impact on lung function according to frequency and severity considering separately is unknown. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic and nonallergic rhinitis without asthma, according to the frequency and severity criteria of rhinitis classified by ARIAm. Methods: In an observational cross sectional study we included children and adolescents aged 5 to 18 years with symptoms of allergic and nonallergic rhinitis without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIAm using an adjusted logistic model. A p value <0.05 was considered statistically significant. Results: We studied 189 patients; 42 (22.2%) had some spirometric abnormalities. Patients with persistent rhinitis had greater impairment of lung function compared to intermittently grade (p = 0.0257). The functional defect was more frequent in rhinitis severe and moderate than mild grade (p = 0.0052) and was independent of atopy status both frequency (p = 0.1574) and severity (p=0.5378). There was no difference in bronchodilator reversibility between groups (p = 0.1859 and p = 0.0575 respectively). Conclusion: Impaired lung function was associated with persistent rhinitis. It was more prevalent in moderate and severe rhinitis, but there wasn't a significant difference between them. The functional defect was demonstrated in both allergic and nonallergic rhinitis.(AU)

[Allergic rhinitis in asthmatic patients]. / Rinitis alérgica en pacientes asmáticos.

BACKGROUND: Allergic rhinitis and bronchial asthma are airways chronic inflammatory processes, with a correlation of 28-78%. OBJECTIVES: To determine the prevalence and classification of allergic rhinitis on asthmatic patients, according to the workshop Allergic Rhinitis and its Impact on Asthma (ARIA), and to assess the total serum concentrations of IgE and the presence of nasal and blood eosinophilia. MATERIAL AND METHOD: A study was done with asthmatic patients ages 7 to 14, attending the Pediatric Service at the Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela. Subjects were polled for signs and symptoms suggesting allergic rhinitis and its impact on quality of life. Blood and nasal swab samples were taken to perform laboratory tests in study. RESULTS: There were 60 asthmatic patients, 73.3% males and 70% scholar age patients. The prevalence of allergic rhinitis was 93.3%, according to ARIA classification. Mild intermittent group was the most frequent type, with 42.8% the most frequent clinic sign was the allergic shiners (86.6%), and the predominant symptom was the nasal aqueous trickle (83.3%), while sleep disorders were the most common affection of quality of life (39.2%). In 85.7% of patients eosinophil percentage was higher than 3%, whereas in 75% total serum IgE values were higher than 100 Ul/mL. In patients with rhinitis, 61.9% of the nasal mucus showed altered eosinophils percentage higher than 10%. CONCLUSION: A high prevalence of allergic rhinitis is present in asthmatic patients, confirmed by laboratory tests, which proves an inflammatory response mediated by IgE.

Antecedentes: la rinitis alérgica y el asma bronquial son procesos inflamatorios crónicos de las vías respiratorias, con una correlación que varía entre 28 y 78%. Objetivos: determinar la prevalencia de rinitis alérgica en pacientes asmáticos y clasificarla según las guías Rinitis Alérgica y su Impacto en Asma (ARIA), así como detectar las concentraciones séricas de IgE total y la existencia de eosinofilia nasal y en sangre periférica. Material y método: estudio en el que pacientes asmáticos entre 7 y 14 años de edad, consultantes del servicio de Pediatría del Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Estado Zulia, Venezuela, fueron encuestados acerca de signos y síntomas sugerentes de rinitis alérgica y su efecto en la calidad de vida. Se tomaron muestras sanguíneas e hisopado nasal para hacer las determinaciones objeto de estudio. Resultados: se evaluaron 60 pacientes asmáticos, 73.3% del sexo masculino y 70% escolares. La prevalencia de rinitis alérgica se estableció en 93.3%, el tipo más frecuente según ARIA fue el intermitente leve, con 42.8%. El signo clínico más frecuente fueron las ojeras alérgicas (86.6%) y el síntoma predominante fue el goteo nasal acuoso (83.3%), la afectación en cuanto a calidad de vida estuvo representada por trastornos del sueño (39.2%). El 85.7% de los encuestados tuvo porcentajes de eosinófilos mayores a 3% y 75% tuvo valores mayores de 100 UI de IgE total sérica. El 61.9% de las muestras de moco nasal de pacientes con rinitis mostró porcentajes de eosinófilos mayores a 10%. Conclusión: existe alta prevalencia de rinitis alérgica en asmáticos confirmada mediante pruebas de laboratorio que evidencian una respuesta inflamatoria mediada por IgE.

[ARIA (Allergic Rhinitis and its Impact on Asthma). Achievements in 10 years and future needs in Latin America]. / ARIA (Rinitis Alérgica y su Impacto en Asma). Logros en 10 años y necesidades futuras en América Latina.

Allergic rhinitis and asthma represent global problems of public health affecting all age groups; asthma and allergic rhinitis frequently coexist in the same patients. In Latin American prevalence of allergic rhinitis, although variable, is very high. Allergic rhinitis and its Impact on Asthma (ARIA) started during a workshop of the World Health Organization performed in 1999 and was published in 2001. ARIA proposed a new classification of allergic rhinitis in intermittent or persistent and mild or moderate-severe. This approach of classification reflects more nearly the impact of allergic rhinitis in patients. In its review of 2010 ARIA developed guidelines for diagnosis and treatment of allergic rhinitis and of clinical practices for management of comorbidities of allergic rhinitis and asthma based on GRADE (Grading of Recommendations, Development and Evaluation). ARIA has been spread and implemented in more than 50 countries. In Latin American an intense activity has been developed to spread these recommendations in almost all the countries of the region and it is important to record the obtained goals in the diffusion and implementation of ARIA, as well as to identify the unsatisfied needs from the clinical, research and implementation points of view. Final objective is to reinforce the priority that allergy and asthma should have, especially in children, in the programs of public health, as they have been prioritized in European Union in 2011.

La rinitis alérgica y el asma representan problemas globales de salud pública que afectan a todos los grupos etarios; el asma y la rinitis alérgica frecuentemente coexisten en los mismos pacientes. En América Latina la prevalencia de rinitis alérgica, aunque variable, es muy elevada. La iniciativa Rinitis Alérgica y su Impacto en Asma (globalmente conocida como ARIA, de su nombre en inglés Allergic Rhinitis and its Impact on Asthma) comenzó durante un taller de la Organización Mundial de la Salud (OMS) realizado en 1999 que se publicó en el año 2001. ARIA propuso una nueva clasificación de rinitis alérgica en intermitente o persistente y leve o moderada-severa. Este esquema de clasificación refleja más estrechamente el impacto de la rinitis alérgica en los pacientes. En su revisión de 2010, la guía ARIA desarrolló pautas para el diagnóstico y tratamiento de la rinitis alérgica y de prácticas clínicas para el manejo de las comorbilidades de la rinitis alérgica y el asma basadas en GRADE (Gradación de Recomendaciones, Desarrollo y Evaluación). ARIA se ha diseminado e implantado en más de 50 países. En América Latina se ha desarrollado una intensa actividad para diseminar estas recomendaciones en casi todos los países de la región y es importante llevar un registro de los logros obtenidos en la difusión e implantación de ARIA, además de identificar las necesidades insatisfechas desde el punto de vista clínico, de la investigación y de la implantación. El objetivo final es reforzar la prioridad que deben tener la alergia y el asma ­especialmente en niños­ en los programas de Salud Pública, tal como los priorizó la Unión Europea en 2011.

Características das microbiotas bacteriana e fúngica presentes na cloaca de jabutis-piranga (geochelone carbonaria) criados em domicílio

RESUMOA popularidade de jabutis criados como animais de estimação vem crescendo e tem causado preocupação quanto ao seu impacto na saúde pública e animal. Há uma escassez quanto aos estudos envolvendo o isolamento de bactérias e fungos presentes na cloaca de répteis. Este trabalho teve como objetivos o estudo das microbiotas bacteriana (bactérias aeróbias e anaeróbias facultativas) e fúngica presentes na cloaca de cem jabutis-piranga (Geochelone carbonaria) criados em domicílio bem como a pesquisa de genes de virulência em Escherichia coli e Salmonella spp. utilizando a PCR. Uma grande diversidade de gêneros de bactérias (18) e fungos (9) foi isolada. Os microrganismos mais frequentemente isolados foram: Escherichia sp. (67%), Klebsiella spp. (54%), Bacillus spp. (42%), Candida spp. (42%), Citrobacter spp. (33%), Staphylococcus spp. (29%), Aeromonas spp. (15%) e Salmonella spp. (7%). Todas Salmonella spp. foram positivas para o gene invA. Nenhum dos isolados de E.coli foi positivo para presença de genes de virulência associados com E. coli Enterotoxigênica, Enteropatogênica e Extra-intestinal. Deve-se atentar para os cuidados com jabutis criados como pets, particularmente quanto aos aspectos de higiene, visando assim a prevenção de transmissão inter espécies de diferentes microrganismos alguns dos quais que albergam genes de virulência.

CARACTERÍSTICAS DAS MICROBIOTAS BACTERIANA E FÚNGICA PRESENTES NA CLOACA DE JABUTIS-PIRANGA (GEOCHELONE CARBONARIA) CRIADOS EM DOMICÍLIO

RESUMOA popularidade de jabutis criados como animais de estimação vem crescendo e tem causado preocupação quanto ao seu impacto na saúde pública e animal. Há uma escassez quanto aos estudos envolvendo o isolamento de bactérias e fungos presentes na cloaca de répteis. Este trabalho teve como objetivos o estudo das microbiotas bacteriana (bactérias aeróbias e anaeróbias facultativas) e fúngica presentes na cloaca de cem jabutis-piranga (Geochelone carbonaria) criados em domicílio bem como a pesquisa de genes de virulência em Escherichia coli e Salmonella spp. utilizando a PCR. Uma grande diversidade de gêneros de bactérias (18) e fungos (9) foi isolada. Os microrganismos mais frequentemente isolados foram: Escherichia sp. (67%), Klebsiella spp. (54%), Bacillus spp. (42%), Candida spp. (42%), Citrobacter spp. (33%), Staphylococcus spp. (29%), Aeromonas spp. (15%) e Salmonella spp. (7%). Todas Salmonella spp. foram positivas para o gene invA. Nenhum dos isolados de E.coli foi positivo para presença de genes de virulência associados com E. coli Enterotoxigênica, Enteropatogênica e Extra-intestinal. Deve-se atentar para os cuidados com jabutis criados como pets, particularmente quanto aos aspectos de higiene, visando assim a prevenção de transmissão inter espécies de diferentes microrganismos alguns dos quais que albergam genes de virulência.

Asociación entre los valores de Rantes y la clínica en pacientes con rinitis alérgica / Association between rantes values and the clinical aspect in patients with allergic rhinitis

Objetivo: Determinar los valores de Rantes, después de la exposición a ácaros, para evaluar su asociación con la escala ARIA, en el grupo de pacientes seleccionado. Diseño: Estudio de corte transversal. Materiales y métodos: Se incluyeron 17 pacientes que consultaron por rinitis alérgica en el Hospital de La Samaritana entre el 1 de julio del 2010 y el 1 julio del 2011, y que cumplieron los criterios de selección, de los cuales se obtuvieron 34 muestras de lavados nasales posteriores a provocación intranasal con ácaros. Resultados: Los pacientes mostraron mayor tendencia a pertenecer al grupo de síntomas de mayor severidad y frecuencia según la escala ARIA. Los valores de Rantes encontrados en lavados nasales tuvieron un promedio de 8,1 pg/ml (+/– 19DS). Conclusión: Se encontró una positividad en los valores de la citoquina CCL5 en los lavados nasales del 20% de los pacientes. El coeficiente de correlación obtenido muestra una asociación débil.

Objective: Determine the values of Rantes, after exposure to mites, to evaluate its association with ARIA scale in the group of selected patients. Design: Cross sectional survey. Materials and Methods: We included 17 patients presenting with allergic rhinitis at the Samaritan Hospital between July 1, 2010 and July 1, 2011, and met the selection criteria, of which 34 samples were obtained from nasal washes after intranasal challenge with mites. Results: Patients showed a greater tendency to belong to the group of symptoms of greater severity and frequency according to the ARIA scale. Rantes values found in nasal washes had an average of 8.1 pg/ml (+/– 19DS). Conclusions: Positivity was found in the values of the cytokine CCL5 in nasal washes of 20% of patients. The correlation coefficient shows a weak association.

Acuracidade da distribuição diamétrica entre métodos de projeção em Floresta Ombrófila Mista

This study aims to evaluate accuracy of projections in diametric Araucaria Forest, using models of the transition matrix and movement ratio, applied in three temporal amplitude (2, 3 and 4 years), and two employees amplitudes diameter classes (5 and 10cm). The information used in the study are from permanent plots established in the National Forest of São Francisco de Paula - RS. The efficiency of the projections was verified based on observed values, using Kolmogorov Smirnov test and analysis of variance. Although they have been influenced by the Markovian properties, projections carried out showed efficiency to describe the future structure of the forest, but the model the movement ratio projections generated more efficient compared to those described by the transition matrix. The time span of 4 years applied the range of 5cm diameter class had the most accurate results of the study overestimated by 1.7% the total number of individuals in the forest.

O estudo tem como objetivo avaliar a acuracidade das projeções diamétricas em uma Floresta Ombrófila Mista, empregando os modelos da Matriz de Transição e Razão de Movimentação, aplicados em três amplitudes temporais (2, 3 e 4 anos), sendo utilizados duas amplitudes de classes diamétricas (5 e 10cm). Os dados utilizados no estudo são oriundos de parcelas permanentes instaladas na Floresta Nacional de São Francisco de Paula - RS. A eficiência das projeções foi verificada com base nos valores observados, adotando-se os testes de Kolmogorov Smirnov e a análise de variância. Embora tenham sido influenciadas pelas Propriedades Markovianas, as projeções realizadas mostraram eficiência para descrever a estrutura futura da floresta, sendo o modelo da Razão de Movimentação o que gerou as projeções mais eficientes se comparada às projeções da Matriz de Transição. A amplitude temporal de 4 anos, associada à amplitude de classe diamétrica de 5cm, apresentou o resultado mais acurado do estudo, superestimando em 1,7% o número total de indivíduos da floresta.

Acuracidade da distribuição diamétrica entre métodos de projeção em Floresta Ombrófila Mista

This study aims to evaluate accuracy of projections in diametric Araucaria Forest, using models of the transition matrix and movement ratio, applied in three temporal amplitude (2, 3 and 4 years), and two employees amplitudes diameter classes (5 and 10cm). The information used in the study are from permanent plots established in the National Forest of São Francisco de Paula - RS. The efficiency of the projections was verified based on observed values, using Kolmogorov Smirnov test and analysis of variance. Although they have been influenced by the Markovian properties, projections carried out showed efficiency to describe the future structure of the forest, but the model the movement ratio projections generated more efficient compared to those described by the transition matrix. The time span of 4 years applied the range of 5cm diameter class had the most accurate results of the study overestimated by 1.7% the total number of individuals in the forest.

O estudo tem como objetivo avaliar a acuracidade das projeções diamétricas em uma Floresta Ombrófila Mista, empregando os modelos da Matriz de Transição e Razão de Movimentação, aplicados em três amplitudes temporais (2, 3 e 4 anos), sendo utilizados duas amplitudes de classes diamétricas (5 e 10cm). Os dados utilizados no estudo são oriundos de parcelas permanentes instaladas na Floresta Nacional de São Francisco de Paula - RS. A eficiência das projeções foi verificada com base nos valores observados, adotando-se os testes de Kolmogorov Smirnov e a análise de variância. Embora tenham sido influenciadas pelas Propriedades Markovianas, as projeções realizadas mostraram eficiência para descrever a estrutura futura da floresta, sendo o modelo da Razão de Movimentação o que gerou as projeções mais eficientes se comparada às projeções da Matriz de Transição. A amplitude temporal de 4 anos, associada à amplitude de classe diamétrica de 5cm, apresentou o resultado mais acurado do estudo, superestimando em 1,7% o número total de indivíduos da floresta.

Fatores ecológicos determinantes na ocorrência de Araucaria angustifolia e Podocarpus lambertii, na Floresta Ombrófila Mista da FLONA de São Francisco de Paula, RS, Brasil

The present research was accomplished at São Francisco de Paula's National Forest (FLONA), in Rio Grande do Sul. The objective was to determine, through logistics regression analysis, the environmental and competition factors that could influence on the occurrence of Araucaria angustifolia (Bertol.) Kuntze and Podocarpus lambertii former Klotzsch Endl. species in Mixed ombrophylous forest. For the study, the individuals with cap=30cm had been evaluated, in 1000 samples of 10 x 10m, demarcated in ten permanent conglomerate of 1ha (100 x 100m) previously installed in the forest. In each sample the factors that might influence the occurrence of the species and the factors related the habitat was assessed as physical of the soil (depth, rocky outcrop and humidity), exhibition to the light and the relief inclination. The competition factors were: basal area, sub-forest density and individuals' frequency . For the obtained results it had been possible to conclude that the Araucaria angustifolia prefers places with deep soils, north exposition and low individuals frequency. On the other hand, Podocarpus lambertii prefers no stony places, little sloping, with south exposition, relatively humid, with high frequency of individuals and high sub-forest density.

O presente trabalho foi realizado na Floresta Nacional (FLONA) de São Francisco de Paula, no Rio Grande do Sul. Teve como objetivo determinar, via análise de regressão logística, os fatores ambientais que influenciam a ocorrência das espécies Araucaria angustifolia (Bertol.) Kuntze e Podocarpus lambertii Klotzsch ex Endl. em uma área de Floresta Ombrófila Mista na FLONA de São Francisco de Paula. Para o estudo, foram avaliados os indivíduos com cap=30cm, em 1.000 subunidades amostrais de 10 x 10m, demarcadas em 10 conglomerados permanentes de 1ha (100 x 100m) previamente instalados na floresta. Em cada subunidade amostral, foram avaliados os fatores passíveis de influenciar a ocorrência das espécies, como os fatores relativos ao habitat: físicos do solo (profundidade, presença de afloramentos rochosos e umidade), exposição à luz e inclinação do terreno; e os fatores relativos à concorrência: área basal, densidade do sub-bosque e frequência de indivíduos. Pelos resultados obtidos, foi possível concluir que a Araucaria angustifolia ocorre em locais com solos profundos, expostos para o norte e com baixa frequência de indivíduos. Por outro lado, Podocarpus lambertii prefere locais não pedregosos, pouco inclinados, com exposição sul, relativamente úmidos, com alta frequência de indivíduos e alta densidade do sub-bosque.

Fatores ecológicos determinantes na ocorrência de Araucaria angustifolia e Podocarpus lambertii, na Floresta Ombrófila Mista da FLONA de São Francisco de Paula, RS, Brasil

The present research was accomplished at São Francisco de Paula's National Forest (FLONA), in Rio Grande do Sul. The objective was to determine, through logistics regression analysis, the environmental and competition factors that could influence on the occurrence of Araucaria angustifolia (Bertol.) Kuntze and Podocarpus lambertii former Klotzsch Endl. species in Mixed ombrophylous forest. For the study, the individuals with cap=30cm had been evaluated, in 1000 samples of 10 x 10m, demarcated in ten permanent conglomerate of 1ha (100 x 100m) previously installed in the forest. In each sample the factors that might influence the occurrence of the species and the factors related the habitat was assessed as physical of the soil (depth, rocky outcrop and humidity), exhibition to the light and the relief inclination. The competition factors were: basal area, sub-forest density and individuals' frequency . For the obtained results it had been possible to conclude that the Araucaria angustifolia prefers places with deep soils, north exposition and low individuals frequency. On the other hand, Podocarpus lambertii prefers no stony places, little sloping, with south exposition, relatively humid, with high frequency of individuals and high sub-forest density.

O presente trabalho foi realizado na Floresta Nacional (FLONA) de São Francisco de Paula, no Rio Grande do Sul. Teve como objetivo determinar, via análise de regressão logística, os fatores ambientais que influenciam a ocorrência das espécies Araucaria angustifolia (Bertol.) Kuntze e Podocarpus lambertii Klotzsch ex Endl. em uma área de Floresta Ombrófila Mista na FLONA de São Francisco de Paula. Para o estudo, foram avaliados os indivíduos com cap=30cm, em 1.000 subunidades amostrais de 10 x 10m, demarcadas em 10 conglomerados permanentes de 1ha (100 x 100m) previamente instalados na floresta. Em cada subunidade amostral, foram avaliados os fatores passíveis de influenciar a ocorrência das espécies, como os fatores relativos ao habitat: físicos do solo (profundidade, presença de afloramentos rochosos e umidade), exposição à luz e inclinação do terreno; e os fatores relativos à concorrência: área basal, densidade do sub-bosque e frequência de indivíduos. Pelos resultados obtidos, foi possível concluir que a Araucaria angustifolia ocorre em locais com solos profundos, expostos para o norte e com baixa frequência de indivíduos. Por outro lado, Podocarpus lambertii prefere locais não pedregosos, pouco inclinados, com exposição sul, relativamente úmidos, com alta frequência de indivíduos e alta densidade do sub-bosque.

Fatores ecológicos determinantes na ocorrência de Araucaria angustifolia e Podocarpus lambertii, na Floresta Ombrófila Mista da FLONA de São Francisco de Paula, RS, Brasil

The present research was accomplished at São Francisco de Paula's National Forest (FLONA), in Rio Grande do Sul. The objective was to determine, through logistics regression analysis, the environmental and competition factors that could influence on the occurrence of Araucaria angustifolia (Bertol.) Kuntze and Podocarpus lambertii former Klotzsch Endl. species in Mixed ombrophylous forest. For the study, the individuals with cap=30cm had been evaluated, in 1000 samples of 10 x 10m, demarcated in ten permanent conglomerate of 1ha (100 x 100m) previously installed in the forest. In each sample the factors that might influence the occurrence of the species and the factors related the habitat was assessed as physical of the soil (depth, rocky outcrop and humidity), exhibition to the light and the relief inclination. The competition factors were: basal area, sub-forest density and individuals' frequency . For the obtained results it had been possible to conclude that the Araucaria angustifolia prefers places with deep soils, north exposition and low individuals frequency. On the other hand, Podocarpus lambertii prefers no stony places, little sloping, with south exposition, relatively humid, with high frequency of individuals and high sub-forest density.

O presente trabalho foi realizado na Floresta Nacional (FLONA) de São Francisco de Paula, no Rio Grande do Sul. Teve como objetivo determinar, via análise de regressão logística, os fatores ambientais que influenciam a ocorrência das espécies Araucaria angustifolia (Bertol.) Kuntze e Podocarpus lambertii Klotzsch ex Endl. em uma área de Floresta Ombrófila Mista na FLONA de São Francisco de Paula. Para o estudo, foram avaliados os indivíduos com cap=30cm, em 1.000 subunidades amostrais de 10 x 10m, demarcadas em 10 conglomerados permanentes de 1ha (100 x 100m) previamente instalados na floresta. Em cada subunidade amostral, foram avaliados os fatores passíveis de influenciar a ocorrência das espécies, como os fatores relativos ao habitat: físicos do solo (profundidade, presença de afloramentos rochosos e umidade), exposição à luz e inclinação do terreno; e os fatores relativos à concorrência: área basal, densidade do sub-bosque e frequência de indivíduos. Pelos resultados obtidos, foi possível concluir que a Araucaria angustifolia ocorre em locais com solos profundos, expostos para o norte e com baixa frequência de indivíduos. Por outro lado, Podocarpus lambertii prefere locais não pedregosos, pouco inclinados, com exposição sul, relativamente úmidos, com alta frequência de indivíduos e alta densidade do sub-bosque.

Fluticasone furoate nasal spray in the treatment of allergic rhinitis.

Allergic rhinitis (AR) is a prevalent disease with great morbidity and significant societal and economic burden. Intranasal corticosteroids are recommended as first-line therapy for patients with moderate-to-severe disease, especially when nasal congestion is a major component of symptoms. To compare the efficacy and safety profile of different available intranasal corticosteroids for the treatment of AR, it is important to understand their different structures and pharmacokinetic and pharmacodynamic properties. Knowledge of these drugs has increased tremendously over the last decade. Studies have elucidated mechanisms of action, pharmacologic properties, and the clinical impact of these drugs in allergic respiratory diseases. Although the existing intranasal corticosteroids are already highly efficient, the introduction of further improved formulations with a better efficacy/safety profile is always desired. Fluticasone furoate nasal spray is a new topical corticosteroid, with enhanced-affinity and a unique side-actuated delivery device. As it has high topical potency and low potential for systemic effects, it is a good candidate for rhinitis treatment.