Tendencia de la mortalidad por asma en Uruguay 1984-2001: relación con la venta de medicamentos antiasmáticos / Trends in asthma mortality in Uruguay 1984-2001: antiasthmatic drugs association

Antecedentes: las tasas de mortalidad por asma han experimentado variaciones en diferentes países en los últimos años. Existen escasos estudios que muestran la realidad en América Latina. Objetivos: evaluar la tendencia de las tasas de mortalidad en Uruguay en un período de 18 años (1984-2001). Relacionar la mortalidad con la venta de medicación antiasmática. Método: se realizó estudio epidemiológico retrospectivo en la población total, para lo cual se recabaron datos del Departamento de Estadística del Ministerio de Salud Pública. Se analizaron las tendencias de las tasas de mortalidad por regresión lineal. Se utilizó correlación de Spearman para relacionar tasas de mortalidad con la venta de medicación antiasmática. Resultados: se comprobó tendencia descendente tanto para las tasas de mortalidad global (promedio 4,96 por 100.000 habitantes en todo el período), como para las del grupo 5-34 años (promedio 0,40 por 100.000), con un descenso más marcado en el período 1995-2001 (promedio 4,19 y 0,22 respectivamente). Para ambas tasas se comprueba descenso significativo de la mortalidad en el período estudiado (p=0,000 y p=0,001 respectivamente). Existe correlación significativa entre las tasas de mortalidad y la venta de medicamentos antiasmáticos: corticoides inhalados (tasa global rho=-0,88, p=0,000 y tasa 5-34 años rho=-0,67, p=0,003); teofilina (tasa global rho=0,83, p=0,000 y tasa 5-34 años rho=0,83, p=0,000); beta 2 agonista oral (tasa global rho=0,86, p=0,000 y tasa 5-34 años rho=0,77, p=0,000). Conclusión: si bien existe un descenso en las tasas de mortalidad global, ésta aún permanece elevada. El descenso es más marcado en el grupo 5-34 años, y las cifras actuales ubican a Uruguay entre los países de menor tasa de mortalidad en Latinoamérica. Este hecho está probablemente vinculado a los nuevos enfoques terapéuticos de la enfermedad.

Allergy to local anaesthetics in dentistry. Myth or reality?

BACKGROUND: Local anesthetics (LA) are frequently used in dentistry. Although these drugs are usually well-tolerated, they can sometimes provoke adverse reactions of various types and severity. The true incidence of LA allergic reactions is unknown. The objectives of this study were (i) to evaluate the incidence of immediate adverse events in subjects requiring local anesthetic injection in order to receive dental treatment; (ii) to assess the incidence of anaphylactic allergic reactions among those recorded as adverse events and (iii) to analyze the relationship between the atopic antecedents of these patients and documented allergic reactions. MATERIALS AND METHODS: A prospective, open-label, non-comparative study including 5,018 subjects who received LA during dental treatment, despite their age, was carried out in 7 private or public odontological centers. All the possible reactions that could appear during the first hour of anesthetic administration were assessed. RESULTS: Twenty-five adverse reactions were diagnosed, representing 0.5 % of the study population. None of these reactions was due to an allergic cause. Most (22/25) were mild, quickly reversible psychogenic or vasovagal reactions. One case was related to defects in the anesthetic technique. In two further cases, allergic etiology was ruled out after skin and dose provocative challenge tests with the anesthetic. In conclusion, allergic reactions to LA are very rare. Most adverse reactions are psychogenic or vasovagal. Physicians and dentists should be aware of these facts in order to minimize the frequent fears and myths concerning the use of LA in the dentist's office.

Asthma mortality in Uruguay, 1984-1998.

BACKGROUND: Asthma mortality rates have increased worldwide during the past several years despite the increased availability of new and effective medications. Few studies show reliable data from Latin American countries. OBJECTIVE: To determine asthma mortality rates from 1984 to 1998 and to relate mortality to sales of asthma medications. METHODS: We conducted a retrospective epidemiologic study in the total population of Uruguay. Data were obtained from the Department of Statistics of the Ministry of Public Health. Trends in mortality rates were analyzed using linear regression procedures. Spearman rank correlations were used to relate mortality rates to sales of asthma medications. RESULTS: The mean overall mortality rate was 5.10 per 100,000 during the period 1984 to 1998, (range 6.08 to 3.39) and showed a decreasing trend (P = 0.001). During the period 1995 to 1998, a more pronounced decrease was observed (mean mortality rate, 4.10 per 100,000). In the 5- to 34-year-old age group the mean mortality rate was 0.43 (range 0.65 to 0.13). Similarly, the mortality rate in this age group decreased particularly in the 1994 to 1998 period (mean 0.19; P = 0.005). Finally, the mortality rate was inversely correlated with sales of inhaled corticosteroids; for the overall mortality rate, p = -0.71, P = 0.003; for 5- to 34-year-old age group, p = -0.63, P = 0.01. CONCLUSIONS: Although mortality attributable to asthma seems to be decreasing, the overall mortality rate is still high compared with more economically developed countries. A more pronounced decrease in asthma mortality has been seen in the 5- to 34-year-old group. At present, Uruguay is a Latin American country with a low rate of asthma mortality. This is probably related to the use of new therapies to treat asthma.

Asthma mortality in Latin America.

There are not enough data concerning asthma mortality in Latin America. The Latin American Society of Allergy and Immunology coordinated this project to provide reliable data for gaining knowledge about our present situation, which is a condition indispensable to changing it. The following countries participated in this study: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, Peru, Uruguay and Venezuela. A uniform protocol was designed in Santa Fe, Argentina. Asthma mortality rates were analyzed in accordance with two variables: age-adjusted rates (5-34) and total death rates. The total population studied was 107, 122, 529 inhabitants. The highest death rates were found in Uruguay and Mexico (5.63), and the lowest in Paraguay (0.8) and Colombia (1.35). Age-adjusted (5-34) rates were higher in Costa Rica (1.38) and lower in Chile (0.28). Regarding sex, the analysis of the information provided by seven countries showed a predominance of females (51.8%) over males (48.18%). In the southern Latin American countries such as Chile, Uruguay, Paraguay and Argentina, which have marked climatic differences, deaths occurred mainly in the winter. It is important to emphasize that, in most countries, deaths from asthma occurred at home: Chile (60.7%), Argentina (63.4%) and Paraguay (88%). However, in Uruguay, 58.6% occurred during hospitalization. Mortality rates from bronchial asthma are high in most of the Latin American countries studied, even though further studies are needed. Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that can be severe and sometimes fatal. The health ministries of each country do not believe asthma is a significant issue. Therefore, we should provide them with sound epidemiological studies to convince them to change their attitude toward this disease.