Chronic gastritis associated with Helicobacter pylori in Mexican children: histopathological patterns.

The objective of this study was to analyze the histopathological patterns of inflammation, distribution, severity, and degree of gastric mucosa of Helicobacter pylori (Hp)-infected children in Northern Mexico, as well as the correlation between colonization density and inflammation intensity. We carried out a cross-sectional study of gastric biopsies performed on children ranging from 2 to 17 years of age who underwent upper gastrointestinal endoscopy for diverse gastroduodenal disorders. This study includes only children who were found to be Hp carriers, with positive results for tests of Hp antigens in feces and in gastric biopsy studies. We studied 107 patients (age 8.2 ± 3.7 years). In 47.7% of patients, the density of Hp colonization was low; only 21.5% had a marked density. Mononuclear leukocyte infiltration showed a similar distribution. Thirty-seven percent of patients had follicular gastritis. An acute inflammatory response was absent in 65% and mild in 20.6% of patients. When inflammation was present, it was primarily located in the antrum (79%). There were no cases of intestinal metaplasia or atrophy. A link was found between Hp density and age, infiltration by mononuclear cells, the presence of follicular gastritis, and the level of neutrophil infiltration (P  =  0.001). Despite the high rates of Hp infection in the region, the histopathological findings in these children were mild and were limited primarily to the antral mucosa. These data indicate the need to study the behavior of this disease in children in diverse study populations to provide localized prevention and treatment strategies.

Immunochromatographic monoclonal test for detection of Helicobacter pylori antigen in stool is useful in children from high-prevalence developing country.

BACKGROUND: Tests to detect Helicobacter pylori antigens in feces for diagnosis of infection in children demonstrate controversial results. One novel and fast monoclonal test improves diagnostic accuracy in adults, but clinical evidence of its usefulness at pediatric age is insufficient to date. The objective of this work was to evaluate the diagnostic accuracy of this test in a sample of Mexican children. METHODS: We conducted a transversal study in 150 selected children with digestive symptoms suggestive of organic disease in whom a clinical history was conducted in addition to a fast monoclonal test (ImmunoCardSTAT HpSA, Meridian Diagnostics) performed by immunochromatography. Patients were submitted to endoscopy and histopathologic study. RESULTS: Of the 150 children (mean age 7.8 +/- 4.7 years), 107 (71.3%) were positive for the test, and presence of H. pylori was confirmed histologically in 109 (72.7%) children, with sensitivity of 96.3% (95% CI = 95.8-96.8), specificity of 95.1% (95% CI = 93.9-96.4), and accuracy of 96.0% (95% CI, -95.6 to -96.3); pretest probability was 0.73, while post-test probability was 0.98. Infection rate and test accuracy increased with age. CONCLUSIONS: This test is useful for detecting H. pylori infection in children of all ages, and is a good alternative for screening studies in developing countries with elevated prevalence, due to its being fast, noninvasive, inexpensive, and easy to carry out.

[Depression's prevalence and risk factors in hospitalized seniors]. / Prevalencia de depresión y factores de riesgo en el adulto mayor hospitalizado.

OBJECTIVE: To determine the prevalence of depression and associated factors in hospitalized seniors. MATERIALS AND METHODS: A prospective and transversal study was made in female and male seniors at General Hospital number 16 of the Mexican Institute of Social Security in Torreón, Coahuila, México between June and December of 2003. There were applied Yesavage, Katz, Lawton and Folstein scales. RESULTS: There were included 320 patients with a mean age of 72 years. Ten patients with dementia (prevalence of 3.1%) were excluded. Depression was found in 50% and dependence in 62% according to Katz index, and 75% of the patients had dependence in daily life activity according to the Lawton scale. In the bivariate analysis, the following variables were associated with depression: age over 80, female gender, patients that have been hospitalized in the internal medicine department, living alone, to be dependent, and to have a chronic illness. In the multivariate analysis using logistic regression four former variables (female sex, living alone, dependence, and to be hospitalized in Internal Medicine department) had a significant association. CONCLUSIONS: The prevalence of depression among hospitalized older patients is high. The strongest factors associated were dependence of other people and to have chronic disease.

[Burnout syndrome in medical staff affiliated to a tertiary care hospital]. / Síndrome de agotamiento profesional en personal médico de un hospital de tercer nivel.

INTRODUCTION: the burnout syndrome (BS) is common among physicians, affecting their behavior, personality and professional goals; thus deteriorating the quality of their performance. OBJECTIVE: to determine the BS prevalence among physicians affiliated to a tertiary care hospital and its associated risk factors. MATERIAL AND METHODS: The study was conducted through a cross-sectional design. The sampling was nonprobabilistic. Participating physicians were interviewed using the Maslach Burnout Inventory and the Beck's depression inventory. The analysis included ascertainment of the BS prevalence and use of chi(2) and logistic regression analysis. The local Internal Review Board and the Ethics Committee approved the project and all participants gave their informed consent. RESULTS: 166 physicians participated; the average age was 42 years, most were men. The response rate was 87.4 %. The prevalence of depression with more than 10 points in the Beck inventory was 18.6 % (95 % CI: 12-24). Depression in the last two years was 38.6%; the prevalence of BS was 26%; 15. 2 % scored above 27 in emotional exhaustion and 19.3 % scored more than 10 points in depersonalization. The risk of being depressed due to BS was five times higher (OR 5.163; 95 % CI 2.130-12.5). Working in the night shift, living without a permanent couple and being depressed were the main risk factors for BS. CONCLUSIONS: BS is common among physicians and is associated with organizational and personal variables.

[Globalization in medical education. Opinions of Mexican medical teachers]. / La globalización en la educación médica. Opinión de médicos docentes mexicanos.

OBJECTIVE: To explore the opinions on globalization and medical education of a group of Mexican physicians who are also teachers. MATERIAL AND METHODS: This was a descriptive, transversal and prospective study. A self-administrated questionnaire was made, validated and applied. The frequency of answers and its association with certain variables were analysed. RESULTS: Most of the participants agreed to define education in quality terms, but not to favor technological aspects over humanistic ones; 40% of the sample disregarded or didn't agree that technical orientation has to do with the globalization process; a third of it didn't know the programs and standards proposed by institutions of higher education. CONCLUSIONS: There is a diversity of opinions on the influence of globalization on medical education. The highest academic level, time of teaching and research activities are associated with the greatest controversy.

[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.

Eustachian tube dysfunction in allergic rhinitis.

OBJECTIVE: To assess eustachian tube function in patients with allergic rhinitis and compare them with a control group. STUDY DESIGN AND SETTING: Tympanometry was performed in 130 patients (260 ears), divided into 2 groups: 80 cases with allergic rhinitis and 50 healthy controls. Cases underwent skin hypersensitivity tests. RESULTS: Cases, age 21.1 +/- 14.9; Controls, age 23.9 +/- 15.6. Most frequent skin hypersensitivity: Dermatophagoides pt (62%), Zea Maiz (44%), and Cockroach (37%). Tympanometry of cases showed negative values of peak tympanometric pressure in both children and adults (P < or = 0.05). Among children under 11 years of age, 15.5% tympanograms showed abnormal curves (13% C curves and 3% B curves); among the control group only normal curves were found (type A). CONCLUSION: Allergic rhinitis patients have a higher risk of eustachian tube dysfunction, particularly during childhood. Tympanometry is a noninvasive, readily available procedure that may be useful in these patients to prevent chronic middle-ear disease.

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.

Serum lead, cadmium, and zinc levels in newborns with neural tube defects from a polluted zone in Mexico.

Serum lead, cadmium and zinc levels from 31 newborns with neural tube defects (NTD), and 54 healthy controls living in a polluted area in Mexico were estimated using atomic absorption spectrophotometry (AAS). NTD family history was found to be of greater importance in the case group (OR 6.95, 95% CI 1.51-36.3, p=0.002). In 25% of the children, serum lead concentrations were above the admissible maximum level (AML) of 10 microg/dL within 24 h of extra-uterine life. Cadmium concentrations were below the AML. Zinc deficiency was found in nine (29%) of the cases and four (9.3%) of the controls (p=0.04). The logistic regression multivariate analysis showed no correlation between NTD and high levels of any of these metals; however, a positive correlation was found to zinc deficiency (OR 5.0, 95% CI 1.07-23.00, p=0.04). These results focus attention to the surrounding nutritional and maternal health factors of major importance in disease etiology.

[Respiratory function in allergic asthmatic children and its relation to the environmental pollen concentration]. / Función respiratoria en niños asmáticos alérgicos y su relación con la concentración ambiental de polen.

BACKGROUND: Bronchial asthma is the most common chronic disease in children, producing the highest absenteeism among children and adults. OBJECTIVE: To determine the relation between respiratory function in asthmatic children and contaminant and climatic environmental factors. MATERIAL AND METHODS: It was performed a study with 26 asthmatic patients, from the Immuno-Allergies Department of the Specialties Hospital no. 71 of the Centro Medico Nacional Torreon, with an 8-month-follow-up. By a home monitoring, subjects determined their peak expiratory flow (PEF) twice a day: PEF1: in the morning, at getting up without or before medication, and PEF2: at night, before sleeping without or before medication. RESULTS: From June to August 1995, as well as from September to November 1995, a relation between pulmonary function, measured by PEF1 and PEF2, and some of the palinologic families or species studied was not found. On the other hand, from December 1995 to February 1996 a significant relation between the concentration of pollen's particles of Chenopodiaceaes and Amaranthaceaes and the difference between PEF1 and PEF2 (Difpef), with a p value < 0.05. CONCLUSIONS: Environmental Chenopodiaceaes' and Amaranthaceaes' pollen is related to a variability of 0.0075 L/min of Difpef for each grain of pollen/m3 in the environment during winter, after rain time of the Comarca Lagunera.

[Fungal spores in the environment of the asthmatic patient in a semi-desert area of Mexico]. / Fungosporas en el hábitat del paciente asmático en una zona semidesértica en México.

OBJECTIVE: To analyze the frequency and type of fungal spores in the habitat of sensitized asthmatic patients, its relationship with skin test reactivity to fungi and indoor factors favoring the fungi development. MATERIAL AND METHODS: Indoor airborne fungi were collected from the houses of 85 patients using fungal culture methods and adherent cover glasses. Data were analyzed as a cross sectional study. RESULTS: The prevalence of positive fungi skin test reactivity was 22%, the main reactivity was for Aspergillus (54%), Alternaria (51%) and Monilia (48%), and most frequent cultured fungi were: Cladosporium (76%), Alternaria (57.5%) and Aspergillus (51.3%). Another molds (Dreshlera, Rhodotorula) not included in the skin test reactivity panel nor immunotherapy plans were cultured. The fungus spores mean concentration was 1788/m3 +/- 1637 (930 to 10,230/m3) without qualitative or quantitative differences when several house areas were compared. The association of skin reactivity and indoor exposure were significant only for Aspergillus (RR 3.14, 95% CI 1.77-5.58). The use of ventilation-air-conditioning systems (42%), personal humidifier or nebulizers (43%), dampness inside the houses were important characteristics. CONCLUSIONS: Indoor fungus pollution is also important in semi-desert areas, due to high prevalence of many factors that contribute for its development and proliferation.

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.

Correlation between respiratory function tests and evolution time in asthmatic patients

Se efectuó un estudio prospectivo para demostrar la relación entre el tiempo de evolución del asma bronquial y las alteraciones observadas por medio de pruebas de función respiratoria realizadas en periodos asintomáticos. Se estudiaron 80 pacientes asmáticos alérgicos de uno y otro sexo. Se investigó el tiempo de evolución del asma bronquial de los pacientes y se les efectuaron pruebas de función respiratoria durante periodos asintomáticos. Los patrones respiratorios se clasificaron como: normal, obstructivo o mixto (obstructivo-restrictivo) y se realizó una correlación de Spearman. Veintinueve pacientes fueron masculinos y 51 femeninos, todos tuvieron entre 5 y 49 años de edad. Del total de pacientes 13 por ciento tuvieron un patrón normal, 57.7 por ciento patrón obstructivo y 28.7 por ciento patrón mixto. En los grupos de más corta evolución el patrón obstructivo fue el más común (75 por ciento de los pacientes de menos de cinco o menos años de evolución y 53.8 por ciento de los pacientes con evolución entre 5 y 10 años). El patrón mixto fue el más común en pacientes con mayor tiempo de evolución de asma (16.6 por ciento en el grupo de pacientes de cinco o menos años de evolución y 50 por ciento en el grupo de más de 20 años de evolución). La correlación de Spearman fue de 0.7 con una p = 0.05. Se concluye que existe mayor daño pulmonar relacionado con periodos de mayor tiempo de evolución del asma bronquial.

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

Educación a niños asmáticos y sus padres para evitar crisis / Educational program to asthmatic children and parents

Material y método: se estudiaron 35 niños asmáticos y la madre (o padre) de cada niño. Se realizó un programa educativo de 11 sesiones mensuales con duración de dos horas cada una. Se aplicaron evaluaciones de conocimientos a cada niño y cada padre o madre al inicio y final del curso. Se compararon el número de crisis e internamientos por asma durante los 11 meses previos a la educación y los 11 meses del curso de asma. Resultados: se encontró una correlación nagativa de las evaluaciones de conocimientos de los niños y sus padres con el número de crisis e internamientos con una significación del 0.0001 al 0.0004. Conclusiones: las regresiones muestran una reducción de 0.36 internamientos y 0.92 crisis por cada punto más de conocimientos de los niños, así como 0.52 internamientos y 1.07 crisis por cada punto de conocimientos de los padres

Asthmatic exacerbations and environmental pollen concentration in La Comarca Lagunera (México)

Para determinar la correlación entre la concentración ambiental de polen y la frecuencia de exacervaciones asmáticas en La Comarca Lagunera se estudió una cohorter de 104 pacientes con diagnóstico de asma alérgica, efectuándose seguimiento mensual (julio 1993 a julio 1995) en el que se registró la presencia de exacervaciones asmáticas. Se realizó muestreo ambiental semanalmente durante el mismo periodo con un muestreador de alto volumen PST (Andersen Samplers INC). Las muestras se procesaron con técnica de acetólisis y el conteo de granos de polen por m a la tercera potencia de aire con paquete estadístico SAS. El seguimiento fue de 1469 personas mes (media de 15.5 meses y la correlación entre las tasas de exacervaciones asmáticas y la concentración ambiental de polen fue significativa (r = 09.63, r² = 0.39, p< 0.01). Al restringirse las exacervaciones de asma asociadas a procesos infecciosos de las vías respiratorias, la correlación se incrementó (r = 0.70, r² = 0.49 y p< 0.01). Concluimos que la concentración ambiental de polen influye en la precipitación de crisis asmáticas en pacientes con asma alérgica

Is the histamine skin test inhibited by prednisone?

Background. A clinical trial was carried out to determine whether therapeutic doses of prednisone could inhibit the response to the histamine skin test. Methods. Forty-five male and female asthmatic and allergic patients participated in the study, their ages ranged from 6-14 years old (16 girls and 29 boys). The clinical trial was random, double-blind, and placebo-controlled. Methods. Three treatment groups were formed and patients were assigned randomly to them. Groups A and B received prednisone at 0.5 and 1 mg/kg/day, respectively, whereas group C received a placebo (p.o.). All treatment lasted for 10 days. The histamine test was applied on the first, fifth and tenth days of treatment, and the size of the wheal and the extension of the flare were evaluated 5 min after the application of the test. The statistical tool used was ANOVA, since the study sought to see the difference among the treatment groups, after including 45 patients in three groups of 15 patietns each. Results. No significant statistical difference was observed among the groups using and ANOVA test. Conclusions. It was concluded that the response to the histamine test was not modified by a 10-day treatment with prednisone at doses of 0.5 mg/kg/day and 1 mg/kg/day

Hipersensibilidad cutánea en pacientes con asma bronquial de La Comarca Lagunera / Cutaneous hipersensibility in pacients with asthma to La Comarca Lagunera

Se efectuó un estudio transversal prospectivo (junio 1994 a junio 1995) en 101 pacientes derechohabientes del IMSS, residentes en La Comarca Lagunera, con diagnóstico de asma bronquial alérgica, para analizar la hipersensibilidad cutánea a ecroalergenos mediante pruebas por intradermorreacción. Se buscaron diferencias en las respuestas en relación con la zona de residencias de los pacientes. Los resultados mostraron mayor reactividad para extractos de polen: los más frecuentes fueron: Capriola dactylon (70 por ciento), Chenopodium album (69 por ciento), Salsola pestifer (61 por ciento), Lolium perenne (61 por ciento), Zea maíz y Prosopis j (57 por ciento). La positividad para extractos de hongos fue menor, Candida (22 por ciento), Helmintosporium (18 por ciento) y Cephalosporium (16 por ciento. El polvo casero fue positivo en 55 por ciento de los pacientes y Dermatophagoides pt en 35 por ciento. La hipersensibilidad para algodón fue muy baja (7 por ciento). No hubo diferencias en la reactividad de los pacientes por zona de resistencia