ALERGIA ALIMENTARIA EN LACTANTE ALIMENTADO CON SENO MATERNO EXCLUSIVO / Food allergy in an exclusively breastfed infant

El término alergia alimentaria se refiere a los eventos adversos a alimentos originados por mecanismo inmunológico. La alergia alimentaria puede aparecer en cualquier etapa de la vida. Es un padecimiento que, en general, se manifiesta en el lactante por llanto excesivo, cólicos, vómitos, diarreas, acompañadas de sangre y eccema en la piel. El objetivo de la investigación es demostrar la sensibilización del lactante a los alérgenos alimentarios que recibió en el útero de la madre y a través de la lactancia materna exclusiva. La metodología fue reporte de un caso al que se le suspendió la lactancia materna exclusiva y se introdujo leche en polvo hipoalergénica Puramino. La IgE total fue de 1.136 kU/l y los valores de IgE alérgeno específico para leche, el huevo y el maní mayores de 100 kU/l y para el trigo 24,4 kU/l. Se concluye así que la leche de vaca, el huevo, el maní y el trigo pueden sensibilizar al niño durante el embarazo y a través del seno materno. El uso de una dieta hipoalergénica durante el período de lactante puede revertir el proceso.(AU)

The term food allergy refers to adverse events caused by immunologic mechanism. Food allergy may appear at any stage of life, it is a condition that generally manifests itself in the baby's excessive crying, colic, vomiting, diarrhea accompanied by blood and skin eczema. The objective of the research is to demonstrate awareness infant to food allergens received in the mother's womb and through the exclusive breastfeeding. The methodology was a case report that was suspended exclusive breastfeeding and milk powder was introduced into hypoallergenic Puramino. The total IgE was 1.136 kU/L and allergen specific IgE values for milk, egg and peanut higher than 100 kU/L and wheat: 24. 4 kU/L. It is concluded that cow's milk, egg, peanuts and wheat can sensitize the child during pregnancy and through the womb. The use of a hypoallergenic diet during the infant can reverse the process.(AU)

EFICACIA Y SEGURIDAD DE LA INMUNOTERAPIA EN ALERGIA ALIMENTARIA / Efficacy and safety of immunotherapy in food allergy

El tratamiento de la alergia alimentaria consiste en educar al paciente para evitar la ingestión y, cuando ello no es posible, emplear, entre otros procedimientos, la inmunoterapia con el alimento causal. El objetivo de esta revisión es presentar evidencias sobre eficacia y seguridad de la inmunoterapia en alergia alimentaria y las vías recomendadas para su aplicación. Se accedió a las bases de datos con los descriptores inmunoterapia, alergia alimentaria, vías, desensibilización, eficacia y seguridad. La inmunoterapia oral (ITO) a partir de leche caliente por microondas fue eficaz con buen perfil de seguridad en niños con alergia a leche de vaca (ALV). La quimotripsina inhibe la formación de ßLg y es un nuevo candidato para la inmunoterapia oral en ALV. La ITO con leche y omalizumab ha demostrado mejoría significativa en las medidas de seguridad, pero no en los resultados de eficacia. ITO en niños con alergia al huevo desarrollan tolerancia disminuyendo el riesgo de reacciones alérgicas. También ha aumentado la tolerancia al huevo sin cocinar. En alergia al maní la ITO indujo desensibilización en niños y dio lugar a un aumento significativo en la tolerancia con buen perfil de seguridad. La coadministración del probiótico Lactobacillus rhamnosus a ITO con maní fue eficaz en la inducción de la falta de respuesta y cambios inmunes sostenidos. Se concluye que la ITO puede ser una vía eficaz y segura para la alergia a la leche, huevo y maní. Los protocolos muestran resultados diferentes en eficacia y seguridad, por lo que se requieren más ensayos clínicos.(AU)

The treatment of food allergy is to educate the patient to avoid ingestion and, when it is not possible, to use, among other procedures, the immunotherapy with the offending food. The objective of this review is to present evidence on efficacy and safety of immunotherapy in food allergy and recommended for implementation pathways. It was accessed databases with describer's immunotherapy, food allergy, pathways, desensitization, efficacy and safety. The OIT from microwave hot milk was effective with good safety profile in children with CM. Chymotrypsin inhibits the formation of ßLg and is a new candidate for oral immunotherapy CM. The OIT with milk and omalizumab has shown significant improvement in security measures, but not in the efficacy results. OIT in children with egg allergy develop tolerance decreasing the risk of allergic reactions. It has also increased tolerance uncooked egg. In peanut allergy desensitization induced OIT in children and resulted in a significant increase in tolerance with good safety profile. The co-administration of probiotic Lactobacillus rhamnosus with peanut OIT was effective in inducing immune unresponsiveness and sustained changes. It is concluded that the OIT can be an effective and safe for allergy to milk, egg and peanut route. Protocols show different results in efficacy and safety so more clinical trials are required.(AU)

La gestión del proceso de fibrilación auricular: un abordaje integral / Managing the atrial fibrillation process: An integral approach

Objetivos. El estudio se ha desarrollado en 3 fases cuyos respectivos objetivos han sido: definir el proceso de gestión más adecuado para la fibrilación auricular (FA) desde el punto de vista de profesionales y pacientes. Conocer cómo se gestiona en la práctica diaria. Identificar los cambios necesarios para que esta práctica diaria se aproxime a una gestión adecuada del proceso. Material y métodos. Diseño: 1.a fase: se han utilizado técnicas de consenso, un análisis de modos de fallo y sus efectos (AMFE) y un grupo focal con pacientes. 2.a fase: se ha desarrollado mediante encuesta. 3.a fase: se han realizado 3 grupos nominales y 3 grupos focales. Emplazamiento: Atención Primaria y Cardiología. Participantes: en la primera fase médicos de familia, cardiólogos y pacientes. En la segunda y tercera, médicos de familia. Mediciones principales: 1.a fase: se ha definido el diagrama de flujo, con sus notas explicativas, del proceso correcto de atención para la FA. 2.a fase: se ha investigado como se atiende en la práctica en la actualidad. 3.a fase: se han identificado las barreras para una correcta atención del proceso y se han definido propuestas para su mejora. Resultados. Casi el 40% de los médicos de familia se implicó en el diagnóstico y tratamiento de sus pacientes con FA. Se identificó la formación, la colaboración entre especialidades, motivación, trabajo en equipo con enfermería y cambios organizacionales como factores imprescindibles para una correcta gestión del proceso. Conclusiones. La FA puede ser gestionada desde Atención Primaria. Para ello son necesarios cambios relevantes en la organización de la asistencia. Se ven como imprescindibles tanto la formación como el apoyo y comunicación entre niveles(AU)

Objectives. The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. Material and methods. Design: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. Setting: Primary Care and Cardiology. Participants: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. Main measurements: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. Results. Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. Conclusions. AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary(AU)

[Managing the atrial fibrillation process: an integral approach]. / La gestión del proceso de fibrilación auricular: un abordaje integral.

OBJECTIVES: The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. DESIGN: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. SETTING: Primary Care and Cardiology. PARTICIPANTS: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. MAIN MEASUREMENTS: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. RESULTS: Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. CONCLUSIONS: AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary.

Estudio comparativo de la morbimortalidad del producto gestacional en mujeres embarazadas con preeclampsia modera o severa / Comparative study of morbimortality of gestational product in pregnant women with mild or severe preeclampsia

INTRODUCCION: La preeclampsia es una enfermedad exclusiva de la gestación humana, que afecta a la embarazada produciendo una disfunción vascular. OBJETIVO: Comparar la morbimortalidad del producto gestacional en mujeres embarazadas con preeclampsia (PE) moderada o severa. PACIENTES Y METODO: Estudio de tipo no experimental, descriptivo, por causa-efecto, de carácter retrospectivo. La población estudiada correspondió a toda paciente que sufrió PE, subclasificada en dos grupos; pacientes con PE moderada y pacientes con PE severa. El estudio se realizó en la Clínica Hospital del Profesor en el período comprendido entre junio del año 2007 y junio del año 2008. Se analizaron variables clínicas del recién nacido y de la embarazada. Los resultados obtenidos fueron analizados por medio de las pruebas de comparación de medias poblacionales y comparación de proporciones poblacionales. RESULTADOS: De un total de 1680 embarazos registrados en la Clínica Hospital del Profesor, 42 fueron diagnosticados con síndrome hipertensivo del embarazo (SHE), correspondiendo a un 2,5 por ciento. 28 (66 por ciento) correspondieron a PE moderada, 13 (32 por ciento) correspondieron a PE severa. El retardo del crecimiento intrauterino (RCIU) presentó diferencia significativa con un p< 0,05. El sufrimiento fetal agudo (SFA) y la mortalidad fetal, no presentaron diferencia significativa con un p> 0,05. CONCLUSION: Si bien las diferencias clínicas para el diagnóstico de preeclampsia moderada y severa son claras, las complicaciones que pueden traer al producto de la gestación no presentan diferencia, salvo al analizar el RCIU.

INTRODUCTION: Preeclampsia is an exclusive disease of human gestation, that affects pregnant women producing vascular dysfunction. AIM: Compare the morbid-mortality of the gestational product in pregnant women with mild or severe preeclampsia (PE). PATIENT AND METHODS: Retrospective, descriptive, non experimental, cause-effect study. The studied subjects were women that suffered with PE, sub-classified in two groups, mild PE patients and severe PE patients. The study was made in the “Clínica Hospital del Profesor” from June 2007 to June 2008. Different clinical parameters from the newborn and the pregnant were analyzed. The results were analyzed by the comparison of population and population ratio tests. RESULTS: From a total of 1680 pregnant women registred in the “Clínica Hospital del Profesor”, 42 were diagnosed pregnancy-induced hypertension / gestational hypertension, which represents 2.5 percent of all pregnancies. 28 (66 percent) represents to a moderate PE, 13(32 percent) represents to a severe PE. Intrauterine growth restriction presented a significant difference with an p< 0,05. The acute fetal suffering and fetal mortality didn’t have a significant difference with an p> 0,05. CONCLUSION: Although the clinical differences for the diagnose of mild and severe PE are clear, the complications that may ocurre to the product of the pregnancy don’t present a significant difference, except for the intrauterine growth restriction, that presented a significant difference with an alpha = 0,05.

High polymorphism in Plasmodium vivax merozoite surface protein-5 (MSP5).

A key issue relating to developing multi-component anti-malarial vaccines, lies in studying Plasmodium vivax surface proteins' genetic variation. The present work was aimed at amplifying, cloning and sequencing the gene encoding P. vivax merozoite surface protein 5 (PvMSP5) in samples obtained from infected patients from Colombian areas having varying malaria transmission rates. Nucleotide sequence data reported in this paper are available in the GenBank, EMBL and DDBJ databases under Accessions numbers DQ341586 to DQ341601. Our results have revealed that PvMSP5 is one of the P. vivax surface proteins having greater polymorphism, this being restricted to specific protein regions. The intron and exon II (which includes the GPI anchor and EGF-like domain) were both highly conserved when compared to exon I; exon I displayed the greatest variation and most of the recombination events occurred within it. No geographical grouping was observed. The Nei-Gojobori test revealed significant positive selection in the samples analysed here, whereas Tajima and Fu and Li tests presented a neutral selection pattern. The results reflected a localized variation pattern, recombination between PvMSP5 alleles and also functional and immune pressures, where stronger selective forces might be acting on exon I than on exon II, suggesting that the latter could be an important region to be included in an anti-malarial vaccine.

Jach'a Uru:¿La esperanza de un pueblo? Carlos Palenque, RTP y los sectores populares urbanos en La Paz

Contenido:1.Observando el complejo mundo urbano 2.Lo popular y alternativo en RTP 3.La formación del poder 4.La formación de la identidad colectiva 5.El poder y la identidad en el campo politico.