UTILIDAD DE PRUEBAS CUTÁNEAS Y OTRAS PRUEBAS DE LABORATORIO EN PACIENTES CON RINITIS ALÉRGICA / Usefulness of skin tests and other laboratory tests in patients with allergic rhinitis

Antecedentes. Existen diferentes pruebas de laboratorio en las que se apoya el alergólogo dentro del abordaje de la rinitis alérgica, que varían en sus ventajas y desventajas, debiendo debiendo correlacionar su prescripción con la clínica del paciente y valorando costo-beneficio. Objetivos. Determinar la utilidad diagnóstica de IgE sérica total, eosinófilos en moco nasal, eosinófilos séricos y pruebas cutáneas para identificar a los pacientes alérgicos. Material y métodos. Se revisaron laboratorios de 400 pacientes con rinitis alérgica y de 57 con rinitis no alérgica, se describieron las variables sexo, edad, niveles séricos de IgE y eosinófilos séricos totales, la frecuencia de positividad de las diferentes pruebas, significación estadística, utilidad diagnóstica, así como correlación y concordancia de las diferentes pruebas de laboratorio y las pruebas cutáneas. Resultados. Se observó diferencia significativa en los niveles de IgE sérica total (p<0,001) y de eosinófilos séricos totales (p<0,001) entre ambos grupos; ambas pruebas muestran baja sensibilidad. Las pruebas cutáneas tienen la mayor sensibilidad y especificidad en el diagnóstico de rinitis alérgica; la correlación entre las diferentes pruebas de laboratorio y las pruebas cutáneas fue en general baja siendo con la IgE sérica total la que mostró mayor correlación 0,20 (p<0,001). Conclusiones. Debido a su baja sensibilidad y concordancia con las pruebas cutáneas, los exámenes IgE sérica total, eosinófilos séricos y eosinófilos en moco nasal no deben solicitarse como pruebas de tamizaje para identificar a pacientes alérgicos.(AU)

Background. There are different diagnosis tests in the approach of a patient suffering from allergic rhinitis; these have pros and cons, allergists should request them considering symptoms and cost-benefit. Objectives. Determine diagnosis utility from total IgE, eosinophils in nasal mucus, eosinophils-cells and skin prick test to identify allergy patients. Materials and methods. We mesured total IgE, eosinophils in nasal mucus, eosinophils-cells and skin prick test in 400 patients with allergic rhinitis and 57 with no allergic rinitis. We described sex, age, total IgE y eosinophils-cells, the positive frequency and stadistic significance, diagnostic value, correlation and concordance of different diagnosis tests. Results. Total IgE (p<0.001) and eosinophils in nasal mucus (p=0.005) showed significant difference, however both test showed low sensibility. The skin prick tests have more sensibility and specificity than others diagnosis tests, the greater concordance was between skin prick test and total IgE. The correlation between three test and skin prick test was low. Total IgE showed greater correlation 0.20 (p<0.001) than other test. Conclusions. Total IgE, eosinophils in nasal mucus, eosinophils-cells should not routilnely because have of its low sensibility and concordance.(AU)

[New concepts about atopic dermatitis]. / Nuevos conceptos en dermatitis atópica.

The atopic dermatitis is a chronic inflammatory skin illness, with remissions and exacerbations, itch, and association with allergic rhinitis and asthma. There is a complex interrelationship of genetic, environmental, pharmacological and psychological factors that contribute to the development and severity of the illness: Different manifestations of immunological disorders are an increment in the number of IgE antibodies toward common antigens, an increment in the liberation of proinflammatory mediators by basophils and mast cells, peripheral and local eosinophilia, biphasic activity Th1/Th2 with the liberation of cytokines (IL-4, IL-5, IL-13), GM-CSF and the IFN-gamma caused by the cells Th1. an increment in the liberation of major basic protein, eosinophil cationic protein besides the expression of chemotactic factors by the monocytes (RANTES, eotaxin, vasoactive intestinal peptide, etc.). In 1980, Hanifin and Rajka made public the diagnostic criteria for the atopic dermatitis and it has been universally accepted as an standard for the diagnosis. Leung reported that a knowledge about the immunopathological bases of the atopic dermatitis has important clinical implications for the diagnosis and possible treatment there are multiple choices for a treatment because of the complexity of the illness. Among these are thalidomide and transfer factor as an immunomodulator treatment with acceptable safety and clinical efficacy.

Neonatal tetanus experience at the National Institute of Pediatrics in Mexico City.

Clinical charts of 44 neonates admitted to the National Institute of Pediatrics with the diagnosis of neonatal tetanus from 1970 to 1990 were reviewed. All patients had an epidemiologic and clinical findings compatible with neonatal tetanus. Delivery had occurred at the homes of the patients in 89% of the cases and in 11% at clinics. The incubation periods ranged from 2 to 10 days, with a mean of 6.2 days. Cole's periods varied from 1 to 144 hours, with a mean of 21 hours. Spasticity, irritability, refusal to feed, lack of sucking and trismus were present in all cases. Thirty-three patients (70.4%) developed complications, the most frequent being sepsis and bronchopneumonia. The most frequent noninfectious complication was atelectasis, followed by renal failure and electrolytic imbalance. Overall mortality was 25%. It is noteworthy that in the most recent decade (1980 to 1990) mortality was 12.9%, considerably lower than that of the previous decade (1970 to 1980) which was 46.6% (P < 0.008). This decrease was probably a result of the greater availability of mechanical ventilation and the intensive care offered at neonatal services. Mortality was associated with the severity of the disease (P < 0.003) and with the presence of complications (P < 0.025).