[Validation of the SF-36 questionnaire in adults with asthma and allergic rhinitis in Mexican population]. / Validación del cuestionario SF-36 en pacientes adultos con asma y rinitis alérgica.

BACKGROUND: Multiple questionnaires demonstrated the effect of the disease on the Quality of Life (QL), especially on allergies. Asthma and allergic rhinitis contributes to the reduction of QL. One of the accepted instruments for the evaluation of QL in chronic diseases is the questionnaire SF-36 (SF-36). Our objective was to validate the SF-36 in Mexican asthmatic with allergic rhinitis adult patients. METHODS: Fifty asthmatic patients with allergic rhinitis participated. They were placed according to the severity of their asthma (GINA 2004) and of allergic rhinitis (ARIA). The SF-36 was applied. The results were analyzed by descriptive statistics and validation by internal consistency through the Cronbach's test. RESULTS: It was observed that greater deterioration of QL in asthmatic patients with allergic rhinitis is directly related with the severity of their disease. Greater deterioration was observed on physical nature and of the perception of health. The aspect less affected was the social function and mental health. The Cronbach's test showed a coefficient of global reliability of 0.9314. CONCLUSIONS: The results obtained for the validation of SF-36, through the Cronbach's test in the population studied allows their use for later studies.

[Asthma or laryngeal amyloidosis? A report of a case and literature review]. / Asma o amiloidosis laríngea? Comunicación de un caso y revisión de la literatura.

The laryngeal amyloidosis is an uncommon disease accounting for 1% of all benign lesions of larynx. The commonest symptom is the dysphonia, sometimes accompanied by stridor, laryngeal globus sensation, dysphagia and, in rare occasions, cough, dyspnea and hemoptysis, specially when the tracheobronchial tree is also affected. This paper describes the case of a 30-year-old female patient, whose main symptoms were progressive dysphonia and dyspnea, admitted at allergy service to rule out asthma. The respiratory function tests showed obstruction in the medium and small caliber ways without reversibility with salbutamol. Biopsies of ventricular band, vocal cord and arytenoid stained with positive Congo red for amyloid tissue, established the laryngeal amyloidosis diagnosis. The complementary studies to rule out amyloid tissue in the remaining tracheobronchial tree were negative. Dyspnea had characteristics of laryngeal origin, caused by a pulmonary ventilation disorder provoked by the difficult arrival of air to alveoli, which caused the decreased partial pressure of oxygen and CO2.

[Anxiety and depression in asthmatic adults in comparison to healthy individuals]. / Ansiedad y depresión en asmáticos adultos en comparación con sujetos sanos.

BACKGROUND: Asthmatic patients present different degrees of anxiety and depression, being psychiatric pathologies the most frequent alterations related to this illness. In this country there is available information of asthma in children but just a few about adult patients. OBJECTIVES: To know the frequency of anxiety and depression in adult asthmatic patients, compare them with healthy individuals and determine their relationship with the severity of illness. PATIENTS AND METHODS: There were included asthmatic adults (GINA 2002) and as control group healthy individuals, using the HAD scale (Hospital Anxiety and Depression Scale) to determine the presence of anxiety and depression RESULTS: 120 patients participated, 60 in each group with a mean age of 34 years old in the group 1 (asthmatic) and 31 years old in group 2 (healthy individuals). The HAD scale results in group 1 showed that 30% of patients presented anxiety, and 8% showed depression; in group 2 18% had anxiety and 3% depression. There are more anxiety and depression in asthmatic patients than in healthy individuals, p < 0.05, correlation between depression and severity of asthma is r = 0.288. CONCLUSIONS: Anxiety is frequent in asthmatic patients, being less common the presence of depression but related with asthma severity. These results contrast with available information where up to 54% of asthmatic patient present anxiety and 30% depression, using the same scale HAD. It is necessary to identify these problems, with the object to give an integral an accurate treatment to the patient.

[The Global Initiative for Asthma and familial medicine-resident physicians. Impact of an educational strategy]. / La Iniciativa Global para el Asma (GINA) y los médicos residentes de medicina familiar. Impacto de una estrategia educativa.

BACKGROUND: The Global Initiative for Asthma (GINA) provides effective medical care to asthmatic patients. Knowledge and appropriate handling of GINAS' management guidelines for medicine residents significantly reduce asthma morbidity and mortality. OBJECTIVE: To evaluate the level of knowledge about asthma on Global initiative for Asthma program before and after an educational strategy in residents. MATERIAL AND METHODS: Forty-four residents of first, second, and third grade of UMF No. 21 and No. 28 took part in this project A magisterial lecture and a workshop about clinical cases on asthma were carried out. The lecture lasted three hours and asthma surveys, before and after the educational strategy; were applied. Descriptive statistics as well as t test in SPSS were used for statistical analysis. RESULTS: Average grade of the 44 residents before the workshop was of 4.24 +/- 1.6, and after the workshop of 6.00 +/- 1.71. Therewere no significant differences among groups peryear of medical residency onthe initial assessment; however, residents of first year showed an increment on asthma knowledge (p < 0.05) in the subsequent test. There were no differences among groups. CONCLUSIONS: Asthma educational workshops increase residents' awareness of asthma, mainly first-year medical students.

[Application of the International Guide for the Diagnosis and Treatment of Asthma using first-contact physicians, before and after an educational strategy]. / Applicación de la Guía Internacional para el Diagnóstico y el Tratamiento del Asma por médicos de primer contacto, antes y después de una estrategia educativa.

BACKGROUND: The objective of the International Guide on Diagnosis and Treatment of Asthma is to reduce prevalence, mortality and morbidity of asthma. OBJECTIVE: To demonstrate that implementation of educational workshop increases the knowledge of first contact physicians on the International Guide for Diagnosis and Treatment of Asthma. MATERIAL AND METHODS: Fifty-nine first contact physicians participated. A validated questionnaire was applied before and after the workshop on the International Guide on Diagnosis and Treatment of Asthma. The Student's t test of the program SPSS was used for a statistical analysis. RESULTS: The grades obtained were 36% of correct answers before the workshop and 59% of correct answers after the workshop with a significant p < 0.05 specially in the general area of knowledge. CONCLUSION: As an educational technique this workshop improves the level of knowledge on the International Guide on Diagnosis and Treatment of Asthma of first contact physicians.

Criterios de diagnóstico y tratamiento de la rinosinusitis crónica en servicios de medicina familiar, de otorrinolaringología y de alergia / Diagnostic and treatment criteria ofrhinosinusitis in units of familial medicine, otolaryngology and allergy

Antecedentes: la rinosinusitis es una respuesta inflamatoria que involucra a la membrana mucosa de la cavidad nasal de uno o más senos paranasales. Su prevalencia es de 14 y de 5 al 13 por ciento en adultos y niños, respectivamente. La rinosinusitis causa un alto índice de ausentismo escolar y laboral. Objetivo: conocer los criterios de diagnóstico y tratamiento de la rinosinusitis en unidades de medicina familiar, otorrinolaringología y alergia. Material y método: se estudió una serie de 25 pacientes obtenidos al azar de las Unidades de Medicina Familiar números 21 y 28 del IMSS. El diagnóstico se evaluó de acuerdo con el consenso de 1998 y la tomografía computada se consideró el estándar de oro, se realizó a todos los pacientes y se evaluó por un radiólogo cegado al estudio. Resultados: el diagnóstico de rinosinusitis lo realizaron las unidades de medicina familiar en 68 por ciento de los casos, el servicio de otorrinolaringología en 40 por ciento y el de alergia en 64 por ciento. Los criterios clínicos más utilizados fueron la congestión nasal y la descarga nasal anterior y posterior. El examen solicitado con mayor frecuencia fue la tomografía computada (38.7 por ciento) y, en 30 por ciento de los casos, no se prescribió tratamiento médico. Conclusiones: los médicos familiares, los otorrinolaringólogos y los alergólogos utilizan poco los criterios internacionales para el diagnóstico y tratamiento de la rinosinusitis crónica. Los otorrinolaringólogos realizan otros diagnósticos diferenciales.

Correlación clínica y espirométrica con alergenos intradomiciliarios y con contaminantes / Clinical correlation and espirometrica with allergens intradomiciliarios and with pollutants

Introducción: la contaminación ambiental incrementa los síntomas respiratorios, sobre todo en pacientes asmáticos. La severidad del asma alérgica en niños se relaciona con la existencia de aeroalergenos intradomiciliarios y contaminantes intramuros. Objetivo: correlacionar las alteraciones clínicas, espirométricas y las pruebas cutáneas con los contaminantes intradomiciliarios en niños asmáticos y sanos. Material y método: niños con edad de 6 a 15 años, procedentes escuelas públicas a quienes se clasificó como sanos o asmáticos. A Todos se les aplicó un cuestionario, elaboró su historia clínca, realizó espirometría, pruebas cutáneas y estudio ambiental en casa. Resultados: se estudiaron 57 niños, de 10 años de edad (ñ3). Grupo 1(23 sanos). Pruebas cutáneas positivas al polvo 66.6 por ciento, ácaros 33.3 por ciento, cucaracha 66.6 por ciento, gato 33.3 por ciento, perro 4.3 por ciento, la exposición pasiva al humo de tabaco 56.5 por ciento. Síntomas clínicos principales: tos 91.3 por ciento, sibilancias 78.3 por ciento y dificultad respiratoria, 39.1 por ciento, de predominio matutino 78.3 por ciento. La espirometría mostró patrón obstructivo en 30.5 por ciento. Grupo 2 (34 asmáticos). Pruebas cutáneas positivas, ácaros 52.1 por ciento, polvo 47.8 por ciento, cucaracha 21.7 por ciento, gato 21.7 por ciento, perro 4.3 por ciento, la exposición pasiva al humo del tabaco 79.5 por ciento. Síntomas clínicos principales: tos 91.3 por ciento, dificultad respiratoria 82.3 por ciento, sibilancias 79.4 por ciento de predominio nocturno 70.5 por ciento. La espirometría mostró patrón obstructivo en 67.7 por ciento. Conclusiones: los niños asmáticos presentan mayor contacto y sensibilización para alergenos intradomiciliarios como ácaros de polvo casero, proteínas de heces de gato, perro y cucaracha; además de mayor frecuencia de tabaquismo pasivo. Es importante destacar que estos factores pueden ser modificables a bajo costo condicionando una mejor calidad de vida del paciente y disminuyendo los costos por atención médica.