Parâmetros bioquímicos e níveis de IgE total e específicas para aeroalérgenos em mulheres obesas com síndrome dos ovários policísticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ≥ 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

Estudo do domínio segurança/proteção da NANDA internacional em pacientes de unidade de terapia intensiva

The study aimed to analyze the field of nursing diagnoses safety / protection of NANDA International present in patients in the Intensive Care Unit. This is a crosssectional study in intensive care complex of a university hospital in northeastern Brazil. The research took place in two stages. The first step was to collect data through an interview form and physical examination, with 86 patients admitted to the unit, during the months of December 2013 to May 2014. Spreadsheets were built in Microsoft Office Excel 2010 Software in which were marked by the researcher of this study, the presence or absence of defining characteristics, related factors and risk factors of the 31 studied diagnoses. In the second stage, held between July and August 2014, the sheets were sent to three diagnosticians, previously trained to perform the diagnostic inference. Data were analyzed using descriptive and inferential statistics for the diagnoses that showed higher frequencies than 50%, using IBM SPSS version 20.0 for Statistic Windows.O project was approved by the 440/414 and Presentation Certificate for Ethics Assessment number 22955113 .2.0000.5292. The results indicated the presence of 29 field of nursing diagnoses safety / protection in hospital clientele in the Intensive Care Unit, of which five were present in 100% of patients, namely: Risk of contamination, injury risk, falls risk,risk of allergic response and risk of trauma. Diagnoses that presented more frequently than 50% were: Risk of infection, dry eye risk, poisoning risk, vascular trauma risk, impaired skin integrity, impaired dentition, bleeding risk, risk imbalance in body temperature, Risk perioperative positioning injury, impaired tissue integrity, peripheral neurovascular dysfunction Risk, Risk adverse response to contrast media with iodine, shock Hazard and Risk of aspiration. For these analyzes, we identified 35 risk factors, 11 defining characteristics and three related factors showed statistically significant association with the studied diagnoses. For diagnostics: Risk of contamination, injury risk, falls risk, allergic response risk, trauma Risk, Risk of infection, dry eye risk and risk poisoning there was no association with any of their risk factors. We conclude that most of the area of nursing diagnoses safety / protection feature is prevalent in critically ill patients, with special attention to the risk diagnoses. There was a significant association between these diagnoses and its components. It is noteworthy, therefore, that the lifting of this profile contributes relevant clues to the inference of the priority nursing diagnoses domain safety / protection in the study population, supporting the practice of nursing and stimulating knowledge on the subject.

Anafilaxia en urgencias: incidencia, diagnóstico y manejo clínico

La anafilaxia fue descrita en 1902, sin embargo, sigue sin existir una definición de anafilaxia universalmente aceptada. La más utilizada, en la actualidad, es la publicada en el documento de consenso del simposio sobre la definición y el manejo de la anafilaxia del año 2005, que la describe como “una reacción alérgica de inicio rápido que puede producir la muerte”. Actualmente, la anafilaxia se clasifica en inmunológica (IgE dependiente o independiente) y no inmunológica (por ejemplo, la originada por algunos contrastes iodados). Sus síntomas están causados por una liberación masiva de mediadores, principalmente de mastocitos y basófilos, que pueden tener como diana cualquier órgano. Los datos epidemiológicos acerca de la anafilaxia son escasos. La prevalencia se estima entre el 0,05% y el 2%, aunque su incidencia parece estar aumentando. En los últimos años, se han publicado varios estudios que han intentado establecer la incidencia de anafilaxia en los servicios de urgencias de diversos hospitales. Los datos publicados en estos estudios oscilan entre el 0,07% y el 0,4%. Esta variabilidad puede deberse a características de la población y zona geográfica, y también a limitaciones metodológicas, condicionadas principalmente por la falta de consenso en cuanto a su definición, las dificultades para la codificación de la anafilaxia mediante códigos CIE y el funcionamiento de los servicios de urgencias. Además, la mayor parte de estos estudios se centran en pacientes adultos, y en menos ocasiones analizan las características de los pacientes en edad pediátrica...

Caracterización fenotípica y bases moleculares de los pacientes con eosinofilia esofágica respondedora a fármacos inhibidores de la bomba de protones

La esofagitis eosinofílica (EEo) es una enfermedad esofágica alérgica de creciente incidencia. Afecta a niños y adultos jóvenes, principalmente hombres (razón 3:1), encontrándose enfermedades atópicas subyacentes (asma y/o rinoconjuntivitis estacional, dermatitis atópica, alergia alimentaria) en el 80%-90% de los casos. Los primeros criterios diagnósticos para la EEo, publicados en el año 2007, se basaban en la conjunción de tres criterios mayores: datos clínicos (síntomas de disfunción esofágica), datos histológicos (infiltración epitelial esofágica por eosinófilos > 15 eos/cga) y ausencia de respuesta a inhibidores de la bomba de protones (IBP) o pHmetría esofágica normal. Sin embargo, la gran mayoría de los pacientes con síntomas de disfunción esofágica e inflamación esofágica eosinofílica eran diagnosticados de EEo sin confirmación de la respuesta a IBP o realización de pHmetría. Por tanto, existía un riesgo evidente de infraestimación de la respuesta a IBP en estos pacientes. Este incumplimiento de las premisas diagnósticas de consenso no sólo impedía cuantificar el porcentaje de pacientes que eran respondedores a IBP, sino que hacía que pacientes potencialmente respondedores a IBP recibieran otros tratamientos específicos para la EEo (corticoides tópicos, dietas de eliminación), los cuales, comparados con los IBP, provocan mayor cantidad de efectos adversos o podían limitar notablemente la calidad de vida de los pacientes. Inmediatamente después de la publicación de las primeras recomendaciones diagnósticas en el año 2007, se comunicaron pequeñas series retrospectivas de pacientes pediátricos con eosinofilia esofágica sintomática que alcanzaron remisión completa con IBP, tanto con pHmetría normal como patológica. Por tanto, estas series iniciales comenzaron cuestionar el papel diagnóstico de la pHmetría y su capacidad para predecir la respuesta a IBP...

Asthma and rhinitis have different genetic profiles for IL13, IL17A and GSTP1 polymorphisms

BACKGROUND: Asthma and rhinitis have a complex etiology, depending on multiple genetic and environmental risk factors. An increasing number of susceptibility genes are currently being identified, but the majority of reported associations have not been consistently replicated across populations of different genetic backgrounds. PURPOSE: To evaluate whether polymorphisms of IL4R (rs1805015), IL13 (rs20541), IL17A (rs2275913) and GSTP1 (rs1695) genes are associated with rhinitis and/or asthma in adults of Portuguese ancestry. METHODS: 192 unrelated healthy individuals and 232 patients, 83 with rhinitis and 149 with asthma, were studied. All polymorphisms were detected by real time polymerase chain reaction (PCR) using TaqMan assays. RESULTS: Comparing to controls, significant association with asthma was observed for GSTP1 rs1695 AA genotype (odds ratio (OR) - 1.96; 95% CI - 1.18 to 3.25; p=0.010). The association sustains for allergic asthma (OR - 2.17; 95% CI - 1.23 to 3.80; p=0.007). IL13 rs20541 GG genotype was associated with less susceptibility to asthma (OR - 0.55, 95% CI - 0.33 to 0.94, p=0.028). Among patients, IL17A rs2275913 AA genotype was less associated with asthma than with rhinitis (OR - 0.20; 95% CI of 0.07 to 0.56; p=0.002). A similar association was found for IL13 rs20541 GG genotype (OR - 0.48; 95% CI of 0.25 to 0.93; p=0.031). There were no significant differences in the distribution of allelic and genotypic frequencies between patients and controls for the IL4R polymorphism' analyzed. CONCLUSION: These results support the existence of a significant association between GSTP1 rs1695 and IL13 rs20541 SNPs, with susceptibility to asthma, in the population studied. Different genotype profiles of IL17A and IL13 genes seem to influence the clinical pattern of disease expression mainly confined to the upper airways, as rhinitis, or including the lower airways, as asthma.

Contact dermatitis from shoes: an update

Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. There are two forms of contact dermatitis: irritant and allergic. Irritant contact dermatitis is caused by the non–immune-modulated irritation of the skin by a substance, leading to skin changes. Allergic contact dermatitis is a delayed hypersensitivity reaction in which a foreign substance comes into contact with the skin; skin changes occur after reexposure to the substance. A medical condition referred to as “shoe dermatitis” is a form of contact dermatitis caused by the contact of the foot with parts of the shoe due to these materials. Shoe dermatitis is a diagnostic and therapeutic challenge and is a common type of contact dermatitis. It is imperative the foot and ankle physician become familiar with recognizing signs and symptoms of shoe dermatitis so that their patients can be accurately diagnosis and appropriately treated to avoid secondary infections and disability. This review will first present causative factors for the etiology of shoe contact dermatitis supported by clinical-based evidence as found in the medical literature. Secondly, a description of the signs and symptoms of shoe contact dermatitis will be presented in a narrative fashion. Finally, both treatment options and preventative measures to avoid shoe.

Asthma and rhinitis have different genetic profiles for IL13, IL17A and GSTP1 polymorphisms

BACKGROUND: Asthma and rhinitis have a complex etiology, depending on multiple genetic and environmental risk factors. An increasing number of susceptibility genes are currently being identified, but the majority of reported associations have not been consistently replicated across populations of different genetic backgrounds. PURPOSE: To evaluate whether polymorphisms of IL4R (rs1805015), IL13 (rs20541), IL17A (rs2275913) and GSTP1 (rs1695) genes are associated with rhinitis and/or asthma in adults of Portuguese ancestry. METHODS: 192 unrelated healthy individuals and 232 patients, 83 with rhinitis and 149 with asthma, were studied. All polymorphisms were detected by real time polymerase chain reaction (PCR) using TaqMan assays. RESULTS: Comparing to controls, significant association with asthma was observed for GSTP1 rs1695 AA genotype (odds ratio (OR) - 1.96; 95% CI - 1.18 to 3.25; p=0.010). The association sustains for allergic asthma (OR - 2.17; 95% CI - 1.23 to 3.80; p=0.007). IL13 rs20541 GG genotype was associated with less susceptibility to asthma (OR - 0.55, 95% CI - 0.33 to 0.94, p=0.028). Among patients, IL17A rs2275913 AA genotype was less associated with asthma than with rhinitis (OR - 0.20; 95% CI of 0.07 to 0.56; p=0.002). A similar association was found for IL13 rs20541 GG genotype (OR - 0.48; 95% CI of 0.25 to 0.93; p=0.031). There were no significant differences in the distribution of allelic and genotypic frequencies between patients and controls for the IL4R polymorphism' analyzed. CONCLUSION: These results support the existence of a significant association between GSTP1 rs1695 and IL13 rs20541 SNPs, with susceptibility to asthma, in the population studied. Different genotype profiles of IL17A and IL13 genes seem to influence the clinical pattern of disease expression mainly confined to the upper airways, as rhinitis, or including the lower airways, as asthma.

Caso imagiológico

Introdução: A tosse constitui um dos principais motivos de consulta médica e, apesar de na maioria dos casos ser de etiologia vírica ou alérgica, por vezes surgem diagnósticos inesperados. Caso Clínico: Criança do sexo feminino, 19 meses, sem antecedentes relevantes. Recorreu ao Serviço de Urgência por tosse produtiva há 3 semanas e rinorreia serosa, sem febre. Noção materna de dificuldade respiratória e recusa alimentar parcial. À admissão, polipneica, com tiragem subcostal e gemido expiratório. Auscultatoriamente, murmúrio vesicular globalmente diminuído, tempo expiratório aumentado e sibilos dispersos. Analiticamente sem alterações. A radiografia torácica evidenciou volumosa imagem quística no hemitórax direito. A TC to- rácica documentou estômago intratorácico. Foi submetida a laparoscopia que constatou hérnia do hiato paraesofágica. Após Fundoplicatura de Nissen ficou assintomática. Discussão: A hérnia do hiato é rara em idade Pediátrica, tendo sido um achado inesperado no caso clínico descrito. Consideramos assim que, apesar da sua raridade, as anomalias anatómicas devem ser consideradas no diagnóstico diferencial da tosse persistente.

MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

Shock anafiláctico con manzana: síndrome LTP

Presentamos el caso de una paciente atendida en urgencias del centro de salud por un cuadro clínico de shock anafiláctico desencadenado tras la ingesta de manzana y realización posterior de ejercicio físico. En alergia a alimentos, hay que tener presente que en algunas personas es necesaria la presencia de determinados cofactores como el ejercicio físico o la ingesta de determinados fármacos como los AINEs para que suceda una reacción alérgica. Se sospecha que el mecanismo responsable consiste en que aceleren la absorción del alimento en el intestino y así lleguen a modular la severidad de los síntomas. Por este motivo cuando las LTP (proteína de transferencia de lípidos) están implicadas, si los cofactores no se detectan y previenen, pueden representar un serio riesgo para el desarrollo de episodios de anafilaxia severos o fatales.

Alteraciones cutáneas de miembros superiores por exposición a agroquímicos en cultivos de arroz, departamento de La Guajira 2016

Introducción: la vida, salud y trabajo del agricultor tienen sus propias particularidades, estilos y actividades, su calidad de vida puede afectarse por exponerse a sustancias químicas, convirtiéndola en una labor muy riesgosa. Objetivo: establecer la prevalencia de las alteraciones cutáneas de miembros superiores por exposición a agroquímicos en cultivos de arroz. Material y método: estudio de corte transversal, población de 100 trabajadores, ubicadas en zona rural de Fonseca La Guajira, durante el año 2016. Se analizaron variables sociodemográficas, laborales y clínicas relacionadas. Para el análisis estadístico se aplicaron las pruebas de Shapiro-Wilk, Ji-Cuadrado de Pearson, medidas de asociación con OR y sus respectivos intervalos de confianza del 95%, análisis multivariado con una Regresión Logística Incondicional, nivel de significancia del 5% (p<0.05) para pruebas estadísticas. Resultados: el 98,9% fueron hombres, las edades oscilaron entre los 18 y 83 años (media de 43,7 años). El 40,91% reporto fumigar y el, 15,15% abona. Reportaron tener rinitis alérgica el 21,2%, alergia ocular 25,3%, asma 16,41%, eczemas en las manos 19,15% y ronchas o habones 17,95%; el 40,31% uso herbicidas, 8,77% fungicidas, 35,09% insecticidas, 14,04% fertilizante y 1,75% coadyuvante. La dependencia es prácticamente nula entre la aparición de eczemas y categoría toxica (p=0,021); R de Pearson (R=0,121; p=0,247) con correlación positiva; no existe una relación entre el número de personas con alergias dérmicas y la toxicidad (X2= 2,271; p=0,518), el R de Pearson (R=-0,152; p=0,150). Conclusión: la exposición a agroquímicos sin las condiciones mínimas de seguridad y salud en el trabajo, se relaciona con la aparición de alteraciones cutáneas.