Verónica Araceli Martínez‐Ordaz

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 conduced 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 immunchromatography. 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.

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. To assess which clinical factors are associated with a rapid response to short-acting beta2 agonists during asthma exacerbations. 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. 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%. These variables are easily measured and predict a therapeutic response in asthma patients when first seen in the emergency room.

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 ≤ 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.