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Introduction and objective: Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. Materials and methods: A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. Results: Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n = 29,253) was 3.69 cases × 1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n = 4,152), it was 26 x 1,000 (95% CI: 22.6 to 29.4). Conclusions: The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69 × 1,000, and in the children that underwent endoscopy, it was 26 × 1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America. Resumen: Introducción y objetivo: La esofagitis eosinofílica es una enfermedad crónica, mediada inmunológicamente, descrita en series y publicaciones alrededor del mundo. En los últimos 20 años diversos estudios han intentado evaluar la incidencia y prevalencia de la enfermedad. El objetivo del presente trabajo es estimar la prevalencia de esofagitis eosinofílica en un grupo de niños atendidos en 36 centros de gastroenterología pediátrica de 10 países latinoamericanos. Materiales y métodos: A través de un protocolo multicéntrico, observacional y transversal se estimó la prevalencia de período de esofagitis eosinofílica entre los niños atendidos en consulta externa y sometidos a endoscopia superior diagnóstica por cualquier motivo en 36 centros de 10 países latinoamericanos durante un período de 3 meses. Resultados: Entre abril y junio de 2016 108 casos de esofagitis eosinofílica fueron evaluados. Asimismo, un promedio de 29,253 consultas ambulatorias y 4,152 endoscopias superiores de carácter diagnóstico fueron realizadas en los 36 centros participantes. La tasa de prevalencia de esofagitis eosinofílica en la población estudiada (n = 29,253) fue de 3,69 casos × 1,000 (IC 95%: 3.04 a 4.44) y entre los niños sometidos a endoscopia superior de rutina (n = 4,152) fue de 26 x 1,000 (IC 95%: 22.6 a 29.4). Conclusión: La tasa general de prevalencia de período de esofagitis eosinofílica en un grupo de niños evaluados en 36 centros latinoamericanos de gastroenterología pediátrica resultó de 3,69 × 1,000, y entre aquellos sometidos a endoscopia fue de 26 × 1,000. La prevalencia mostró una importante variabilidad entre los países y centros participantes. Este es el primer estudio de prevalencia de esofagitis eosinofílica pediátrica en Latinoamérica. Keywords: Esophagitis, Eosinophilic, Children, Prevalence, Latin America, Palabras clave: Esofagitis, Eosinofílica, Niños, Prevalencia, Latinoamérica

Background In 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA). Hand function was incorporated into evaluations from 2014 onward. The objectives were to examine hand function in our cohort, compare hand function with function in healthy controls and determine the factors associated with impaired function. Methods From February 2014 to June 2015, 139 patients (97.2 % of the cohort) had disease activity scored (28 joints, [DAS28]); the Michigan Hand Outcome Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) were completed, and the tip-, key- and palmar-pinch and grip strengths were measured. Sixty-nine healthy controls underwent the same evaluations. Ninety-nine patients underwent a second evaluation one year after their baseline. Descriptive statistics and linear regression models were used. Patients and controls signed informed consent. Results Patients were primarily middle-aged females with a median disease duration of 7 years; 91 patients had DAS28-remission, and 16, 23, and 9 patients had low, moderate and high disease activity, respectively. Controls scored better than did patients with (any) disease activity level; remission patients had similar DASH and key pinch function as did controls with poorer MHQ and both tip and palmar pinch and grip strength. DAS28 was consistently associated with impaired hand function. Among the patients with a one-year re-assessment, changes in DAS28 correlated (rho = 0.34 to 0.63) with changes in hand function (p ≤ 0.01 for all comparisons), but there was no correlation with palmar pinch strength. Conclusions Disease activity was associated with hand function impairment in RA patients with variable follow-up. MHQ discriminated poorer hand function in remission patients who otherwise had similar DASH scores as the controls did.

Stem cell factor (SCF), also known as mast cell growth factor, kit ligand, and steel factor, is the ligand for the tyrosine kinase receptor (SCFR) that is encoded by the c-kit proto-oncogene. We analyzed the effects of recombinant human SCF (r-hSCF, 5-50 micrograms/kg/day, injected subcutaneously) on mast cells and melanocytes in a phase I study of 10 patients with advanced breast carcinoma. A wheal and flare reaction developed at each r-hSCF injection site; by electron microscopy, most dermal mast cells at these sites exhibited extensive, anaphylactic-type degranulation. A 14-d course of r-hSCF significantly increased dermal mast cell density at sites distant to those injected with the cytokine and also increased both urinary levels of the major histamine metabolite, methyl-histamine, and serum levels of mast cell alpha-tryptase. Five subjects developed areas of persistent hyperpigmentation at r-hSCF injection sites; by light microscopy, these sites exhibited markedly increased epidermal melanization and increased numbers of melanocytes. The demonstration that r-hSCF can promote both the hyperplasia and the functional activation of human mast cells and melanocytes in vivo has implications for our understanding of the role of endogenous SCF in health and disease. These findings also indicate that the interaction between SCF and its receptor represents a potential therapeutic target for regulating the numbers and functional activity of both mast cells and cutaneous melanocytes.

Plasma concentrations of various lipid fractions (total lipids, free glycerol, true triglycerides, free fatty acids, and cholesterol) were studied in 20 normally grown neonates ranging in birthweight from 820 to 1500 gm and in gestational age from 28 to 34 weeks. They were subdivided into three weight categories: 750 to 999, 1000 to 1249, and 1250 to 1500 gm. A lipid emulsion was infused at a constant rate over 24 hours, beginning with an hourly infusion rate of 0.04 gm/kg and increasing each day by 0.04 gm/kg up to a maximum of 0.16 gm/kg. Neonates who weighed less than 1000 gm had higher mean plasma concentrations of total lipids and free glycerol at hourly infusion rates of 0.08 and 0.16 and of triglycerides and free fatty acids at hourly infusion rate of 0.16 gm/kg than their heavier peers. These data suggest that extreme caution be used when administering parenteral fat emulsions to neonates who weigh less than 1000 gm and that we need to monitor plasma closely for signs of hyperlipemia.

Determining the risk season for the presence of pollen in the atmosphere aids primary care physicians in the diagnosis and treatment of allergic diseases. Our objective was to identify the taxa of pollen that cause allergic rhinoconjunctivitis in a sample of patients from a health center who presented seasonal symptoms.We designed an observational, cross-sectional, non-randomized study to be carried out in the Cazoña Health Center in Santander, Spain. We selected 30 volunteers of both sexes, aged between 13 and 69 year old, who suffered seasonal rhinoconjunctivitis symptoms and who had always lived in Santander. Patients underwent skin-prick tests with the 25 pollen extracts routinely used in Spain, house dust mite (HDM), cat dander and Alternaria extracts by means of the Prick-Film system. The test result was expressed as the percentage of the papule area caused by histamine. Measurement was performed by scanning the copied papule area with the Prick-Scan program for PC.All patients were positive to grass pollen, 26 % were sensitized to grass pollen only and 23 % were also sensitized to other non-pollen allergens. Twenty-seven percent tested positive to Plantago, 20 % to Quercus and 13 % to Morus; the remaining pollen extracts were positive in less than 10 %. Fifty-six percent of the patients were positive to HDM and 6 % to cat dander.A warning period for pollinosis patients in the city of Santander can be defined. In our case, the important period is the grass pollen season, since the remaining pollen taxa sensitized few patients. Most of our patients were also sensitized to HDM.

Seven new HLA-B locus alleles have been described. B*44022 and B*44032 are silent substitutions altering known alleles. B*4411 carries a unique Bw4-like epitope. B*4420, B*4421, and B*4424 carry new combinations of motifs previously observed in other alleles. B*8301 appears to be the result of the replacement of exon 2 from B*4402 with exon 2 from B*5603.

The safety and optimal dose and schedule of stem cell factor (SCF) administered in combination with filgrastim for the mobilization of peripheral blood progenitor cells (PBPCs) was determined in 215 patients with high-risk breast cancer. Patients received either filgrastim alone (10 microg/kg/d for 7 days) or the combination of 10 microg/kg/d filgrastim and 5 to 30 microg/kg/d SCF for either 7, 10, or 13 days. SCF patients were premedicated with antiallergy prophylaxis. Leukapheresis was performed on the final 3 days of cytokine therapy and, after high-dose chemotherapy and infusion of PBPCs, patients received 10 microg/kg/d filgrastim until absolute neutrophil count recovery. The median number of CD34+ cells collected was greater for patients receiving the combination of filgrastim and SCF, at doses greater than 10 microg/kg/d, than for those receiving filgrastim alone (7.7 v 3.2 x 10(6)/kg, P.05). There were significantly (P.05) more CD34+ cells harvested for the 20 microg/kg/d SCF (median, 7.9 x 10(6)/kg) and 25 microg/kg/d SCF (median, 13.6 x 10(6)/kg) 7-day combination groups than for the filgrastim alone patients (median, 3.2 x 10(6)/kg). The duration of administration of SCF and filgrastim (7, 10, or 13 days) did not significantly affect CD34+ cell yield. Treatment groups mobilized with filgrastim alone or with the cytokine combination had similar hematopoietic engraftment and overall survival after PBPC infusion. In conclusion, the results of this study indicate that SCF therapy enhances CD34+ cell yield and is associated with manageable levels of toxicity when combined with filgrastim for PBPC mobilization. The combination of 20 microg/kg/d SCF and 10 microg/kg/d filgrastim with daily apheresis beginning on day 5 was selected as the optimal dose and schedule for the mobilization of PBPCs.

Plasma lipid patterns (total lipids, free glycerol, triglycerides, free fatty acids, and cholesterol) were studied in 10 very low-birthweight neonates assigned alternately to continuous drip versus every 2-hr bolus feedings with a formula containing 50% of its fat as medium-chain triglycerides. In the group of neonates fed continuously, plasma lipids did not vary significantly during the 4-day study. In the bolus-fed group, free fatty acid concentrations peaked 30 min after feeding; the other fractions did not vary significantly during 2 hr after feeding. Mean plasma concentrations of total lipids and triglycerides were higher in the continuous than in the bolus-fed neonates; concentrations of the other fractions were similar. Compared to plasma concentrations measured in a group of 4-day-old very low-birthweight neonates before any exposure to exogenous fat, continuously fed neonates had higher total lipid, triglyceride, free fatty acid, and cholesterol concentrations; bolus-fed neonates only had significantly higher triglyceride levels. These data emphasize the need to obtain information on plasma lipid patterns that is specific for gestational maturity, postnatal age, and method and type of feeding.

Forty-one very low birth weight neonates (820 to 1,510 g and 27 to 34 weeks of gestation) requiring total parenteral nutrition were randomly assigned to one of three regimens of administration of fat emulsion for a period of eight days. Groups I and II received the emulsion at a constant rate for, respectively, 24 and 16 hours, beginning with a daily dosage of 1 g/kg and increasing daily by 1 g/kg to a maximum of 4 g/kg. Group III received the emulsion at a constant rate or 4 g/kg for 24 hours. Blood pH and alveolar-arteriolar gradient of oxygen diffusion in the lungs were measured at regular intervals. The various regimens and rates of fat infusion appeared to have no deleterious effect on blood pH and alveolar-arteriolar oxygen diffusion gradient. Infusion rates as used in the study for appropriate for gestational age very low birth weight neonates appear to be safe, although caution is always warranted when dealing with tiny neonates whose pulmonary reserve is minimal. In view of data from other studies, it is suggested to infuse fat at a constant rate for 24 hours to avoid overloading the clearance mechanisms of fat particles from plasma.

• Fluid and energy intakes and plasma concentrations of various lipid fractions were studied in 45 newborn infants, weighing between 820 and 1550 g, randomly assigned to one of three regimens for infusion of a fat emulsion: group 1, stepwise increase in daily dosage (1 to 4 g/kg) at a steady rate over 24 hours; group 2, stepwise increase in daily dosage (1 to 4 g/kg) at a steady rate over 16 hours, followed by a rest period of eight hours; and group 3, full dosage (4 g/kg) at a steady rate over 24 hours. At a given daily rate of infusion, mean plasma concentrations of the various lipid fractions tended to be higher in group 2 than in either group 1 or group 3. Plasma lipid concentrations correlated best with the hourly rate of lipid infusion, regardless of whether the infusion was continuous over 24 hours or intermittent. ( AJDC 1988;142:145-152)