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1.
Arch. bronconeumol. (Ed. impr.) ; 60(3): 153-160, Mar. 2024. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-231099

RESUMO

Background: Predicting the response to pulmonary rehabilitation (PR) could be valuable in defining admission priorities. We aimed to investigate whether the response of individuals recovering from a COPD exacerbation (ECOPD) could be forecasted using machine learning approaches. Method: This multicenter, retrospective study recorded data on anthropometrics, demographics, physiological characteristics, post-PR changes in six-minute walking distance test (6MWT), Medical Research Council scale for dyspnea (MRC), Barthel Index dyspnea (BId), COPD assessment test (CAT) and proportion of participants reaching the minimal clinically important difference (MCID). The ability of multivariate approaches (linear regression, quantile regression, regression trees, and conditional inference trees) in predicting changes in each outcome measure has been assessed. Results: Individuals with lower baseline 6MWT, as well as those with less severe airway obstruction or admitted from acute care hospitals, exhibited greater improvements in 6MWT, whereas older as well as more dyspnoeic individuals had a lower forecasted improvement. Individuals with more severe CAT and dyspnea, and lower 6MWT had a greater potential improvement in CAT. More dyspnoeic individuals were also more likely to show improvement in BId and MRC. The Mean Absolute Error estimates of change prediction were 44.70m, 3.22 points, 5.35 points, and 0.32 points for 6MWT, CAT, BId, and MRC respectively. Sensitivity and specificity in discriminating individuals reaching the MCID of outcomes ranged from 61.78% to 98.99% and from 14.00% to 71.20%, respectively. Conclusion: While the assessed models were not entirely satisfactory, predictive equations derived from clinical practice data might help in forecasting the response to PR in individuals recovering from an ECOPD. Future larger studies will be essential to confirm the methodology, variables, and utility.(AU)


Assuntos
Humanos , Masculino , Feminino , Doença Pulmonar Obstrutiva Crônica/reabilitação , Dispneia , Exacerbação dos Sintomas , Antropometria , Demografia , Teste de Caminhada , Pneumopatias , Doenças Respiratórias , Estudos Retrospectivos , Recidiva , Sensibilidade e Especificidade
2.
Allergol. immunopatol ; 52(1): 9-15, 01 jan. 2024. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-229171

RESUMO

Background: Asthma is one of the most common chronic respiratory diseases with inflammatory involvement and has a high burden worldwide. This study aimed to determine the effect of Thymus vulgaris (TV) on cough in children between 5 and 12 years old with mild to moderate asthma exacerbation. Methods: In this randomized, triple-blind clinical trial, 60 children between the ages of 5 and 12 with asthma exacerbations were randomly divided into two groups. The intervention group (n = 30) was given TV powder at a dose of 20 mg/kg every 8 hours, prepared as syrup, along with routine medical treatment for a week, and the control group (n = 30) received only routine medical treatment with placebo syrup. At the end of the week, clinical and laboratory symptoms, and spirometry data were re-recorded for both groups. Finally, the recorded factors were compared and statistically analyzed. Results: The results showed that after the intervention, activity-induced cough reduced, and difference was statistically significant between the two groups (p = 0.042), but the reduction in wheezing and breathlessness had no statistically significant difference. Spirometry data showed a significant difference in forced expiratory volume in 1 second (FEV1) between the two groups after intervention (p = 0.048), but this difference was not significant in FEV1/FVC (forced vital capacity), peak expiratory flow (PEF), and forced expiratory flow at 25–75% of the vital capacity (FEF25–75%). Conclusion: The results show that TV syrup may be useful as an adjuvant treatment in children with asthma exacerbations (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Asma/tratamento farmacológico , Thymus (Planta) , Exacerbação dos Sintomas , Extratos Vegetais/uso terapêutico , Adjuvantes Imunológicos , Tosse/tratamento farmacológico , Dispneia , Resultado do Tratamento
3.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 49(6): [e101998], sept. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-224803

RESUMO

En la enfermedad pulmonar obstructiva crónica el síndrome de agudización (SAE) es un episodio de inestabilidad clínica por agravamiento de la limitación espiratoria al flujo aéreo o del proceso inflamatorio subyacente. La gravedad del SAE depende de la estratificación del riesgo basal y la intensidad del episodio agudo. La Atención Primaria es el epicentro del circuito asistencial del SAE, pero puede extenderse al Servicio de Urgencias Extrahospitalarias y al propio hospital dependiendo de la situación clínica, del nivel de gravedad, de la disponibilidad de pruebas complementarias y de los recursos terapéuticos necesarios para cada paciente. El registro de los datos clínicos, antecedentes, factores desencadenantes, tratamiento y evolución de los episodios previos de SAE en la historia clínica electrónica son un aspecto esencial para ajustar el tratamiento actual y prevenir la aparición de futuros episodios (AU)


In chronic obstructive pulmonary disease, an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an episode of clinical instability due to the worsening of expiratory airflow limitation or of the underlying inflammatory process. The severity of AECOPD depends on baseline risk stratification and the intensity of the acute episode. Primary Care is the epicenter of the AECOPD care circuit, but it can be extended to the out-of-hospital emergency department and the hospital itself depending on the clinical situation, the level of severity, the availability of complementary tests, and the therapeutic resources required for each patient. Recording clinical data, history, triggering factors, treatment, and evolution of previous episodes of AECOPD in the electronic medical record is an essential aspect to adjust current treatment and prevent the occurrence of future episodes (AU)


Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Serviços Médicos de Emergência , Exacerbação dos Sintomas , Protocolos Clínicos
4.
Allergol. immunopatol ; 51(3): 124-134, 01 mayo 2023. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-219820

RESUMO

Background: Psoriasis is one of the chronic and autoimmune skin diseases. It is important to uncover the mechanisms underlying the psoriasis. Transcription factor activator protein (TFAP-2) gamma, also known as AP2-gamma, is a protein encoded by the TFAP2C gene. Immune-mediated pathophysiological processes could be linked to psoriasis, but the mechanism is still unclear. Therefore, to date the cause of psoriasis has not been understood completely. Materials and methods: Psoriasis is a complex disease triggered by genetic, immunological, and environmental stimuli. Keratinocytes play an important role in both initiation and maintenance phases of psoriasis. A psoriatic keratinocyte model was established by stimulating high sensitivity of human epidermal keratinocytes (HaCaT) to topoisomerase inhibitor cell lines using the accumulation of M5 cytokines comprising interleukin (IL)-17A, IL-22, oncostatin M, IL-1α, and tumor necrosis factor-α (TNF-α). The TFAP2C and transcriptional enhanced associate domain 4 (TEAD4) genes expression was evaluated by reverse transcription-quantitative polymerase chain reaction. Western blot analysis was used to examine protein expression. Cell viability (quantitative) of keratinocytes, including cytotoxicity, proliferation, and cell activation, was evaluated by the MTT assay. The relative percentage values of interleukin (IL)-17a, interferon gamma, and IL-4+ cells were measured by flow cytometry. Accordingly, chromatin immunoprecipitation and luciferase reporter assays were applied to evaluate the binding affinity of TFAP2C and TEAD4 promoter. Results: Level of the TFAP2C gene was elevated in the lesional skin of psoriasis patients. On the other hand, silencing of the TFAP2C gene suppressed the proliferation and inflammatory response in M5-induced keratinocytes (AU)


Assuntos
Humanos , Animais , Camundongos , Psoríase/imunologia , Células Th1/metabolismo , Células Th17/metabolismo , Exacerbação dos Sintomas , Citometria de Fluxo , Imuno-Histoquímica , Western Blotting
5.
Rev. clín. esp. (Ed. impr.) ; 223(4): 244-249, abr. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-218789

RESUMO

Objective The COVID-19-12O-score has been validated to determine the risk of respiratory failure in patients hospitalized for COVID-19. Our study aims to assess whether the score is effective in patients with SARS-CoV-2 pneumonia discharged from a hospital emergency department (HED) to predict readmission and revisit. Metho Retrospective cohort of patients with SARS-CoV-2 pneumonia discharged consecutively from an HUS of a tertiary hospital, from January 7 to February 17, 2021, where we applied the COVID-19-12O -score, with a cut-off point of 9 points to define the risk of admission or revisit. The primary outcome variable was revisit with or without hospital readmission after 30 days of discharge from HUS. Results We included 77 patients, with a median age of 59 years, 63.6% men and Charlson index of 2. 9.1% had an emergency room revisit and 15.3% had a deferred hospital admission. The relative risk (RR) for emergency journal was 0.46 (0.04–4.62, 95% CI, p=0.452), and the RR for hospital readmission was 6.88 (1.20–39.49, 95% CI, p<0.005). Conclusions The COVID-19-12O -score is effective in determining the risk of hospital readmission in patients discharged from HED with SARS-CoV-2 pneumonia, but is not useful for assessing the risk of revisit (AU)


Objetivo La escala COVID-19-12O se ha validado para determinar el riesgo de insuficiencia respiratoria en pacientes hospitalizados por COVID-19. Nuestro estudio pretende evaluar si la escala es efectiva en pacientes con neumonía por SARS-CoV-2 dados de alta desde un servicio de urgencias hospitalario (SUH) para predecir el reingreso y revisita. Método Cohorte retrospectiva de pacientes con neumonía por SARS-CoV-2 dados de alta de forma consecutiva desde un SUH de un hospital terciario, del 7 de enero al 17 de febrero de 2021, donde aplicamos la escala COVID-19-12O, con un punto de corte de 9 puntos para definir el riesgo de ingreso o revisita. La variable de resultado principal fue la revisita con o sin reingreso hospitalario tras los 30 días de su alta desde el SUH. Resultados Se incluyeron 77 pacientes, con una edad mediana de 59 años, 63,6 % hombres e índice Charlson de 2. El 9,1 % tuvieron revisita a urgencias y en el 15,3 % se produjo un ingreso hospitalario diferido. El riesgo relativo (RR) para revista de urgencias fue 0,46 (0,04−4,62, IC 95 %, p=0,452), y el RR para el reingreso hospitalario de 6,88 (1,20–39,49, IC 95 %, p<0,005). Conclusiones La escala COVID-19-12O es efectiva en determinar el riesgo de reingreso hospitalario en pacientes dados de alta desde el SUH con neumonía por SARS-CoV-2, pero no es útil para valorar el riesgo de revisita (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Readmissão do Paciente , Exacerbação dos Sintomas , Infecções por Coronavirus , Pneumonia Viral , Serviço Hospitalar de Emergência , Estudos Retrospectivos , Alta do Paciente , Prognóstico
6.
Allergol. immunopatol ; 51(2): 1-10, 01 mar. 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-216793

RESUMO

Background and aim: A precise scaling system of acute asthma leads to an accurate assessment of disease severity. This study aimed to compare the accuracy of the Buddhasothorn Asthma Severity Score (BASS) with the Wood–Downes–Ferrés Scale (WDFS) to recognize the severity level of acute asthma. Materials and methods: A cross-sectional study was conducted comprising Thai children aged 2–15 years with acute asthma. The BASS and WFDS were rated once in the emergency department. The degree of severity was determined by frequency and type of nebulized bronchodilator administrations at the time of initial treatment. The optimum cutoff points for the area under the curve (AUC) were established to predict severe asthma exacerbations. Results: All 73 episodes of asthma exacerbations (EAEs) in 35 participants were analyzed. Fifty-nine (80.8%) EAEs were classified as severe. Both scales had good significance to recognize the selection of nebulized bronchodilator treatments by AUC of 0.815 (95% Confidence Interval [CI]: 0.680–0.950) in case of BASS, and AUC of 0.822 (95% CI: 0.70–0.944) in case of WDFS. Cutoff points of BASS ≥ 8 had sensitivity 72.9%, specificity 64.3%, positive predictive value (PPV) 89.6%, negative predictive value (NPV) 36.0% at an AUC of 0.718 (95% CI: 0.563–0.873) for severe exacerbations. These results were consistent for cutoff points of WDFS ≥ 5 with sensitivity 78.0%, specificity 50.0%, PPV 86.8%, NPV 35.0% at an AUC of 0.768 (95% CI: 0.650–0.886) for predicting severe exacerbations. There was no significant difference between the AUCs of both scales. Conclusions: Both the BASS and WDFS were good and accurate scales and effective screening tools for predicting severe asthma exacerbations in pediatric patients by optimal cutoff points (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Exacerbação dos Sintomas , Broncodilatadores/administração & dosagem , Asma/tratamento farmacológico , Asma/classificação , Índice de Gravidade de Doença , Estudos Transversais
7.
Allergol. immunopatol ; 51(1): 187-194, ene. 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-214034

RESUMO

Background: Long noncoding RNA (lncRNA) THRIL targets microRNA (miR)-34a and miR-125b to modify immunity, inflammation, and respiratory injury. The current study aimed to determine the inter-correlation of lncRNA THRIL with miR-34a and miR-125b and their relationship with childhood asthma risk, severity, and inflammation. Methods: Exacerbated asthma children (N=65), remissive asthma children (N=65), and healthy controls (N=65) were enrolled in this case-control study. LncRNA THRIL, miR-34a, and miR-125b in peripheral blood mononuclear cells, as well as inflammatory cytokines in serum, were detected by reverse transcription-quantitative polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. Results: LncRNA THRIL was highest in exacerbated asthma children, then in remissive asthma children, and lowest in healthy controls (P<0.001); reversely, miR-34a (P<0.001) and miR-125b (P=0.004) exhibited the opposite treads. LncRNA THRIL (area under curve (AUC)=0.686) and miR-34a (AUC=0.614) could predict exacerbation risk of asthma, while miR-125b failed. Interestingly, lncRNA THRIL was negatively related to miR-34a and miR-125b in exacerbated asthma children and remissive asthma children (all P<0.05) but not in healthy controls (both P>0.05). Specifically, in exacerbated asthma children: lncRNA THRIL is related to increased eosinophil count (P=0.013), immunoglobulin E (P=0.020), tumor necrosis factor-α (P=0.002), interleukin-1β (P=0.004), interleukin-6 (P=0.012), interleukin-17 (P=0.004) and exacerbated severity (P=0.030); Meanwhile, miR-34a and miR-125b linked with decreased levels of most of the above indexes (most P<0.05). Conclusion: LncRNA THRIL negatively relates to miR-34a and miR-125b, correlate with inflammatory cytokines, and exacerbated the risk and severity of childhood asthma, indicating their potential as biomarkers for childhood asthma management (AU)


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , MicroRNAs/genética , Asma/genética , Inflamação , Estudos de Casos e Controles , Índice de Gravidade de Doença , Fatores de Risco , Marcadores Genéticos , Exacerbação dos Sintomas
8.
Allergol. immunopatol ; 51(6): 37-44, 2023. tab
Artigo em Português | IBECS | ID: ibc-227307

RESUMO

Introduction: The frequency of visits to emergency department for asthma is a significant public health problem in pediatrics. This study aimed to identify the characteristics of children who visited the pediatric emergency department for asthma exacerbation and evaluated their therapeutic management prior to admission. Methods: A prospective study was conducted over a 6-month period in the pediatric emergency departments of five hospitals involving children aged 1–16 years admitted to the department with a clinical diagnosis of asthma exacerbation. Results: In all, 143 patients were enrolled in the study. Asthma episodes were moderate to severe in 69.2% of cases (n = 99). Initial treatment prior to admission to the emergency department was adequate in only 17.5% of cases (n = 25). Hospitalization for more than 24 h occurred in 18.2% (n = 26) patients. In children aged <3 years, viral infection was present in 91.4% cases (n = 64) and exacerbations were more severe in younger patients (P = 0.002) and children belonging to low-income stratum (P = 0.025). Only 17.4% (n = 25) were positive for SARS–CoV-2 (antigen test or polymerase chain reaction test), suggesting that the involvement of traditional respiratory viruses in asthma exacerbation continued even during pandemic. Regarding the pre-hospital care, 70.6% (n = 101) had received prior treatment, but this treatment was inadequate in 53.1% cases (n = 76). Conclusion: This study showed that asthmatic children and their families had little knowledge about the disease and that physicians must be sufficiently aware of current recommendations for managing asthmatic children. Admission to the emergency department for asthma could be avoided partially by better diagnosis and therapeutic education (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Serviço Hospitalar de Emergência , Hospitalização , Asma/diagnóstico , Asma/terapia , Exacerbação dos Sintomas , Estudos Prospectivos , Recidiva
12.
Artigo em Inglês | IBECS | ID: ibc-219410

RESUMO

The clinical and socioeconomic burden of asthma exacerbations (AEs) constitutes a major public health problem. In the last 4 years, there has been an increase in ethnic diversity in candidate-gene and genome-wide association studies of AEs, which in the latter case led to the identification of novel genes and underlying pathobiological processes. Pharmacogenomics, admixture mapping analyses, and the combination of multiple “omics” layers have helped to prioritize genomic regions of interest and/or facilitated our understanding of the functional consequences of genetic variation. Nevertheless, the field still lags behind the genomics of asthma, where a vast compendium of genetic approaches has been used (eg, gene–environment interactions, next-generation sequencing, and polygenic risk scores). Furthermore, the roles of the DNA methylome and histone modifications in AEs have received little attention, and microRNA findings remain to be validated in independent studies. Likewise, the most recent transcriptomic studies highlight the importance of the host–airway microbiome interaction in the modulation of risk of AEs. Leveraging -omics and deep-phenotyping data from subtypes or homogenous subgroups of patients will be crucial if we are to overcome the inherent heterogeneity of AEs, boost the identification of potential therapeutic targets, and implement precision medicine approaches to AEs in clinical practice (AU)


La carga clínica y socioeconómica de las exacerbaciones asmáticas (EA) representa un importante problema de salud pública. En los últimos cuatro años, ha aumentado la diversidad étnica en los estudios de asociación de genes candidatos y del genoma completo (GWAS) de las EA, lo que, en este último caso, ha llevado a la identificación de nuevos genes y procesos fisiopatológicos subyacentes. La farmacogenómica, los análisis de mapeo por mezcla y la combinación de múltiples capas "ómicas" han contribuido a priorizar regiones genómicas de interés y/o comprender las consecuencias funcionales de la variación genética. A pesar de esto, el campo todavía está en desarrollo en comparación con la genómica del asma, donde se ha utilizado un amplio compendio de enfoques genéticos (por ejemplo: interacciones gen-ambiente, secuenciación de nueva generación o puntuaciones de riesgo poligénico). Además, el papel de la metilación del ADN y las modificaciones de las histonas en las EA se ha explorado escasamente, y los hallazgos relacionados con los microARNs aún no se han validado en estudios independientes. Asimismo, los estudios transcriptómicos más recientes destacan la importancia de la interacción entre el microbioma de las vías respiratorias y el huésped en la modulación del riesgo de las EA. La integración de datos ómicos y de fenotipado profundo de subtipos o subgrupos homogéneos de pacientes será crucial para superar la heterogeneidad inherente de las EA e impulsar la identificación de dianas terapéuticas potenciales y la implementación de la medicina de precisión para las EA en la práctica clínica (AU)


Assuntos
Humanos , Transcriptoma/genética , Asma/genética , Exacerbação dos Sintomas , Genômica , Epigenômica
14.
J. investig. allergol. clin. immunol ; 33(4): 281-288, 2023. tab
Artigo em Inglês | IBECS | ID: ibc-223542

RESUMO

Introduction: Comorbidities can influence asthma control and promote asthma exacerbations (AEs). However, the impact of multimorbidity in AEs, assessed based on long-term follow-up of patients with asthma of different degrees of severity, has received little attention in real-life conditions. Objective: To describe the epidemiological and clinical characteristics and predictors of AEs in patients who had presented at least 1 AE in the previous year in the MEchanism of Genesis and Evolution of Asthma (MEGA) cohort. Methods: The work-up included a detailed clinical examination, pulmonary function testing, fractional exhaled nitric oxide (FeNO), blood counts, induced sputum, skin prick-tests, asthma questionnaires, and assessment of multimorbidity. The number of moderate-severe AEs in the preceding year was registered for each patient. Results: The study population comprised 486 patients with asthma (23.7% mild, 35% moderate, 41.3% severe). Disease remained uncontrolled in 41.9%, and 47.3% presented ≥1 moderate-severe AE, with a mean (SD) annual exacerbation rate of 0.47 (0.91) vs 2.11 (2.82) in mild and severe asthma, respectively. Comorbidity was detected in 56.4% (66.6% among those with severe asthma). Bronchiectasis, chronic rhinosinusitis with nasal polyps, atopy, psychiatric illnesses, hyperlipidemia, and hypertension were significantly associated with AEs. No associations were found for FeNO, blood eosinophils, or total serum IgE. Sputum eosinophilia and a high-T2 inflammatory pattern were significantly associated with AEs. Multivariable regression analysis showed a significant association with asthma severity, uncontrolled disease, and low prebronchodilator FEV1/FVC.Conclusions: Our study revealed a high frequency of AE in the MEGA cohort. This was strongly associated with multimorbidity, asthma severity, poor asthma control, airflow obstruction, higher sputum eosinophils, and a very high-T2 inflammatory pattern (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Asma/diagnóstico , Asma/epidemiologia , Eosinofilia/diagnóstico , Exacerbação dos Sintomas , Índice de Gravidade de Doença , Múltiplas Afecções Crônicas , Morbidade , Fatores de Risco , Óxido Nítrico
15.
Rev. esp. patol. torac ; 34(4): 209-216, dic. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-214619

RESUMO

Introducción: Hay poca información actualizada sobre las características clínicas y la gravedad de los pacientes con EPOC que ingresan por una agudización. Nuestro objetivo fue caracterizar a los pacientes que ingresan por agudización de EPOC según la limitación al flujo aéreo: obstrucción leve (Volumen Espiratorio Forzado en el primer segundo [VEF1] ≥ 80%); moderada (VEF1 50 - 79%); grave (VEF1 30 - 49%); o muy grave (VEF1 <3 0%).Métodos: Realizamos un análisis post-hoc del ensayo clínico multicéntrico SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), que reclutó pacientes consecutivos con agudización de EPOC que requirieron ingreso en 18 hospitales españoles en el periodo comprendido entre septiembre de 2014 y julio de 2020.Resultados: Incluimos 737 pacientes, con una edad media (DE) de 70,2 ± 9,9 años, y un predominio de hombres (73,5%). La espirometría clasificó a los pacientes con obstrucción leve, moderada, grave o muy grave en el 8%, 31,5%, 45% y el 15,5%, respectivamente. Al comparar a los pacientes de acuerdo al grado de obstrucción, observamos que los pacientes con mayor obstrucción al flujo aéreo eran más jóvenes (leve: 71,7 ± 8,8, moderada: 72,4 ± 10, grave: 70,2 ± 9,8, muy grave: 66,6 ± 9,2; p < 0,001), presentaban más insuficiencia respiratoria crónica (37,3% vs. 30,2% vs. 44,9% vs. 64,3%; p < 0,001), presentaban más cianosis (5,8% vs. 5,9% vs. 8,5% vs. 15,3%; p < 0,001), presentaron mayor porcentaje de agudizaciones y estaban más taquicárdicos a su llegada al centro hospitalario (92 ± 16 latidos por minuto [lpm] vs. 94 ± 18 vs. 96 ± 18 lpm vs. 99 ± 18 lpm; p < 0,001). Además, la gasometría arterial al ingreso mostraba un pH menor y una pCO2 mayor cuanto más grave era la obstrucción al flujo aéreo (p < 0,001). Conclusión: La gravedad de la obstrucción al flujo aéreo se asocia con la forma de presentación y el resultado de la gasometría arterial del paciente con agudización de EPOC que requiere ingreso hospitalario. (AU)


Introduction: There is little up-to-date information on the clinical characteristics and severity of COPD patients admitted for an exacerbation. Our objective was to characterize patients admitted due to COPD exacerbation according to airflow limitation: mild obstruction (Forced Expiratory Volume in 1 second [FEV1] ≥ 80%); moderate (FEV1 50 - 79%); severe (FEV1 30 - 49%); or very severe (FEV1 <3 0%).Methods: We performed a post-hoc analysis of the multicenter clinical trial SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), which recruited consecutive patients with COPD exacerbation who required admission to 18 Spanish hospitals in the period between September 2014 and July 2020.Results: We included 737 patients, with a mean (SD) age of 70.2 ± 9.9 years, and a predominance of men (73.5%). Spirometry classified patients with mild, moderate, severe, or very severe obstruction in 8%, 31.5%, 45%, and 15.5%, respectively. When comparing the patients according to the degree of obstruction, we observed that the patients with greater airflow obstruction were younger (mild: 71.7 ± 8.8, moderate: 72.4 ± 10, severe: 70.2 ± 9.8, very severe: 66.6 ± 9.2; p < 0.001), had more chronic respiratory failure (37.3% vs. 30.2% vs. 44.9% vs. 64.3%; p < 0.001), had more cyanosis (5.8% vs. 5.9% vs. 8.5% vs. 15.3%; p < 0.001), had a higher percentage of exacerbations and were more tachycardic on arrival at the center hospital (92 ± 16 beats per minute [bpm] vs. 94 ± 18 vs. 96 ± 18 bpm vs. 99 ± 18 bpm; p < 0.001). In addition, arterial blood gases on admission showed a lower pH and a higher pCO2 the more severe the airflow obstruction was (p < 0.001).Conclusion: The severity of the airflow obstruction is associated with the form of presentation and the result of the arterial blood gases of the patient with COPD exacerbation who requires hospital admission. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica , Exacerbação dos Sintomas , Espanha , Hospitalização , Espirometria
16.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 48(8): 1-8, nov.-dic. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-212748

RESUMO

Objetivos Las nuevas directrices de la Organización Mundial de la Salud recomiendan estudios con exposición simultánea a varios contaminantes atmosféricos. El objetivo principal ha sido conocer la fuerza de la asociación entre diferentes concentraciones de PM10 y NO2 y la agudización de enfermedad respiratoria (AER), en concreto del asma y la enfermedad pulmonar obstructiva crónica. Material y métodos Estudio transversal retrospectivo. La población analizada estuvo compuesta por adultos atendidos en un SUAP en determinados días lag+1 de 2019, siendo los días posteriores a las fechas en las que se registran elevaciones de PM10 por encima del valor límite diario. Se han elaborado 3 índices (1: niveles elevados de PM10 y NO2; 2: nivel elevado de PM10 y nivel bajo de NO2, y 3: niveles bajos de PM10 y NO2) y un modelo de regresión logística para cada uno de ellos, con la AER como variable de resultado, y la adición progresiva de variables de ajuste (sexo, edad, tabaco, índice de Charlson, estación, precipitación, viento y temperatura). Resultado Se analizaron 461 personas, 17 con AER. Los modelos 1 y 2 presentaron valores muy similares en la OR ajustada (4,28 [IC95% 1,05-17]), R2 (0,88) y el área bajo la curva ROC (>0,72). En ambos se mantuvo la significación tras incluir las variables de ajuste, mientras que el modelo 3 solo permitió la precipitación. La inclusión del índice de Charlson y el consumo de tabaco en los 3 modelos suponía la pérdida de la significación de la combinación PM10/NO2 respecto a la AER. Conclusiones Los niveles elevados de PM10 presentan relación con la AER y tienen mayor impacto que el NO2, siendo el consumo de tabaco y las comorbilidades los principales precipitantes de las AER (AU)


Objectives The new World Health Organization guidelines recommend studies with simultaneous exposure to multiple air pollutants. The main objective has been to analyze the strength of the association between different concentrations of PM10 and NO2 and the exacerbation of chronic respiratory diseases (ECRD), specifically asthma and chronic obstructive pulmonary disease. Material and methods Retrospective cross-sectional study. The population analyzed were adults treated in an urgent and primary health care center on certain lag+1 days in 2019. Three indices have been developed (1: high levels of PM10 and NO2; 2: high level of PM10 and low level of NO2, and 3: low levels of PM10 and NO2) and a logistic regression model for each of them, with ECRD as the outcome variable, and the progressive addition of adjustment variables (sex, age, tobacco, Charlson index, season, precipitation, wind and temperature). Results Four hundred and sixty-one people were analyzed, 17 with ECRD. Models 1 and 2 presented very similar values in the adjusted OR (4.28 [95% CI 1.05–17]), R2 (0.88) and the area under the ROC curve (>0.72). In both of them the significance was maintained after including the adjustment variables, while model 3 only allowed the addition of precipitation. The inclusion of the Charlson index and the tobacco consumption in the 3 models implied the loss of statistical significance of the PM10/NO2 combination regarding ECRD. Conclusions High levels of PM10 are related to ECRD and have a greater impact than NO2, with tobacco use and comorbidities being the main precipitants of ECRD (AU)


Assuntos
Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doenças Respiratórias/etiologia , Poluição do Ar/análise , Dióxido de Nitrogênio/análise , Material Particulado , Exacerbação dos Sintomas , Estudos Transversais , Estudos Retrospectivos , Doença Crônica
18.
Actas dermo-sifiliogr. (Ed. impr.) ; 113(3): 286-293, Mar. 2022. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-206409

RESUMO

Atopic dermatitis (AD) is a chronic skin disease that may be triggered by psychological conditions and several allergens. Patients with AD may be experienced disease exacerbation due to the COVID-19 pandemic lifestyle including home-quarantine and increased stress. We obtained the electronic data of 100 AD patients admitted to our hospital from 2016 to 2019 and called them with specific phone line.Out of 100 patients, 43 were male, and 57 were female (mean age±SD: 45.85±16.90). Sixty patients (37 females and 23males; mean age: 42.22±14.71) confronted disease flare-up during the COVID-19 era. Exacerbation of AD was correlated with treatment dose alteration, a lengthy history of atopic dermatitis, eczema duration, self-isolation, frequent handwashing, hand disinfection, and POEM scoring (P<0.05). Regarding the POEM scoring, 61 patients with moderate to severe AD experienced higher anxiety than 39 patients with silent to mild AD (P=0.013).In this study, most patients experienced disease exacerbation and perceived mild anxiety in this pandemic (AU)


La dermatitis atópica (DA) es una enfermedad cutánea crónica que puede desencadenarse debido a situaciones psicológicas y ciertos alérgenos. Los pacientes con DA pueden haber experimentado una exacerbación de la enfermedad debido al estilo de vida durante la pandemia de la COVID-19, incluyendo el confinamiento domiciliario y el incremento del estrés. Obtuvimos los datos electrónicos de 100 pacientes con DA ingresados en nuestro hospital de 2016 a 2019, y les llamamos con una línea telefónica específica.De los 100 pacientes, 43 eran varones y 57 mujeres (edad media ± DE: 45,85 ± 16,90), de los cuales 60 (37 mujeres y 23 varones, con edad media de 42,22 ± 14,71) experimentaron el brote de la enfermedad durante la etapa de la COVID-19. La exacerbación de la DA guardó relación con la alteración de la dosis de tratamiento, un largo historial de dermatitis atópica, la duración del eccema, el autoaislamiento, la frecuencia del lavado de manos, la desinfección de las manos, y la puntuación POEM (p < 0,05). En lo referente a dicha puntuación, los 61 pacientes con DA de moderada a grave experimentaron mayor ansiedad que los 39 pacientes con DA de silente a leve (p = 0,013).En este estudio muchos pacientes experimentaron exacerbación de la enfermedad y percibieron ansiedad leve durante la pandemia (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Dermatite Atópica/epidemiologia , Exacerbação dos Sintomas , Índice de Gravidade de Doença , Progressão da Doença
19.
Actas dermo-sifiliogr. (Ed. impr.) ; 113(3): t286-t293, Mar. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-206410

RESUMO

La dermatitis atópica (DA) es una enfermedad cutánea crónica que puede desencadenarse debido a situaciones psicológicas y ciertos alérgenos. Los pacientes con DA pueden haber experimentado una exacerbación de la enfermedad debido al estilo de vida durante la pandemia de la COVID-19, incluyendo el confinamiento domiciliario y el incremento del estrés. Obtuvimos los datos electrónicos de 100 pacientes de DA ingresados en nuestro hospital de 2016 a 2019, y les llamamos con una línea telefónica específica.De los 100 pacientes, 43 eran varones y 57 mujeres (edad media±DE: 45,85±16,90), de los cuales 60 (37 mujeres y 23 varones, con edad media de 42,22±14,71) experimentaron el brote de la enfermedad durante la etapa de la COVID-19. La exacerbación de la DA guardó relación con la alteración de la dosis de tratamiento, un largo historial de dermatitis atópica, la duración del eccema, el autoaislamiento, la frecuencia del lavado de manos, la desinfección de las manos, y la puntuación POEM (P<0,05). En lo referente a dicha puntuación, los 61 pacientes con DA de moderada a grave experimentaron mayor ansiedad que los 39 pacientes con DA de silente a leve (p=0,013).En este estudio muchos pacientes experimentaron exacerbación de la enfermedad y percibieron ansiedad leve durante la pandemia (AU)


Atopic dermatitis (AD) is a chronic skin disease that may be triggered by psychological conditions and several allergens. Patients with AD may be experienced disease exacerbation due to the COVID-19 pandemic lifestyle including home-quarantine and increased stress. We obtained the electronic data of 100 AD patients admitted to our hospital from 2016 to 2019 and called them with specific phone line.Out of 100 patients, 43 were male, and 57 were female (mean age±SD: 45.85±16.90). Sixty patients (37 females and 23males; mean age: 42.22±14.71) confronted disease flare-up during the COVID-19 era. Exacerbation of AD was correlated with treatment dose alteration, a lengthy history of atopic dermatitis, eczema duration, self-isolation, frequent handwashing, hand disinfection, and POEM scoring (P<0.05). Regarding the POEM scoring, 61 patients with moderate to severe AD experienced higher anxiety than 39 patients with silent to mild AD (p=0.013).In this study, most patients experienced disease exacerbation and perceived mild anxiety in this pandemic (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Dermatite Atópica/epidemiologia , Exacerbação dos Sintomas , Índice de Gravidade de Doença , Progressão da Doença
20.
Pediatr. aten. prim ; 24(93)ene. - mar. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-210325

RESUMO

La reagudización o crisis asmática es uno de los motivos de consulta más frecuentes en las consultas de Atención Primaria y en los servicios de urgencias pediátricas. Se trata de una patología con un algoritmo de actuación y de tratamiento según la gravedad bien establecido, con fármacos con un buen perfil de seguridad para la edad pediátrica. Se presenta un caso con mala respuesta inicial que ilustra un efecto paradójico del salbutamol (AU)


Asthma exacerbations are among the most frequent reasons for paediatric primary care and emergency care visits. Asthma is a disease with a well-established management and treatment algorithm based on severity, and drugs with a good safety profile for the paediatric population are available for its treatment. We present a case with a poor inital response illustrating a paradoxical reaction to salbutamol. (AU)


Assuntos
Humanos , Feminino , Criança , Asma/fisiopatologia , Exacerbação dos Sintomas , Albuterol/efeitos adversos , Broncodilatadores/efeitos adversos , Índice de Gravidade de Doença
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