Knowledge and perceptions regarding pulmonary rehabilitation amongst Ecuadorian physicians following COVID-19 outbreak.

Background: Pulmonary rehabilitation is already an established technique for patients with chronic respiratory disease, aimed at improving breathlessness, exercise capacity, health status, and well-being. The aim of this study was to assess the knowledge and perceptions about pulmonary rehabilitation post-COVID-19 infection among Ecuadorian physicians. Methods: We conducted a cross-sectional online survey-based study using a 27-item questionnaire to assess the knowledge about specific topics related to pulmonary rehabilitation. The sample comprised Ecuadorian physicians who were currently enrolled to an active medical practice that included care to COVID-19 patients. Descriptive statistics were applied for demographic variables of interest. A chi-square goodness of fit test was used to determine whether the observed frequencies of each of the answers per query were within or outside of the expected frequencies by chance. Results: In total, 295 participants answered the survey, out of which 57.3% were general practitioners. Most agreed that COVID-19 infected patients must be followed-up with some measurement of respiratory function (81.4%, p=0.000), but only 18.3% (n=54, p=0.000) were aware of specific guidelines related to rehabilitation. 93.6% (n=276, p=0.000) considered that pulmonary rehabilitation provides a benefit, of any kind, to patients with past COVID-19 infection. Conclusions: Most physicians considered pulmonary rehabilitation beneficial following COVID-19. However, there is uncertainty on how to adequately follow up patients, complementary tests, and specific guidelines outlining rehabilitative interventions.

Long-term respiratory consequences of COVID-19 related pneumonia: a cohort study.

BACKGROUND: Our aims were to describe respiratory sequelae up to 12 months after discharge in COVID-19 patients with severe pneumonia requiring non-invasive respiratory support therapies. METHODS: This study was undertaken at University Hospital Doctor Josep Trueta (Girona, Spain) between March 2020 and June 2020. Three months after discharge, we evaluated their dyspnoea and performed Saint George's respiratory questionnaire, pulmonary function tests, blood test, 6-min walking test, and a high-resolution CT (HRCT). At the six and 12-month follow-up, we repeated all tests except for pulmonary function, 6-min walking test, and HRCT, which were performed only if abnormal findings had been previously detected. RESULTS: Out of the 94 patients recruited, 73% were male, the median age was 62.9 years old, and most were non-smokers (58%). When comparing data three and 12 months after discharge, the percentage of patients presenting dyspnoea ≥ 2 decreased (19% vs 7%), the quality-of-life total score improved (22.8% vs 18.9%; p = 0.019), there were less abnormal results in the pulmonary function tests (47% vs 23%), the 6-min walking test distance was enhanced (368.3 m vs 390.7 m, p = 0.020), ground glass opacities findings waned (51.6% vs 11.5%), and traction bronchiectasis increased (5.6% vs 15.9%). Only age showed significant differences between patients with and without pulmonary fibrotic-like changes. CONCLUSION: Most patients improved their clinical condition, pulmonary function, exercise capacity and quality of life one year after discharge. Nonetheless, pulmonary fibrotic-like changes were observed during the follow-ups.

Antileishmanial and cytotoxic activities of four Andean plant extracts from Colombia.

BACKGROUND AND AIM: Licania salicifolia (L.S) Cuatrec., Persea ferruginea (P.F) Kunth, Oreopanax floribundus (O.F), and Psychotria buchtienii (P.B) belong to the families Chrysobalanaceae, Lauraceae, Araliaceae, and Rubiaceae, respectively, which have been used as medicines by communities in the Andes. This study evaluated the leishmanicidal and cytotoxic activities of alcohol and non-alcohol extracts from four Andean plant extracts (L.S, O.F, P.F, and P.B). MATERIALS AND METHODS: Extracts were obtained by percolation with solvents of different polarities - hexane, dichloromethane, ethyl acetate, and ethanol. Phytochemical screening was conducted based on reported methods. All products were evaluated in vitro to determine the leishmanicidal activity against amastigotes of Leishmania panamensis and cytotoxicity against U937 cells. RESULTS: Flavonoids, triterpenes, and tannins were the main secondary metabolites found. From the results, dichloromethane extracts from O.F and P.B, ethanol extract from P.B, and ethyl acetate extracts of all plants were active, with EC50 <30 µg/mL. Ethyl acetate was the most active extract, which showed EC50 values of 9.8, 14.1, 23.7, and 25.5 µg/mL, for L.S, P.B, O.F, and P.F, respectively. Hexane extracts from P.B and O.F exhibited moderate activity with EC50 values of 84.8 and 87.4 µg/mL, respectively. Hexane and ethanol extracts from O.F, ethyl acetate, and ethanol extracts from L.S, and all extracts from P.F were not toxic. Alternatively, hexane and dichloromethane extracts from L.S and P.B as well as dichloromethane and ethyl acetate extracts from O.F displayed high toxicity. CONCLUSION: Based on the activity we observed, ethyl acetate extract can continue in its usage in the search for new antileishmanial drugs, mainly ethyl acetate extract from L.S showed activity comparable to meglumine antimoniate and was not cytotoxic.

Influence of Generational Cohorts on the Preferences for Information and Communication Technologies in Latin American Patients with Obstructive Lung Diseases.

BACKGROUND: Advances in information and communication technologies (ICTs) represent a growing platform for the expansion of healthcare related services, but there is little information on how generational differences might account for distinct patterns of use and interest for ICTs. Our study aims to achieve a better understanding on how generational cohorts might influence the use and preferences for ICTs among patients with obstructive lung diseases in Latin America. MATERIALS AND METHODS: We conducted an anonymous cross-sectional survey-based study, involving 968 patients with obstructive lung diseases (OLD) in Latin America. Patients rated their frequency of use and preferences of ICTs through a modified version of the Michigan Questionnaire. Chi-square test for association and adjusted regression analyses were performed. RESULTS: Of all, 63.6% of participants had Internet access. Younger generations, in particular Generation Z and Millennials, had the highest rate of Internet access and smartphone ownership, as well as of overall frequency of ICT use. Web-based Internet was found to be the main source to seek information about the disease (36.9%) across all generational cohorts. Generation Z and Millennials presented the highest odds to be interested in using Twitter (OR 31.79 and 8.86) for receiving health-related information, and email (OR 4.87 and 4.86) as the preferred way to ask physicians information related to their disease through ICTs. CONCLUSION: Generational cohorts influence the use and preferences for ICTs among patients with obstructive lung diseases. Younger generational cohorts were associated with higher access to the Internet and smartphone ownership, as well as higher interest for using ICTs to receive and ask for health-related information.

Preferences of ICT among Patients with Chronic Kidney Disease Undergoing Hemodialysis: An Ecuadorian Cross-Sectional Study.

OBJECTIVES: The aim of the present study was to assess the frequency of use, and preferences regarding information and communication technologies (ICTs) among Ecuadorian patients with chronic kidney disease (CKD) undergoing hemodialysis. METHODS: We conducted an anonymous cross-sectional survey-based study from January 2016 to April 2017, involving 393 patients with end-stage renal disease from 9 hemodialysis centers, in which they rated their use and preferences of various ICTs through a modified version of the Michigan Questionnaire. The questionnaire collected information regarding demographics, patients' interest in obtaining health-related information through ICTs, and interest in using ICTs as a potential way to communicate with their healthcare providers. A chi-square test for association and adjusted regression analyses were performed. RESULTS: Among all patients who participated, 64.3% reported owning a cellphone, with less than a third reporting active Internet connection. The most used ICT for obtaining information about CKD and/or hemodialysis was web-based Internet, followed by YouTube. SMS was rated the highest to receive and seek health-related information, followed by Facebook. Younger age and higher levels of education were associated with a higher overall usage of ICTs. Finally, more than half of the patients reported interest in using WhatsApp for communicating with their healthcare providers. CONCLUSIONS: Understanding the preferences of ICTs among patients with CKD undergoing hemodialysis could help to improve their outcomes through the potential uses and benefits of ICTs. Further research is needed to assess their role in improving the care of patients with chronic diseases.

[Are natural analgesic products safe in patients with allergy to non-steroidal anti-inflammatory drugs?] / ¿Son seguros los productos naturales analgésicos en los pacientes con alergia a los antiinflamatorios no esteroideos?

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAID)-induced hypersensitivity reactions can be clinically apparent with asthma, rhinosinusitis, anaphylaxis or rash. Although natural anti-inflammatory products can have similar components, they are not subjected to rigorous quality control standards. CASE REPORT: The case is presented of a 22-year-old female with NSAID allergy who attended with facial and laryngeal angioedema associated with pruritus in eyelids and pharynx. She developed these symptoms fifteen minutes after taking an over-the-counter (OTC) natural anti-inflammatory product. She received treatment with epinephrine, antihistamines and corticosteroids. CONCLUSION: Different natural anti-inflammatory products are freely available both OTC and online. Some contain dangerous substances that can cause important, and even lethal. side effects. Allergologists, dermatologists and general practitioners should be able to recognize that the consumption of these products, which is widely spread, can cause angioedema.

Antecedentes: Las reacciones de hipersensibilidad inducidas por antiinflamatorios no esteroideos pueden manifestarse clínicamente con asma, rinosinusitis, anafilaxia o urticaria. Aunque los productos antiinflamatorios naturales pueden tener componentes similares, no son sometidos a rigurosos estándares de control de calidad. Reporte de caso: Se describe el caso de una mujer de 22 años de edad, con alergia a los antiinflamatorios no esteroideos, quien consultó por angioedema facial y laríngeo asociado con prurito en párpados y faringe. Desarrolló los síntomas 15 minutos después del consumo de un producto antiinflamatorio natural de venta libre. Recibió tratamiento con epinefrina, antihistamínicos y corticoides. Conclusiones: Diversos productos antiinflamatorios naturales están disponibles en venta libre y en la web. Algunos contienen sustancias peligrosas que pueden causar efectos secundarios importantes e, incluso, letales. Alergólogos, dermatólogos y médicos generales deben ser capaces de reconocer que el consumo de estos productos, que se ha generalizado, puede ocasionar angioedema.

What Kind of Information and Communication Technologies Do Patients with Type 2 Diabetes Mellitus Prefer? An Ecuadorian Cross-Sectional Study.

PURPOSE: The purpose of this study is to assess the frequency of use of information and communication technologies and patterns of preference among Ecuadorian patients with diabetes. METHODS: We conducted an anonymous cross-sectional survey on type 2 diabetes mellitus. A chi-square test for association and adjusted regression analyses were performed. RESULTS: 248 patients were enrolled, with a mean sample age of 57.7 years. SMS was the most used ICT (66.0%). The Internet was used by 45.2% of patients to obtain information about diabetes. SMS and email were rated as the most useful ICTs for receiving information (64.5% and 28.1%, resp.) and asking physicians about diabetes (63.8% and 26.1%, resp.). Patients were also interested in receiving disease information (82.4%) and asking physicians about diabetes (84.7%) through WhatsApp. Adjusted logistic regressions revealed that individuals aged 55 years or younger, those with superior degree level, and those with long diabetes history preferred email for receiving information and asking physicians about diabetes compared to those above 55 years, those with low education level, and those with short diabetes history, respectively. CONCLUSION: Understanding preferences of ICTs among patients with diabetes could facilitate application development targeted towards specific requirements from patients.

Ecuadorian Cancer Patients' Preference for Information and Communication Technologies: Cross-Sectional Study.

BACKGROUND: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. OBJECTIVE: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. METHODS: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. RESULTS: Of the total, 43.2% (216/500) of participants reported that they had access to the Internet, and 25.4% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5%, 145/218) and short message service (SMS) text messaging (61.0%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0%, 157/218) followed by SMS (63.8%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. CONCLUSIONS: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries.

Obstructive sleep apnea knowledge and attitudes among recent medical graduates training in Ecuador.

BACKGROUND: We aimed to assess recent Latin American medical school graduates' knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians. METHODS: Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates' data with data collected in 2010-2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly. RESULTS: Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%; p < 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception-recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1.03-2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP. CONCLUSIONS: OSA-focused educational interventions during medical school should help to improve recent medical graduates' abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students' exposure to sleep education.

Management and attitudes about IPF (Idiopathic Pulmonary Fibrosis) among physicians from Latin America.

BACKGROUND: The aim of our study was to assess current practice patterns and attitudes towards diagnosis and management of idiopathic pulmonary fibrosis (IPF) patients in Latin America. METHODS: A Cross-sectional survey was developed and up to 455 physicians were enrolled. We used a rigorous method of validation using the translated version of the AIR Survey. RESULTS: Mean age was 47.5 years (SD 12.6) with 20.4 years (SD 12.3) of practice. In around 30% of physicians were reported access to radiologist, pathologist and multidisciplinary team. Despite almost all physicians reported that (ATS/ERS/JRS/ALAT) guidelines are useful, half of them prescribed corticoids for treatment of disease. Most respondents (69.9%) reported cough as the presenting symptom. Around 80% considered IPF to be an important clinical disorder, and felt that identifying patients at risk for IPF was important or extremely important. However, only 59.7% felt confident in managing patients with IPF, and similar numbers (60.8%) felt confident about their knowledge. Pulmonologist have more confidence and management of IPF that no pulmonologist. CONCLUSION: The results of this survey of Latin American physicians could help to fill gaps regarding awareness, management and treatment of IPF and improve earlier diagnosis of IPF.

Etiology of chronic urticaria: the Ecuadorian experience.

BACKGROUND: The purpose of this study was to identify chronic urticaria (CU) etiologies and treatment modalities in Ecuador. We propose that the sample distribution fits the expected one, and that there is an association between the etiology and its treatment. METHODS: We performed a retrospective study involving 112 patients diagnosed with CU using a Checklist for a complete chronic urticaria medical history. Demographic and clinical variables were collected. The etiology of CU was classified using the EAACI/GA2LEN/EDF/WAO guideline. Descriptive analyses were performed for demographical and clinical variables. Chi square tests were applied to analyze the fit of distribution and the independence of variables. P values less than 0.05 were considered significant. RESULTS: Among all the patients, 76.8% were diagnosed with chronic spontaneous urticaria (CSU), of which 22.3% had a known etiology or possible exacerbating condition. Food allergy was identified as the most common accompanying condition in patients with CSU (10.7%) (p < 0.01).. On the other hand, 23.2% inducible urticarias (CIndU) were indentified; dermographism was the most common (10.7%) (p < 0.01).Regarding treatment regimens, sg-H1-antihistamines alone represented the highest proportion (44.6%). The combination of any H1-antihistamine plus other drug was a close second (42.0%) (p < 0.01). Almost 48% of CSUs of unknown etiology were treated with any antihistamine plus another drug. In patients with known etiology, sg-antihistamines alone (44.0%) was the most common management. In addition, 53.8% of CIndUs were treated with sg-antihistamines alone. Though, these associations were not statistically significant. CONCLUSION: CSU is the most frequent subtype of CU. Modern non-sedating antihistamines in licensed doses are the drug of choice. Nevertheless, a great proportion of patients require the addition of another type of medication.

[Does Ecuadorians with asthma has preferences in the use of information and communication technologies? Pilot study]. / ¿Los ecuatorianos con asma tienen preferencias en el uso de tecnologías de la información y comunicación? Estudio piloto.

BACKGROUND: Inadequate communication between asthmatic patients and their physicians may interfere directly with asthma control. In the last years, the use of information and communication technologies (ICTs) it has increased in Latin-America. This technology seems to be a good tool to improve communication and management of the asthmatic patient. OBJECTIVE: We evaluated the frequency and preference patterns of communication and information technologies in Ecuadorian patients with bronchial asthma. METHODS: We conducted a pilot cross-sectional study to identify the frequency and preferences of ICT in patients with asthma. The Spanish version of the Michigan questionnaire was used. Age and educational level were categorized into 3 groups. We used logistic regression between these groups regarding the frequency of use, interest in seeking and receiving information related to their asthma for the age and educational level of the patients. RESULTS: A total of 222 patients participated in our study. The mean age was 45.6 years (SD 17.4), the most common sex was female with 89.25 %. Almost all patients had a cell phone (87.5 %) and internet access (62.7 %). The three ICTs most likely to be used to search for or receive information about their illness were WhatsApp, Facebook and email (p <0.05). CONCLUSION: Information and communication technologies improve the care of asthmatic patients. In our pilot study email and text messages are the most preferred ICT among patients however WhatsApp and Facebook may be appropriate for certain ages especially young asthmatic. Knowledge of preferences can help the development of ICT in a personalized way and improve the outcomes in patients with asthma.

Antecedentes: La comunicación inadecuada entre los pacientes y sus médicos puede interferir directamente con el control del asma. En los últimos años, el uso de tecnologías de la información y comunicación se ha incrementado en Latinoamérica y parece ser un recurso útil para mejorar la comunicación, adherencia y control del paciente con asma. Objetivo: evaluar la frecuencia y patrones de preferencia de las tecnologías de comunicación e información en pacientes ecuatorianos con asma bronquial. Métodos: estudio transversal en el que se utilizó la versión en español del cuestionario Michigan. La edad y el nivel educacional fueron categorizados en tres grupos. Se utilizó regresión logística entre los grupos respecto a la frecuencia de uso e interés en buscar y recibir información relacionada con el asma, según la edad y nivel educativo. Resultados: en nuestro estudio participaron 222 pacientes. La edad media fue de 45.6 ± 17.4 años y el sexo más común fue el femenino, con 89.25 %. Casi todos los pacientes tenían teléfono celular (87.5 %) y acceso a internet (62.7 %). Las tres tecnologías de la información y comunicación con mayor probabilidad de ser usadas con fines de buscar o recibir información acerca de la enfermedad fueron WhatsApp, Facebook y correo electrónico (p < 0.05). Conclusión: el correo electrónico y los mensajes de texto fueron preferidos por los pacientes, sin embargo, WhatsApp y Facebook pueden ser apropiados para ciertos grupos, especialmente para los jóvenes. La selección de TIC adecuadas para la comunicación médico-paciente podría mejorar la adherencia y el control de los pacientes con asma.

[Is it possible for chronic urticaria diagnostic approach to be simplified? A clinical data checklist]. / ¿Es posible simplificar el abordaje diagnóstico de urticaria crónica? Una lista de verificación de información clínica.

BACKGROUND: Existing clinical guidelines do not offer an efficient alternative for the collection of data on relevant clinical traits during history and physical of the patient with chronic urticaria. OBJECTIVE: Our aim was to provide a clinical data checklist together with its guide to allow for thorough information to be obtained and for a physical exam that identifies the main features and triggering factors of the disease to be carried out. METHODS: A search was conducted for relevant literature on chronic urticaria in Medline, the Cochrane library and PubMed. RESULTS: We developed an easy-to-use clinical data checklist with its corresponding clinical guide, comprised by 42 items based on two components: essential clues for history taking and chronic urticaria diagnosis (typical symptoms according to subgroups, etiology and laboratory results). Some components are the time of disease onset, wheals' duration, shape, size, color and distribution, associated angioedema, atopy, triggering factors and others. CONCLUSION: The clinical data checklist and its guide constitute a tool to focus, guide and save time in medical consultation, with the main purpose to aid physicians in providing better diagnosis and management of the disease.

Antecedentes: Las guías clínicas existentes no ofrecen una alternativa eficiente para la recolección de rasgos clínicos relevantes durante la anamnesis y el examen físico del paciente con urticaria crónica. Objetivo: Proporcionar una lista de verificación de información clínica y una guía que permitan obtener información completa y realizar un examen físico que identifique las características principales de la enfermedad y los factores desencadenantes. Métodos: Se realizó una búsqueda de literatura relevante sobre urticaria crónica en Medline, la Biblioteca Cochrane y PubMed. Resultados: Desarrollamos una lista de verificación de información clínica fácil de usar, con su respectiva guía clínica, integrada por 42 elementos basados en 2 componentes: pistas esenciales para la anamnesis y el diagnóstico de la urticaria crónica (síntomas típicos según sus subtipos, etiología y resultados de laboratorio). Algunos componentes son el tiempo de aparición de la enfermedad, duración, forma, tamaño, color y distribución de las erupciones; angioedema aso-ciado, atopia, factores desencadenantes y otros. Conclusiones: La lista de verificación de información clínica y su guía constituyen una herramien-ta para enfocar, orientar y ahorrar tiempo en la consulta médica, con el fin principal de que los médicos realicen un mejor diagnóstico y manejo de la enfermedad.

[Knowledge and attitudes about aspirin exacerbated respiratory disease among Ecuadorian physicians]. / Conocimiento y actitudes en médicos ecuatorianos sobre enfermedades respiratorias exacerbadas por aspirina.

BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is an asthma phenotype that involves high costs and significant burden for health systems. OBJECTIVE: To determine the level of knowledge and attitudes towards AERD among Ecuadorian physicians. METHODS: Descriptive, observational study. A questionnaire about knowledge on the disease and attitude towards it (confidence in the treatment and importance of AERD, measured with a Likert scale) was developed. The answers about knowledge were dichotomized into right and wrong; attitude was rated as high or low. Means and percentages were obtained; the answers of doctors with or without specialty were compared using the chi-square test. RESULTS: One-hundred eighteen physicians participated. The age was 41.3 ± 11.7 years; 48.3 % were specialists. Less than 50% answered correctly the questions about knowledge. Specialist physicians obtained more correct answers regarding first symptoms, prevalence and leukotriene overproduction (67.9 %, 46.3% and 90.7 %), when compared with general practitioners (45.0 %, 25% and 74.6 %) (p < 0.05). More than 70 % of physicians indicated high confidence in the identification of patients with AERD. There were no significant differences in attitudes (p > 0.05). CONCLUSION: Medical education programs should be developed in order to improve the level of knowledge about AERD.

Antecedentes: La enfermedad respiratoria exacerbada por aspirina (EREA) es un fenotipo de asma que conlleva un alto costo e importante carga para los sistemas de salud. Objetivo: Determinar los conocimientos y actitudes hacia la EREA en médicos ecuatorianos. Métodos: Estudio observacional descriptivo. Se elaboró un cuestionario acerca de los conocimientos sobre la enfermedad y la actitud hacia ella (confianza en el tratamiento e importancia de la EREA, medidas con una escala de Likert). Las respuestas sobre conocimiento se dicotomizaron en correctas e incorrectas; la actitud se calificó como alta o baja. Se obtuvo media y porcentaje; con c2 se compararon las respuestas de los médicos con o sin especialidad. Resultados: Participaron 118 médicos. La edad fue de 41.3 ± 11.7 años; 48.3 % era especialista. Menos de 50 % contestó correctamente las preguntas sobre conocimiento. Los especialistas obtuvieron más respuestas correctas respecto a los primeros síntomas, prevalencia y sobreproducción de leucotrienos (67.9, 46.3 y 90.7 %), al compararlos con los médicos generales (45, 25 y 74.6 %) (p < 0.05). Más de 70 % de los médicos indicó alta confianza en la identificación de pacientes con EREA. No hubo diferencias significativas en las actitudes (p > 0.05). Conclusión: Se deben desarrollar programas de educación médica para mejorar el conocimiento acerca de la EREA.

Omalizumab for chronic urticaria in Latin America.

BACKGROUND: Chronic urticaria (CU) is defined as the spontaneous appearance of wheals, with or without angioedema, persisting for ≥6 weeks. Chronic Spontaneous Urticaria (CSU) is a type of CU which affects 0.5-1 % of the global population, but it represents a high burden to patients. In recent years, omalizumab is available as treatment of disease. Our aim is to extend previous findings, analyzing effects of omalizumab on symptoms in Latin American patients with CSU. METHODS: Retrospective analysis of patients treated with omalizumab in Cuenca-Ecuador. 150 mg omalizumab was administered every 4 weeks, and its effects were measured by Urticaria Activity Score (UAS) at baseline and each month in follow up. Complete response was defined as a UAS of 0 or 1, and partial response was classified as a UAS of 2 or more. Also, demographic and clinical variables were collected. Descriptive analyses were employed. Response rates were summarized as counts and percentages after 3 and 5 months. Related Samples Wilcoxon signed rank tests were used to compare UAS at baseline and after 3 months. P values <0.05 indicated statistical significance. RESULTS: 26 subjects were enrolled, almost half were female individuals (57.7 %), with mean age 47.8 years (range, 18-81 years). Mean duration of CU after diagnosis was 23.3 months (range, 2-180 months). Mean UAS at baseline was 5.7 points (range, 4-6 points). Nine patients (34.6 %) completed 3 months of treatment (33 % reported a complete response), with a mean difference in UAS of 3.33 (p = 0.01). Four patients completed 5 months of treatment (75.0 % showed a complete response). All patients previously treated with first-generation antihistamines plus corticosteroids showed no responses at neither 3 nor 5 months of treatment. CONCLUSION: Omalizumab is an effective treatment for patients with CU. It is necessary to conduct some future investigations where we can establish if 150 mg could be an option in developing countries.

Patient-physician relationship in the management of asthma: Multicentric approach in Latin America.

OBJECTIVE: To investigate and compare how Latin American physicians rate themselves on the use of communication strategies in the management of asthma patients, and to explore their personal experience and opinions on asthma treatment. METHODS: A cross-sectional survey of physicians attending international medical conferences in Latin America was conducted. Participants rated themselves on frequency of use of 24 communication strategies using a 5-point Likert scale. For statistical analysis, self-rating responses were divided into two classes: very likely to (always or often on a Likert scale) and not very likely to (sometimes, seldom or never on a Likert scale). Participants also answered 4 multiple choice questions about management of asthma patients. Overall responses were analyzed using descriptive statistics and Chi-square. Multivariate logistic regression analysis was performed to evaluate self-ratings by country, gender, practice area (GP or specialist) and age. RESULTS: A total of 304 physicians from Ecuador, Argentina and Peru responded. Overall, the majority of respondents rated themselves very likely to use 21 of the 24 communication strategies. Some significant differences were observed in self-ratings among physicians from different countries, between males and females, between GPs and specialists and between younger and older physicians. Responses to the multiple choice questions showed that 79.6% of the respondents believed that most or almost all patients can achieve asthma control. CONCLUSIONS: A high percentage of the Latin American physicians surveyed rated themselves very likely to use good communication strategies when managing asthma patients and felt that asthma control can be achieved in most or almost all patients.

Oxidation of CO and Methanol on Pd-Ni Catalysts Supported on Different Chemically-Treated Carbon Nanofibers.

In this work, palladium-nickel nanoparticles supported on carbon nanofibers were synthesized, with metal contents close to 25 wt % and Pd:Ni atomic ratios near to 1:2. These catalysts were previously studied in order to determine their activity toward the oxygen reduction reaction. Before the deposition of metals, the carbon nanofibers were chemically treated in order to generate oxygen and nitrogen groups on their surface. Transmission electron microscopy analysis (TEM) images revealed particle diameters between 3 and 4 nm, overcoming the sizes observed for the nanoparticles supported on carbon black (catalyst Pd-Ni CB 1:2). From the CO oxidation at different temperatures, the activation energy Eact for this reaction was determined. These values indicated a high tolerance of the catalysts toward the CO poisoning, especially in the case of the catalysts supported on the non-chemically treated carbon nanofibers. On the other hand, apparent activation energy Eap for the methanol oxidation was also determined finding-as a rate determining step-the COads diffusion to the OHads for the catalysts supported on carbon nanofibers. The results here presented showed that the surface functional groups only play a role in the obtaining of lower particle sizes, which is an important factor in the obtaining of low CO oxidation activation energies.

Urticaria as initial finding of a patient with carcinoid tumor.

BACKGROUND: Typical carcinoid syndrome is characterized by flushing, abdominal pain and diarrhea and occurs in <10 % of carcinoid tumor patients. Very rarely, initial signs include skin manifestations. Our purpose is to highlight cutaneous manifestations in the diagnosis and assessment of a patient with atypical manifestation of type I gastric carcinoid tumor. CASE PRESENTATION: A 50-year-old woman presented with anemia, chronic urticaria and angioedema. Urticaria was triggered principally by seafood and appeared in the first hour after. Urticaria Activity Score 7 was 24, and quality of life (CU-Q2oL) was 3.61. P. Laboratory findings showed anemia, diminished iron, ferritin, and vitamin B12, with increased gastrin and anti-parietal cell antibody levels. 15 gastric carcinoids 5 mm in diameter were observed in the greater curvature of the stomach during gastric endoscopy and confirmed by biopsy, suggesting that this patient had type I gastric carcinoids. Four additional tumors were found in the small intestine upon examination via video capsule. Endoscopic argon plasma therapy was performed. The patient experienced definitive improvement in quality of life and urticaria activity score. CONCLUSION: This patient, whose principal symptoms were anemia, urticaria and angioedema, was found to have atypical carcinoid syndrome, with tumors located in the stomach. Allergists, immunologists, internists and primary care physicians should consider the possibility of neuroendocrine malignancies, specifically type I carcinoid tumors, when evaluating patients with urticaria, and consider screening patients with chronic urticaria for elevated anti-parietal cell antibody levels.