Aspectos éticos y recomendaciones para investigación en seres humanos en la era genómica

Este artículo revisa los principales desafíos éticos que plantea la investigación vinculada al genoma humano a la luz de la bibliografía internacional y entrega recomendaciones sobre su abordaje basada en nuestra experiencia en el Comité de Ética para la Investigación en Seres Humanos de la Facultad de Medicina, Universidad de Chile, incluyendo las regulaciones legales nacionales. Los estándares éticos de la investigación en seres humanos deben extremarse para proteger adecuadamente a los participantes en estudios involucrados con la genómica. Especialmente relevantes en este contexto son: la protección de la confidencialidad y anonimato; la política de entrega de resultados y la posibilidad de retirarse del estudio. Compartir datos resultantes de investigaciones genéticas permite optimizar recursos, otorga mayor transparencia y replicabilidad de los análisis y permite descubrir alteraciones genéticas responsables de enfermedades raras y genes involucrados en enfermedades hereditarias multifactoriales, además de contribuir al diseño de medicina de precisión y de nuevas estrategias terapéuticas. Sin embargo, plantea grandes desafíos: proteger la privacidad y evitar la re-identificación de los voluntarios, la entrega de resultados con asesoría pre y post estudio. Estos aspectos requieren la elaboración de un cuidadoso proceso de consentimiento informado para investigaciones genómicas cuyos componentes principales se analizan en este artículo.

This article reviews the main ethical challenges posed by human genome research in the light of the international literature and provides recommendations on how to approach them based on our experience in the Ethics Committee for Research on Human Subjects of the Faculty of Medicine, University of Chile, including national legal regulations. Ethical standards in human research must be extreme, in order to adequately protect participants in studies involving genomics. Particularly relevant in this context are the protection of confidentiality and anonymity; the policy of delivery of results and the possibility of withdrawing from the study. Sharing data resulting from genetic research optimizes resources, provides greater transparency, and replicability of the analyses and makes it possible to discover genetic alterations responsible for rare diseases and genes involved in multi-factorial hereditary diseases, as well as contributing to the design of precision medicine and new therapeutic strategies. However, it poses great challenges: protecting privacy and avoiding re-identification of volunteers, delivery of results with pre- and post-study counseling. These aspects require the elaboration of a careful informed consent process for genomic research, the main components of which are discussed in this article.

[The impact of climate change on health]. / Impacto del cambio climático en la salud.

Climate changes evidenced by an increase in our planet's mean temperature, changes in rainfall, increased sea level and extreme weather conditions, favor air and soil contamination, ocean acidification, droughts, floods, heat waves and forest fires, which affect the health and wellbeing of exposed populations. These changes will exert negative effects on respiratory and cardiovascular systems, nutritional status, burden of infectious diseases, especially vector-borne infections, and human mental health. Moreover, environmental damages, such as loss of biodiversity, ecological collapse and deterioration of socioeconomic factors such as agricultural and fishery production, and the loss of habitable land, will impulse massive migrations. This article summarizes the impact that climate change is expected to have on respiratory, cardiovascular and infectious diseases and its repercussions on people of extreme ages. It is imperative to achieve the immediate commitment of worldwide national governments to control green-house gas emissions. The appropriate technology does exist, but political will is urgently needed to accomplish this goal.

Impacto del cambio climático en la salud / The impact of climate change on health

Climate changes evidenced by an increase in our planet's mean temperature, changes in rainfall, increased sea level and extreme weather conditions, favor air and soil contamination, ocean acidification, droughts, floods, heat waves and forest fires, which affect the health and wellbeing of exposed populations. These changes will exert negative effects on respiratory and cardiovascular systems, nutritional status, burden of infectious diseases, especially vector-borne infections, and human mental health. Moreover, environmental damages, such as loss of biodiversity, ecological collapse and deterioration of socioeconomic factors such as agricultural and fishery production, and the loss of habitable land, will impulse massive migrations. This article summarizes the impact that climate change is expected to have on respiratory, cardiovascular and infectious diseases and its repercussions on people of extreme ages. It is imperative to achieve the immediate commitment of worldwide national governments to control green-house gas emissions. The appropriate technology does exist, but political will is urgently needed to accomplish this goal.

Impacto de la contaminación aérea por incendios forestales en la morbimortalidad de la población expuesta / Impact of air pollution by forest fires and the morbidity of the exposed population

La exposición a las emanaciones de incendios forestales es un importante problema de salud pública nacional e internacional. El cambio climático que conlleva sequía y aumento de la temperatura estival aumenta el riesgo y magnitud de los episodios de incendios forestales, generándose grandes incendios cuyas emanaciones pueden afectar a poblaciones distanciadas del epicentro. La asociación entre la exposición a las emanaciones de los incendios forestales, el aumento de las concentraciones de material particulado aéreo y la morbilidad respiratoria (exacerbación de asma y enfermedades respiratorias crónicas) ha sido evidenciada en diversos estudios. Sin embargo, es difícil realizar un metaanálisis de ellos, ya que la metodología empleada es muy disímil. Entre los principales mecanismos de morbilidad se encontrarían: la producción de citoquinas proinflamatorias, la activación endotelial y la disfunción del sistema nervioso autónomo. Ante la exposición al humo de incendios forestales, se produce daño tisular, aumento de los mecanismos protrombóticos, aumento de la presión arterial y cambios en el ritmo cardiaco, que explicaría los efectos cardiovasculares. Los sujetos con patología cardiovascular preexistente podrían tener mayor riesgo cardiovascular; sin embargo, existen factores confundentes en esta asociación. Por otra parte, el posible riesgo cancerígeno con la exposición a estas emanaciones requiere mayores estudios poblacionales.

Exposure to forest fire fumes is a major national and international public health issue. Climate change that leads to drought and increased summer temperature increases the risk and magnitude of wildfires episodes, generating mega-fires whose fumes not only affect the boundary population, but they may become transcontinental. Association between exposure to forest fire fumes, mainly increased concentrations of air born particulate matter and respiratory morbidity (exacerbation of asthma and chronic respiratory diseases) has been evidenced by diverse studies. However, it is difficult to carry out meta-analysis with them since the methodology used is dissimilar. Among the main causes of morbidity have been postulated the production of pro-inflammatory cytokines, endothelial activation and dysfunction of the autonomic nervous system. Occurrence of tissue damage, increased prothrombotic mechanisms, increased blood pressure and changes in heart rate, would explain the cardiovascular effects associated with exposure to smoke from these fires. However, epidemiological outcomes have not been entirely consistent, as the association between cardiovascular morbidity and exposure to wildfire fumes may be mixed with confounding factors. Despite this, patients with pre-existing cardiovascular pathology may be at increased risk. Finally, the potential risk of carcinogen with exposure to these fumes requires further population studies.

[Impact of Particulate Matter (PM 2,5 ) and children's hospitalizations for respiratory diseases. A case cross-over study]. / Impacto del Material Particulado aéreo (MP 2,5 ) sobre las hospitalizaciones por enfermedades respiratorias en niños: estudio caso-control alterno.

INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2.5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2,5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.

Impacto del Material Particulado aéreo (MP 2, 5 ) sobre las hospitalizaciones por enfermedades respiratorias en niños: estudio caso-control alterno / Impact of Particulate Matter (PM 2, 5 ) and children's hospitalizations for respiratory diseases: a case cross-over study

INTRODUCCIÓN: Santiago de Chile con 7 millones de habitantes alcanza elevados niveles de contaminación atmosférica en invierno, el material particulado habitualmente excede los estándares de la OMS. OBJETIVO: Evaluar la influencia de la contaminación atmosférica por material particulado en las hospitalizaciones por enfermedades respiratorias en niños, entre 2001 y 2005 en la Región Metropolitana de Chile, independientemente de la presencia ambiental de virus sincicial respiratorio (VRS). MATERIAL Y MÉTODO: 72.479 hospitalizaciones públicas y privadas por enfermedades respiratorias de niños menores de 15 años residentes en la región del estudio se analizaron con un diseño de caso control alternante, con estratificación temporal. Se evaluó principalmente: hospitalizaciones por enfermedades respiratorias (J00-J99), neumonía (J12-J18); asma (J21.0 - J21.9) y bronquiolitis (J45 - J46). Recopilándose diariamente temperatura, MP10, MP2,5, ozono, virus respiratorios (VRS) y humedad ambientales. RESULTADOS: Los promedios de MP10 y MP2,5 fueron 81,5 y 41,2 pg/m3 respectivamente. El promedio de temperatura fue 12,8 °C y de la humedad del aire 72,6 %. Un aumento de 10 pg/m3 de MP25 con 1 y 2 días de rezago se asoció con un incremento de las hospitalizaciones por enfermedades respiratorias cercano a 2%, este porcentaje aumentó a 5% cuando la exposición fue con 8 días de rezago, reflejando sinergismo entre material particulado y virus respiratorio (VRS). CONCLUSIÓN: La exposición breve a contaminación atmosférica puede provocar hospitalizaciones por enfermedades respiratorias en niños.

INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2,5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2.5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.

Mecanismos de los efectos nocivos para la salud de la contaminación atmosférica proveniente de incendios forestales / Mechanisms of noxious effects of wildfire air pollution over human health

Los incendios forestales representan un problema creciente de la salud pública a nivel mundial, especialmente para la población más vulnerable (niños, ancianos, embarazadas y portadores de enfermedades cardiovasculares o respiratorias crónicas) expuesta al humo y a otros contaminantes aéreos. A diferencia de la contaminación atmosférica habitual de grandes urbes, aquella derivada de los incendios forestales tiene una composición diferente y su ocurrencia es esporádica y difícil de prever. La exposición a contaminantes atmosféricos derivados de incendios forestales se asocia a aumento de la morbilidad respiratoria y cardiovascular, mediada por una respuesta inflamatoria pulmonar y sistémica, estrés oxidativo y disfunción endotelial. En sujetos expuestos a humo de incendios forestales se ha observado un aumento en la producción de citoquinas pro-inflamatorias, activación endotelial y disfunción del sistema nervioso autónomo, que produce daño tisular, aumento de los mecanismos protrombóticos, aumento de la presión arterial y cambios en el ritmo cardiaco. Esta revisión analiza los mecanismos que han sido involucrados en generar efectos nocivos para la salud de seres humanos expuestos a material particulado y gases emanados de incendios forestales.

Wildfires represent a growing global public health issue, especially to the most vulnerable segment of the population (children, old people, pregnant women, patients with cardiovascular or respiratory diseases) exposed to smoke and other air borne contaminants generated from these events. In contrast to great cities ' usual atmospheric pollution, that derives from forest fires differ in composition and its occurrence is sporadic and usually unpredictable. Exposure to atmospheric pollutants derived from forest fires has been associated to increased respiratory and cardiovascular morbidity, mediated by an inflammatory systemic response, oxidative stress and endothelial dysfunction. In people exposed to forest fire smoke an increased production of pro-inflammatory cytokines, endothelial activation and autonomic nervous system dysfunction has been observed, that leads to tissue injury, increased prothrombotic response, increased blood pressure and changes in heart rhythm. This review analyzes the mechanisms that have been involved in generating harmful health effects in humans exposed to inhaled particulate matter and gases steaming from wildfires.

Espirometría: Manual de procedimientos. SERChile / Spirometry Procedure Manual. SER Chile 2018

La espirometría es una prueba fundamental en la evaluación funcional respiratoria. Actualmente es muy utilizada debido a su bajo costo y aceptable reproducibilidad incluso en niños entre 2 y 6 años de vida. Considerando la importancia de aplicar procedimientos estandarizados para realizar espirometrías, el año 2006 un comité de especialistas en función pulmonar de la Sociedad Chilena de Enfermedades Respiratorias, elaboró un manual de procedimientos para realizar espirometrías. El año 2014 se publicaron ecuaciones de referencia para adultos chilenos y recientemente se han publicado recomendaciones para estandarizar el informe de los resultados de las pruebas de Función Pulmonar por las Sociedades Americana y Europea de Enfermedades Respiratorias ATS/ERS 2017. El objetivo de esta publicación ha sido actualizar el manual de procedimientos ya existente e incluir los nuevos conceptos de espirometrías en preescolares, valores de referencia, formato e interpretación de los informes.

Spirometry is a basic test for assessing pulmonary function. This test is largely used nowadays, because of its low cost and acceptable reproducibility. Its feasibility has been shown even in 2 to 6 year old children. Considering the importance of applying standardized techniques in spirometry, a committee of specialists on pulmonary function from Chilean Respiratory Society, published in 2006 a procedures manual on spirometry. By 2014 new spirometric reference equations for healthy Chilean adults were published and more recently in 2017, the American Thoracic Society and the European Respiratory Society have published recommendations for a standardized pulmonary function report. The aim of this manual is to report international norms performing spirometry, in order to promote their application in clinical and laboratory practice. In addition, this reviewed manual encloses newest concepts on spirometry in preschool children, reference values, and a general assent way for interpreting and reporting spirometric values at clinical and at laboratory work is proposed.

Reflexiones sobre el nacimiento y desarrollo de nuestra especialidad en Chile. Celebrando el 50° Congreso de la Sociedad Chilena de Enfermedades Respiratorias / Reflections on the birth and development of our speciality in Chile. Celebrating the 50° Congress of Chilean Society of Respiratory Diseases

Resumen La Sociedad Chilena de Enfermedades Respiratorias nació en 1930 como una sociedad de Tisiología, ya que la tuberculosis era un problema crítico de salud pública en esos tiempos. Desde entonces y hasta ahora los miembros de la sociedad han logrado incorporar los grandes y progresivos avances del conocimiento global sobre las enfermedades respiratorias y sus tecnologías en la práctica, docencia e investigación de esta especialidad médica en Chile. Este artículo comenta sobre los inicios y ulterior desarrollo y evolución de la neumología en medicina y pediatría en Chile. También se refiere a los pioneros y a algunos de los más destacados protagonistas como también a las instituciones involucradas y a las principales actividades realizadas por la ahora llamada Sociedad Chilena de Enfermedades Respiratorias de 87 años de edad. Se plantean algunos de sus principales desafíos presentes y futuros. Es de esperar que la Sociedad pueda superar estos desafíos respetando rigurosamente los principios éticos y humanitarios que inspiraron a sus fundadores.

Chilean Society of Respiratory Diseases was born in 1930 as a Tisiology society, because tuberculosis was a crucial problem of public health at those times. From then to our nowadays the society's members have been able to incorporate the great and progressive advances of the global knowledge on respiratory diseases and its technologies into the practice, teaching and research of this medical specialty in Chile. This article comments about the beginnings and the further development and evolution of respiratory medicine and pediatrics in Chile. It also refers to the pioneers and some of the most relevant protagonists as well the institutions involved and the main activities carried out by the now 87 years-old organism so called Chilean Respiratory Society. Some of present and future major challenges for this Society are outlined. Hopefully the Society will be able to cope with these challenges honoring the ethical and humanitarian principles that inspired to its founders.

[Effect of copper sulphate on the lung damage induced by chronic intermittent exposure to ozone]. / Efecto del sulfato de cobre en el daño pulmonar inducido por la exposición crónica intermitente a ozono.

BACKGROUND: Ozone exposure could increase lung damage induced by airborne particulate matter. Particulate matter lung toxicity has been attributed to its metallic content. AIM: To evaluate the acute effect of intratracheal administration of copper sulfate (CuSO4) on rat lungs previously damaged by a chronic intermittent ozone exposure. MATERIAL AND METHODS: Two-months-old male Sprague-Dawley rats were exposed to 0.5 ppm ozone four h per day, five days a week, during two months. CuSO4 was intratracheally instilled 20 h after ozone exposure. Controls breathed filtered air or were instilled with 0.9% NaCl or with CuSO4 or were only exposed to ozone. We evaluated lung histopathology. F2 isoprostanes were determined in plasma. Cell count, total proteins, γ glutamyl-transpeptidase (GGT) and alkaline phosphatases (AP) were determined in bronchoalveolar lavage fluid (BALF). RESULTS: Ozone increased total cell count, macrophages, proteins and AP in BALF (p < 0.05), and induced pulmonary neutrophil inflammation. CuSO4 plus air increased plasma F2 isoprostane levels and total cell count, neutrophils and proteins in BALF (p < 0.05). Histopathology showed foamy macrophages. Ozone plus CuSO4 exposed animals showed a neutrophil inflammatory lung response and an increase in total cell count, proteins, GGT and AP in BALF (p < 0.05). Foamy and pigmented alveolar macrophages were detected in all lungs of these animals (p < 0.001). CONCLUSIONS: Intratracheal instillation of a single dose of CuSO4 in rats previously subjected to a chronic and intermittent exposure to ozone induces a neutrophil pulmonary inflammatory response and cytoplasmic damage in macrophages.

Efecto del sulfato de cobre en el daño pulmonar inducido por la exposición crónica intermitente a ozono / Effect of copper sulphate on the lung damage induced by chronic intermittent exposure to ozone

Background: Ozone exposure could increase lung damage induced by airborne particulate matter. Particulate matter lung toxicity has been attributed to its metallic content. Aim: To evaluate the acute effect of intratracheal administration of copper sulfate (CuSO4) on rat lungs previously damaged by a chronic intermittent ozone exposure. Material and Methods: Two-months-old male Sprague-Dawley rats were exposed to 0.5 ppm ozone four h per day, five days a week, during two months. CuSO4 was intratracheally instilled 20 h after ozone exposure. Controls breathed filtered air or were instilled with 0.9% NaCl or with CuSO4 or were only exposed to ozone. We evaluated lung histopathology. F2 isoprostanes were determined in plasma. Cell count, total proteins, γ glutamyl-transpeptidase (GGT) and alkaline phosphatases (AP) were determined in bronchoalveolar lavage fluid (BALF). Results: Ozone increased total cell count, macrophages, proteins and AP in BALF (p < 0.05), and induced pulmonary neutrophil inflammation. CuSO4 plus air increased plasma F2 isoprostane levels and total cell count, neutrophils and proteins in BALF (p < 0.05). Histopathology showed foamy macrophages. Ozone plus CuSO4 exposed animals showed a neutrophil inflammatory lung response and an increase in total cell count, proteins, GGT and AP in BALF (p < 0.05). Foamy and pigmented alveolar macrophages were detected in all lungs of these animals (p < 0.001). Conclusions: Intratracheal instillation of a single dose of CuSO4 in rats previously subjected to a chronic and intermittent exposure to ozone induces a neutrophil pulmonary inflammatory response and cytoplasmic damage in macrophages.

Análisis bibliométrico de las revistas de enfermedades respiratorias de América Latina / A bibliometric analysis of Latin American journals on respiratory diseases

In 2007, the editorial situation of seven Latin American journals on respiratory diseases was analyzed in a meeting sponsored by ALAT (Latin American Association of Thoracic Diseases). Among the major problems reported were the lack of a regular and adequate periodicity in issue’s circulation, high turnover of editors and lack of original papers submitted, that lead to a low percentage of submitted papers rejection. The present situation of Latin American journals on respiratory diseases is currently compared with the Iberian Peninsula journals Archivos de Bronconeumología and Revista Portuguesa de Pneumologia, through the international data base LILACS (Literatura Latinoamericana en Ciencias de la Salud), SciELO (Scientific Electronic Library on Line), SCImago Journal & Country Rank, MEDLINE (National Library of Medicine, USA) and JCR (Journal Citation Report). The Jornal Brasileiro de Pneumologia is the Latin American journal with the best bibliometric indices; nevertheless, it is ranked behind Spain’s Archivos de Bronconeumología (ABN). Interestingly 11% of the 238 citable articles published in ABN from 2013 to 2015 had authors from Latin America. Conclusions: Although Latin American journals on respiratory diseases disseminate valuable information in their national environment accomplishing an educational role, their global impact and bibliometric indices are exiguous.

En una reunión patrocinada por la ALAT (Asociación Latinoamericana de Tórax) realizada en 2007, se analizó la situación editorial de siete revistas latinoamericanas de enfermedades respiratorias. Entre los principales problemas se señalaron la carencia de una periodicidad regular y adecuada en la publicación de los fascículos, el elevado recambio de editores y la escasez de manuscritos originales enviados para su eventual publicación, de lo cual resulta un bajo porcentaje de rechazo en los manuscritos sometidos a revisión. La actual situación de las revistas latinoamericanas de enfermedades respiratorias es comparada en este artículo con las revistas de la península ibérica Archivos de Bronconeumología y Revista Portuguesa de Pneumologia, mediante las bases de datos internacionales LILACS (Literatura Latinoamericana en Ciencias de la Salud), SciELO (Scientific Electronic Library on line), SCImago Journal & Country Rank, MEDLINE (National Library of Medicine, USA) y JCR (Journal Citation Report). El Jornal Brasileiro de Pneumologia es la revista latinoamericana que tiene los mejores índices bibliométricos, sin embargo, está clasificada por debajo de Archivos de Bronconeumología (ABN). Es interesante destacar que 11% de los 238 artículos citables publicados en ABN entre 2013 y 2015 fueron generados por autores de América Latina. Conclusiones: Si bien las revistas latinoamericanas de enfermedades respiratorias difunden una valiosa información en sus ambientes nacionales cumpliendo una función educacional, tanto su impacto global como sus índices bibliométricos son exiguos.

[Experience of a research Ethics Committee and the challenges of the new Chilean legislation on research in human beings]. / Experiencia del Comité de Ética de Investigación en Seres Humanos de la Facultad de Medicina de la Universidad de Chile y los desafíos que impone la nueva legislación chilena en la investigación médica.

The welfare of research participants must be guaranteed by international ethical standards. This article communicates the procedures of the Research Ethics Committee of the School of Medicine, University of Chile (CEISH). The new Chilean legislation on research in human beings is also discussed. Law 20.120: "On scientific research in human beings, its genome and forbidding human cloning" establishes the ethical principles that must be accomplished in every research involving human beings. Article 28 of the Law 20.584 "Regulation of the rights and duties of health care users", forbids the participation of handicapped people who cannot express their will in scientific research. Article 13 states that people not related directly with patient care cannot have access to his clinical records (with the exception of people with notarial authorization by the patient). CEISH proposes that, in case of people with intellectual deficiency, the decision to approve a scientific research should be analyzed on an individual basis. If the person is capable of expressing his or her will or has stated his or her consent beforehand, the research can be authorized. If the person cannot express his or her will, the scientific research cannot take place. In prospective studies, a consent from the patient and an authorization of the health authority should be required to access clinical records. In retrospective studies, consent should be obtained from the patient when personal information is going to be used. If the information is nameless, the consent can be disregarded.

El ejercicio físico aumenta el daño pulmonar inducido por la exposición aguda e intermitente a 0, 5 ppm de ozono en ratas juveniles / Physical exercise increases pulmonary damage induced by acute and intermittent exposure to 0.5 ppm of ozone in juvenile rats

El ozono (O3) troposférico es el principal oxidante del esmog fotoquímico. Como es un contaminante aéreo, sus efectos están relacionados con la dosis efectiva = [Concentración] x [tiempo de exposición] x [ventilación minuto]. Objetivo: Determinar si el ejercicio físico -que aumenta la ventilación minuto- puede aumentar el daño pulmonar inducido por la exposición a O3 en ratas en reposo. Material y Métodos: Se usó 4 series de ratas Sprague-Dawley juveniles. Dos series fueron expuestas a 0,5 ppm de O3 (4 h diarias por 2 días) en reposo (n = 13) o durante ejercicio (n = 12). Dos series control respiraron aire filtrado (AF) en reposo (n = 13) o durante sesiones de ejercicio (n = 13), en una rueda vertical giratoria (15 min de ejercicio alternados con 15 min de descanso hasta completar 4 h diarias durante 2 días). Las ratas fueron eutanasiadas y se determinó la razón peso húmedo/peso seco (PH/PS) en el pulmón izquierdo. En el lavado broncoalveolar (LBA) del pulmón derecho, se determinó recuento total de células, proteínas totales y actividad de gamma-glutamiltraspeptidasa (GGT). Resultados: la razón PH/PS y el recuento de células y las proteínas del LBA aumentaron en las ratas en reposo expuestas a O3 comparadas con las ratas en reposo que respiraron AF (p < 0,05 ANOVA & Newman-Keuls). La actividad de GGT en el LBA fue mayor en las ratas que en ejercicio respiraron AF en comparación con las ratas que respiraron AF en reposo (p < 0,05). Hubo aumento de GGT, proteínas y recuento de células en el LBA de la serie [ejercicio + O3] comparada con la serie [reposo + O3] (p < 0,05). Conclusión: El ejercicio físico aumenta el daño pulmonar inducido por la exposición aguda e intermitente a 0,5 ppm de O3 en ratas juveniles.

Tropospheric ozone (O3) is the major oxidant of photochemical smog. Being an air pollutant, its effects are related to effective dose = [Concentration] x [exposure time] x [pulmonary ventilation]. Objective: Determine whether physical exercise -that increases pulmonary ventilation- is able to augment the pulmonary damage induced by O3 exposure in resting rats. Material and Methods: Four series of juvenile Sprague-Dawley rats were used. Two series were exposed to 0.5 ppm O3 (4 hours a day for 2 days) at rest (n=13) or during exercise (n=12). Two control series breathed filtered air (FA) at rest (n=13) or during exercise sessions (n=13), in a vertical rotary wheel (15 min exercise alternated with 15 min resting until to completing 4 hours a day for 2 days). Rats were euthanized and wet weight / dry weight ratio (W/D ratio) was determined in left lung. Total cell counting, total protein content and γ-glutamyltraspeptidase (GGT) activity were determined in the right lung bronchoalveolar lavage fluid (BALF). Results: W/D weight ratio as well as total cell counting and protein content increased in BALF from resting rats exposed to O3 as compared with resting rats breathing FA (p < 0.05 ANOVA & Newman-Keuls test). GGT activity in BALF increased in rats under exercise breathing FA as compared with resting rats breathing FA (p<0.05). GGT, proteins and cells counting increased in BALFfrom series [exercise + O3] as compared to series [resting + O3] (p< 0.05). Conclusion: Physical exercise increases lung damage induced by intermittent and acute 0.5 ppm O3 exposure in juvenile rats.