Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study.

BACKGROUND: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. METHODS: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. RESULTS: The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. CONCLUSIONS: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain).

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.

[Epidemiology, presentation forms, radiological stage and diagnostic methods of sarcoidosis in the area of Leon (2001-2008)]. / Epidemiología, formas de presentación, estadio radiológico y métodos diagnósticos de la sarcoidosis en el área de León (2001-2008).

BACKGROUNDS: The epidemiological studies of sarcoidosis in Spain and other countries are from more than one decade ago. OBJECTIVES: To know the current incidence in the health care area of Leon, the reasons for consultation, the thoracic radiologyl involvement, delay and diagnostic methods. PATIENTS AND METHODS: We reviewed the cases of sarcoidosis seen in our hospital between the years 2001-2008. The study is retrospective. RESULTS: 118 patients fulfilled the criteria for sarcoidosis with an incidence of 4.51/100,000 inhab./year. Of these, 53 (44.9%) were male with a mean age of 36.4 ± 12.2 and 65 (55.1%) women, with a mean age of 42.6 ± 17.2 years (P = 0.029). The most frequent presentation form was Löfgren Syndrome with 45.8%, followed by respiratory symptoms 20.3%, radiological findings 12.7%, general syndrome 10.2% and miscellaneous 11%. Thoracic radiological affectations at the time of diagnosis were: stage I: 59.3%, stage II: 19.8%, stage III: 10%, fibrosis 3.4% and stage 0: 8.5%. Transbronchial biopsy was the most frequent diagnosis. Time to diagnosis was very variable with a median of 24.5 days, when it debuted as erythema nodosum, 80 in the less frequent forms. CONCLUSIONS: The incidence of sarcoidosis was superior to that previously demonstrated. It affected young adults, but with an increase in the number of cases in those over 50 years with clear female predominance. Löfgren syndrome was the most frequent presentation form, with a higher incidence in spring. Diagnostic delay varied according to the different presentation forms. Transbronchial biopsy was the main diagnostic tool.

The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies.

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

Predicted change in the number of permanent medical teachers from 2017 to 2026. The training of future physicians in critical condition. / Evolución previsible en el número de profesores permanentes de Medicina del 2017 al 2026. La formación de los futuros médicos en situación crítica.

The significant and progressive reduction in the number of permanent teachers in medical schools (professor, associate professor and assistant professor) is a reason for concern for the National Conference of Deans. This reduction will intensify in the coming decade (2017-2026). Forty-three percent of the permanent faculty will retire, as will 55% of the faculty linked to clinical areas, 34% of the faculty not linked to clinical areas and 32% of the faculty of basic areas. This deficit is significant now, and, in a few years, the situation will be unsustainable, especially in the clinical areas. This report reveals the pressing need to adopt urgent measures to alleviate the present situation and prevent a greater problem. The training of future physicians, immediately responsible for the health of our society, depends largely on the theoretical and practical training taught in medical schools, with the essential collaboration of healthcare institutions. Paradoxically, while the number of teachers decreases substantially, there is an exponential increase in the number of medical schools and students who are admitted every year without academic or healthcare justification.

[Method for the study of pulmonary function in laryngectomized patients]. / Método para el estudio de la función pulmonar en los laringectomizados.

OBJECTIVE: The aim of the study is to develop a instrumental method capable to achieve pulmonary air function test (spirometry) by assembling the spirometer mouthpiece to the laryngectomized patient's stoma. MATERIAL AND METHOD: Our study was carried out in 33 laryngectomized patients (all male). The spirometer tests were done with a Datospir 92 by Sibelmed equipment, which consists of a dry Fleish pneumotacographer with flow and volume chart register. We have made a stoma-spirometer adapter with a cardboard tube, an adhesive and silicone disc. RESULTS: The whole sample achieved excellent outcome with the stoma-spirometer adapter. Nor air leak neither high resistence were measured while spirometry was performed. CONCLUSIONS: We consider that the facts studied may enable us to add, pragmatically, new resources to the more effective understanding of the respiratory handicap in the laryngectomized population.

[Qualitative spectral evaluation of oesophagic voice]. / Evaluación espectral cualitativa de la voz esofágica.

OBJECTIVES: The aim of the study is to determine the accuracy of acoustic spectrography as an outstanding tool in the characterization and monitoring of esophageal voice. MATERIAL AND METHODS: Our subjects were comprised of 33 laryngectomized patients (all male) that underwent qualitative acoustic (spectrography of vowel /a/ and a sentence), quantitative acoustic (phonation time, fundamental frequency, maximun intensity sound level, speech rate) and perceptual protocol. RESULTS: There is a significant statistical relationship among Yanagihara-like spectrographic chart classification, psycho-acoustical perception and quantitative acoustic parameters. CONCLUSION: We consider that acoustic spectrography is an easy, effective method for studying esophageal voice, seeking for improving oral communication skills and rehabilitation in the laryngectomee population.

[Amyloidosis in the ORL field]. / La amiloidosis en el area otorrinolaringológica.

OBJECTIVES: To review the clinical and pathological characteristics of upper aerodigestive tract amyloidosis with particular attention to laryngeal amyloidosis. Amyloidosis of the upper aerodigestive tract is relatively rare. The larynx is the most common site of involvement in head and neck isolated amyloidosis and the supraglottic region represents the major site of involvement. MATERIAL AND METHODS: Retrospective review of 6 patients diagnosed with upper aerodigestive tract amyloidosis. Hoarseness and airway compromise were the main presenting symptoms. RESULTS: Laryngeal CO2 laser microsurgery was performed and then we refered the patients to the Medical Deparment seeking for systemic involvement and ENT Clinic follow up. CONCLUSIONS: In our experience, laryngeal CO2 laser microsurgery is a succesfull way to treat isolated laryngeal amyloidosis with clinical improvement and low recurrence rates.

[Unilateral vocal fold paralysis: quality of voice after speech therapy]. / Parálisis de cuerda vocal unilateral: estudio de la calidad vocaldespués del tratamiento logopédico

BACKGROUND: To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol. METHODS: Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination,blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy. RESULTS: The average age was 51 years (range 20-80), 60%women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001).Only 8.5% of the patients required surgical intervention after treatment. CONCLUSIONS: Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis.

[Acoustic and aerodynamic characteristics of the oesophageal voice]. / Caracterización acústica y aerodinámica de la voz esofágica.

OBJECTIVE: The aim of the study is to determine the physiology and pathophisiology of esophageal voice according to objective aerodynamic and acoustic parameters (quantitative and qualitative parameters). MATERIAL AND METHODS: Our subjects were comprised of 33 laryngectomized patients (all male) that underwent aerodynamic, acoustic and perceptual protocol. RESULTS: There is a statistical association between acoustic and aerodynamic qualitative parameters (phonation flow chart type, sound spectrum, perceptual analysis) among quantitative parameters (neoglotic pressure, phonation flow, phonation time, fundamental frequency, maximum intensity sound level, speech rate). CONCLUSION: Nevertheles, not always such observations bring practical resources to clinical practice. We consider that the facts studied may enable us to add, pragmatically, new resources to the more effective vocal rehabilitation to these patients. The physiology of esophageal voice is well understood by the method we have applied, also seeking for rehabilitation, improving oral communication skills in the laryngectomee population.

[Magnetoencephalography in cognitive disorders involving frontal lobes]. / La magnetoencefalografía en los trastornos cognitivos del lóbulo frontal.

INTRODUCTION AND DEVELOPMENT: Frontal lobe, more specifically prefrontal cortex, is one of the brain regions that undergoes more protracted ongoing development. The wider the developmental window of one brain structure, the more vulnerable the functions related to it. Hence, executive functions, which are mediated by prefrontal networks, seems to be specially vulnerable during childhood. Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders. Functional neuroimaging techniques have shown a dysfunction in a fronto-striatal network in this disorder, that is likely subserving deficits in executive processes, such as in response inhibition. DISCUSSION: This review focuses on contributions of neuroimaging techniques, with high spatial (SPECT, PET and fMRI), temporal (ERP) and spatio-temporal (MEG) resolution, to the neurofunctionality of ADHD.

[The neurofunctional foundation of cognitive rigidity in attention deficit hyperactivity disorder: some preliminary findings]. / Sustrato neurofuncional de la rigidez cognitiva en el trastorno por deficit de atencion con hiperactividad: resultados preliminares.

INTRODUCTION: It has been proposed that there is an impairment in cognitive flexibility in children with attention deficit hyperactivity disorder (ADHD). The Wisconsin card sorting test (WCST) is the most widely used neuropsychological test for assessing this process. Previous studies have reported the presence of a subgroup of children with ADHD which has a low cognitive flexibility. In addition this subgroup showed a high resistance to the treatment with stimulant medication. OBJECTIVES: The aim of this study was to examine whether there were different patterns of brain magnetic activity in different subgroups of ADHD, during the performance of a cognitive flexibility task, such as WCST. PATIENTS AND METHODS: We recruited a sample of 18 children, divided into three groups according to DSM IV R diagnostic criteria. Here we present preliminary data based on a subsample of nine children. Brain magnetic activity was registered while the children performed the WCST by means of Magnetoencephalography (MEG). This is a non invasive neuroimaging technique with a high spatio temporal resolution. RESULTS: Preliminary results showed that ADHD mixed group had a higher rate of perseverative responses. In addition, a different pattern of brain magnetic activity was noted in this group, showing less activation in anterior cingulate cortex and dorsolateral prefrontal cortex in the left hemisphere during the first 400 ms. CONCLUSIONS: MEG seems to be an useful tool to describe the brain network that subserves cognitive flexibility in different groups of children. It could have important repercussions in the classification of ADHD, both neuropsychologically and pharmacologically.

[Antitumoral effect of HSV-tk suicide gene associated with ganciclovir in an experimental model of head and neck epidermoid carcinoma]. / Efecto antitumoral del gen suicida HSV-tk y ganciclovir en un modelo experimental de carcinoma epidermoide de cabeza y cuello.

INTRODUCTION: We studied the transfection by adenoviral vectors and the antitumoral effect of HSV-tk gene associated with ganciclovir (AdCMVtk/GCV) in KB human oral cavity squamous cell carcinoma, in vitro and in vivo. MATERIALS AND METHODS: Transfection was assessed by the X-gal stain. It was used in cell cultures and tumoral sections previously exposed to adenoviral vector AdCMVlacZ. In vitro, in order to study the antitumoral effect of AdCMVtk/GCV, survival of cell cultures exposed to AdCMVtk/GCV and to AdCMVlacZ/GCV was compared. In vivo, necrotic volume as a percentage of total tumoral volume, was compared between AdCMVtk/GCV treated group and AdCMVlacZ/GCV exposed group. Hepatic and renal toxicities were assessed. RESULTS: In vitro, survival of cell cultures treated with AdCMVtk/GCV was less than AdCMVlacZ/GCV exposed cells. In vivo, necrotic volume was larger in AdCMVtk/GCV treated group than in AdCMVlacZ/GCV exposed group. No toxicity was found (hepatic, renal). CONCLUSIONS: KB cells are transfected by adenoviral vectors and are killed by AdCMVtk/GCV, both in vitro and in vivo (no toxicity was found in the animal model).

[Respiratory effects of nicotine and naloxone]. / Efectos respiratorios de nicotina y naloxona.

The effect of an i.v. bolus injection of nicotine 50 micrograms/kg-1, was compared in 6 awake dogs with the effect of nicotine injection after naloxone, 400 micrograms/kg-1. Respiratory inhibition was produced immediately after beginning the nicotine injection, followed by hyperpnea. Naloxone produced a significant decrease of the respiratory inhibition followed by hyperpnea increase compared to the trial with only nicotine.

[Laryngeal apnea]. / Apnea laríngea.

The apneic laryngeal chemoreflex (QRL), elicited by water on the vocal cords and the reflex by mechanical stimulation (MRL) has been compared in dog. The response decrease with naloxone at a 400 micrograms.kg-1, suggesting that the reflex inhibition depends on endogenous opioids of the respiratory centre.

[Recent contributions from magnetoencephalography to the neurobiology of attention-deficit/hyperactivity disorder]. / Nuevas aportaciones a la neurobiología del trastorno por déficit de atención con hiperactividad desde la magnetoencefalografía.

INTRODUCTION AND DEVELOPMENT: Current theories postulate that the core cognitive deficit in attention-deficit/hyperactivity disorder (ADHD) is an executive dysfunction. Neuroimaging studies on the whole have provided both anatomical and functional evidence supporting the fronto-striatal dysfunction hypothesis in ADHD. However, recent neuroimaging studies have found anatomical and functional impairments in posterior cortical regions, such as the inferior parietal and posterior temporal cortices, which have been related to a deficit in selective attention. Event related potential (ERP) studies show that ADHD children have an impairment in early components (within the first 200 ms of processing), such as P1 or N1, both of which are sensitive to selective attention effects. These findings cast doubt regarding the fronto-striatal/executive dysfunction as the core deficit in ADHD. CONCLUSIONS: One of the main objectives of ADHD research is the search for its core cognitive deficit and the neural networks underlying it, because it has important repercussions over ADHD diagnosis and treatment. High temporal resolution techniques, such as ERP or magnetoencephalography may be particularly useful in distinguishing the precise moment of cognitive processing during which the brain activity of children with ADHD begins to be impaired. As a consequence, this may help to elucidate the core cognitive deficit in ADHD.

[Apneic laryngeal chemoreflex and naloxone]. / Quimiorreflejo laríngeo apneico y naloxona.

The apneic laryngeal chemoreflex (QRL), elicited by water on the vocal cords and by mechanical stimulation (MRL) has been compared in dog. Both stimuli cause apnea, bradycardia, hypotension and constriction of the glottis. In QRL apnea predominates white in MRL bradycardia is more intense. All the components of the response decrease with naloxone at a 400 micrograms X kg-1 doses, suggesting that the reflex inhibition depends on endogenous opioids located in the respiratory centre.