Morphological and transcriptional analysis of Colletotrichum lindemuthianum race 7 during early stages of infection in common bean.

The infection process of the hemibiotrophic fungus Colletotrichum lindemuthianum has been independently studied at the microscopic and genomic levels. However, the relationship between the morphological changes and the pathogenicity mechanisms of the fungus at the early stages of the infection remains uncharacterized. Therefore, this study attempts to bridge this gap by integrating microscopic and transcriptional approaches to understand the infection process of C. lindemuthianum. Fungal structures were followed by fluorescence microscopy for 120 hours. Simultaneously, the transcriptomic profile was made using RNAseq. Morphological characterization shows that appressoria, infective vesicles, and secondary hypha formation occur before 72 hours. Additionally, we assembled 38,206 transcripts with lengths between 201 and 3,548 bp. The secretome annotation revealed the expression of 1,204 CAZymes, of which 17 exhibited secretion domains and were identified as chitinases and ß-1,3-glucanases, 27 were effector candidates, and 30 were transport proteins mostly associated with ABC-type. Finally, we confirmed the presence and expression of CAC1 role during the appressoria formation of Clr7. This result represents the first report of adenylate cyclase expression evaluated under three different approaches. In conclusion, C. lindemuthianum colonizes the host through different infection structures complemented with the expression of multiple enzymes, where CAC1 favors disease development.

Effects of usual yoga practice on the diaphragmatic contractility: A cross-sectional controlled study.

Objectives: The aim of this study is to observe and compare the effects of regular yoga practice on the main inspiratory muscle, the diaphragm, by analyzing its thickness, excursion, velocity and contraction time, using ultrasound. Design: A Cross-Sectional Controlled Study. Participants: 80 healthy subjects (40 habitual yoga practitioners and 40 non-practitioners), without previous respiratory pathology participated in this study. During maximum diaphragmatic breathing, the diaphragmatic thickness (at rest and after maximum inspiration), excursion, velocity and contraction time were measured by ultrasound. Results: in the experimental group, practicing yoga, statistically significant differences (p < 0.001) were observed compared to the control group, not practicing, in the thickness of the diaphragm at rest (0.26 ± 0.02 vs 0.22 ± 0.01 cm); the diaphragmatic thickness in maximum inspiration (0.34 ± 0.03 vs 0.28 ± 0.03 cm); contraction velocity (1.54 ± 0.54 vs 2.23 ± 0.86 cm/s), contraction time (3.28 ± 0.45 vs 2.58 ± 0.49 s) and Borg scale of perceived exertion (1.05 ± 1.6 vs 1.70 ± 1.34), p = 0.05. However, the diaphragmatic excursion was greater in the control group (5.45 ± 1.42 vs 4.87 ± 1.33 cm) with no statistically significant differences (p = 0.06). Conclusions: the regular practice of yoga improves the parameters of diaphragm thickness, speed and contraction time measured in ultrasound and the sensation of perceived exertion during a maximum inspiration. So it can be considered as another method for training the inspiratory muscles in clinical practice.

Decrease in Readmissions after Hospitalisation for COPD Exacerbation through a Home Care Model.

Objective: To decrease readmissions at 30 and 90 days post-discharge from a hospital admission for chronic obstructive pulmonary disease exacerbation (COPDE) through the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU), increase patient survival at one year, and validate our readmission risk scale (RRS). Materials and methods: This was an observational study, with a prospective data collection and a retrospective data analysis. A total of 491 patients with a spirometry diagnosis of chronic obstructive pulmonary disease (COPD) requiring hospitalisation for an exacerbation were included in the study. Subjects recruited within the first year (204 cases) received conventional care (CC). In the following year a home care (HC) programme was implemented and of those recruited that year (287) 104 were included in the ACRCU, administered by a specialised nurse. Results: In the group of patients included in the home care model of the Ambulatory Chronic Respiratory Care Unit (ACRCU) a lower number of readmissions was observed at 30 and 90 days after discharge (30.5% vs. 50%, p = 0.012 and 47.7% vs. 65.2%, p = 0.031, respectively) and a greater one-year survival (85.3% vs. 59.1%, p < 0.001). The validation of our RRS revealed that the tool's capacity to predict readmissions at both 30 and 90 days was not high (AUC = 0.69 and AUC = 0.66, respectively). Conclusions: The inclusion of exacerbator or fragile COPD patients in the ACRCU could achieve a decrease in readmissions and an increase in survival. The number of episodes of exacerbation within the 12 months prior to the hospital admission is the variable that best predicts the risk of readmission.

Objetivo: Disminuir los reingresos a los 30 y 90 días tras el alta por un ingreso hospitalario por exacerbación de enfermedad pulmonar obstructiva crónica (EPOC) a través del modelo de atención domiciliaria de la Unidad de Cuidados Crónicos Respiratorios Ambulatorios (UCCRA), aumentar la supervivencia al año y validar nuestra escala de riesgo de reingreso (ERR). Material y métodos: Estudio observacional con recogida prospectiva de datos. Se incluyó en el estudio a un total de 491 pacientes con diagnóstico espirométrico de enfermedad pulmonar obstructiva crónica que requirieron hospitalización por una agudización. Los sujetos reclutados dentro del primer año (204 casos) recibieron atención convencional (AC). Al año siguiente se implementó un programa de atención domiciliaria (AD) y de los pacientes reclutados ese año (287), 104 fueron incluidos en la UCCRA con seguimiento de una enfermera especializada. Resultados: En el grupo de pacientes incluidos en el modelo de atención domiciliaria de la UCCRA se observó un menor número de reingresos a los 30 y 90 días tras el alta (30,5% vs 50%, p = 0,012 y 47,7% vs. 65,2%, p = 0,031, respectivamente) y una mayor supervivencia al año (85,3% vs. 59,1%, p < 0,001). La validación de nuestra ERR reveló que la capacidad de la misma para predecir reingresos tanto a los 30 como a los 90 días no era alta (AUC = 0,69 y AUC = 0,66, respectivamente). Conclusiones: La inclusión de pacientes con EPOC agudizadores o frágiles en la UCCRA podría conseguir una disminución de los reingresos y una aumento de la supervivencia. El número de agudizaciones en los 12 meses previos al ingreso hospitalario es la variable que mejor predice el riesgo de reingreso.

Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments.

Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.

Elevated levels of arginase activity are related to inflammation in patients with COPD exacerbation.

INTRODUCTION: Within the pathogenesis of the chronic obstructive pulmonary disease (COPD) there are interactions between different inflammatory mediators that are enhanced during an exacerbation. Arginase is present in bronchial epithelial cells, endothelial, fibroblasts and alveolar macrophages, which make it a probable key enzyme in the regulation of inflammation and remodelling. We aimed to find a potential relationship between arginase activity, inflammatory mediators in COPD patients in stable phase and during exacerbations. METHODS: We performed a prospective, observational study of cases and controls, with 4 study groups (healthy controls, stable COPD, COPD during an exacerbation and COPD 3 months after exacerbation). We measured arginase, inflammation markers (IL-6, IL-8, TNF-∝, IFN-γ and C reactive protein), and mediators of immunity: neutrophils, monocytes, total TCD3 + lymphocytes (CD3ζ), CD4 + T cells, CD8 + T cells, NK cells. RESULTS: A total of 49 subjects were recruited, average age of 69.73 years (59.18% male). Arginase activity is elevated during an exacerbation of COPD, and this rise is related to an increase in IL-6 production. The levels of IL-6 and IL-8 remained elevated in patients with COPD at 3 months after hospital exacerbation. We did not find a clear relationship between arginase activity, immunity or with the degree of obstruction in COPD patients. CONCLUSIONS: Arginase activity is elevated during an exacerbation of COPD, and it could be related to an increase in the production of IL-6. Levels of IL-6, IL-8, and arginase activity remain elevated in patients with COPD at 3 months after hospital exacerbation. Arginase activity could contribute to the development of COPD.

Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.

INTRODUCTION: Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. METHODS: We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. RESULTS: A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). CONCLUSIONS: TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.

Patient Management Assisted by a Neural Network Reduces Mortality in an Intermediate Care Unit / El manejo del paciente asistido por una red neuronal disminuye la mortalidad en una unidad de cuidados intermedios

INTRODUCTION: Mortality risk prediction for Intermediate Respiratory Care Unit's (IRCU) patients can facilitate optimal treatment in high-risk patients. While Intensive Care Units (ICUs) have a long term experience in using algorithms for this purpose, due to the special features of the IRCUs, the same strategics are not applicable. The aim of this study is to develop an IRCU specific mortality predictor tool using machine learning methods. METHODS: Vital signs of patients were recorded from 1966 patients admitted from 2007 to 2017 in the Jiménez Díaz Foundation University Hospital's IRCU. A neural network was used to select the variables that better predict mortality status. Multivariate logistic regression provided us cut-off points that best discriminated the mortality status for each of the parameters. A new guideline for risk assessment was applied and mortality was recorded during one year. RESULTS: Our algorithm shows that thrombocytopenia, metabolic acidosis, anemia, tachypnea, age, sodium levels, hypoxemia, leukocytopenia and hyperkalemia are the most relevant parameters associated with mortality. First year with this decision scene showed a decrease in failure rate of a 50%. CONCLUSIONS: We have generated a neural network model capable of identifying and classifying mortality predictors in the IRCU of a general hospital. Combined with multivariate regression analysis, it has provided us with an useful tool for the real-time monitoring of patients to detect specific mortality risks. The overall algorithm can be scaled to any type of unit offering personalized results and will increase accuracy over time when more patients are included to the cohorts

INTRODUCCIÓN: La predicción del riesgo de mortalidad de los pacientes en la unidad de cuidados respiratorios intermedios (UCRI) puede facilitar un tratamiento óptimo en pacientes de alto riesgo. Si bien las unidades de cuidados intensivos (UCI) tienen una experiencia a largo plazo en el uso de algoritmos para este propósito, debido a las características especiales de las UCRI, no se pueden aplicar las mismas estrategias. El objetivo de este estudio es desarrollar una herramienta de predicción de mortalidad específica para la UCRI utilizando métodos de aprendizaje automático. MÉTODOS: Se registraron los signos vitales de 1.966 pacientes ingresados entre 2007 y 2017 en la UCRI del Hospital Universitario de la Fundación Jiménez Díaz. Se utilizó una red neuronal para seleccionar las variables que mejor predijeran el estado de mortalidad. La regresión logística multivariante nos proporcionó los puntos de corte que discriminaban mejor el estado de la mortalidad para cada uno de los parámetros. Se aplicó una nueva guía para la evaluación de riesgos, y se registró la mortalidad durante un año. RESULTADOS: Nuestro algoritmo muestra que la trombocitopenia, la acidosis metabólica, la anemia, la taquipnea, la edad, los niveles de sodio, la hipoxemia, la leucocitopenia y la hipercalemia son los parámetros más relevantes asociados con la mortalidad. En el primer año con este escenario de decisión se mostró una disminución en la tasa de fracaso de un 50%. CONCLUSIONES: Hemos generado un modelo de red neuronal capaz de identificar y clasificar predictores de mortalidad en la UCRI de un hospital general. Combinado con el análisis de regresión multivariante, nos ha proporcionado una herramienta útil para la monitorización en tiempo real de pacientes para detectar riesgos de mortalidad específicos. El algoritmo general se puede modificar a escala para cualquier tipo de unidad, lo que ofrecerá resultados personalizados, y su precisión aumentará con el tiempo, según se incluyan más pacientes en las cohortes

Recomendaciones de diagnóstico y tratamiento del ataque cerebrovascular isquémico agudo durante la contingencia por covid-19 / Recommendations for diagnosis and treatment of the acute ischemic stroke during COVID-19 contingency

RESUMEN INTRODUCCIÓN. El tiempo es un factor importante en el tratamiento del ACV agudo, con la pandemia de covid-19 se puede ver afectada la adherencia a las guías. Se han reportado tasas de ACV en presencia de covid-19 alrededor del 5%, además un aumento en el tiempo de consulta de los pacientes en otras regiones del mundo y una mayor ocupación de camas de UCI para patologías respiratorias que usualmente se destinan a pacientes con ACV. Este documento recoge las recomendaciones del comité de Enfermedad Cerebrovascular de la Asociación Colombiana de Neurología basados en la literatura y votadas por consenso. OBJETIVOS. Proporcionar una guía rápida adaptada a los diferentes escenarios de atención de ACV en Colombia, divididos en centro listo, primario y avanzado incluyendo una ruta de atención para paciente con sospecha de covid-19 denominada Código ACV protegido, que incluye el uso de elementos de protección personal para pacientes y personal de salud. PUNTOS PRINCIPALES. Dentro de las recomendaciones principales está el cuestionario de tamizaje al ingreso a urgencias, uso de tapabocas para el paciente, considerar todo Código ACV sospechoso de covid-19, toma de PCR para covid-19 en todos los ACV y llevar a zona buffer. En sospecha de oclusión proximal incluir tomo-grafía de tórax a la evaluación de imágenes. CONCLUSIONES. Establecer pautas de atención durante la pandemia covid-19 permite optimizar protección para pacientes y personal de salud, disminuir retrasos y tratar de evitar que pacientes no reciban el tratamiento adecuado en los diferentes niveles de atención del sistema de salud.

SUMMARY INTRODUCTION. Time is an important factor in the treatment of acute stroke, with the COVID-19 pandemic adherence to guidelines can be affected. Stroke rates in the presence of COVID-19 have been reported around 5%, in addition to an increase in the consultation time of patients in other regions of the world and a greater occupation of ICU beds for respiratory pathologies that are usually intended for patients with stroke. This document contains the recommendations of the Cerebrovascular Disease Committee of the Colombian Neurology Association based on the literature and voted by consensus. OBJECTIVES. Provide a quick guide adapted to the different stroke care scenarios in Colombia, divided into ready, primary and advanced centers, including a care route for a patient with suspected COVID-19 called the protected stroke code, which includes the use of protection elements for the patient and the healthcare team. MAIN FACTS. Among the main recommendations are the screening questionnaire on admission to the emergency department, the use of face masks for the patient, considering all suspected stroke code as COVID-19, taking the PCR for COVID-19 in all strokes and taking them to the buffer zone. In suspected large vessel occlusion, include chest tomography to image evaluation. CONCLUSIONS. Establishing guidelines of care during the COVID-19 pandemic allows optimizing protection for patients and health care personnel, reducing delays and trying to avoid patients not receiving adequate treatment at different levels of attention in the health system.

Eficacia y seguridad del tenecteplase en el tratamiento del ACV isquémico agudo / Safety and efficacy of tenecteplase in acute ischemia stroke a narrative review

RESUMEN El alteplase es el único fibrinolítico actualmente autorizado en Colombia para el tratamiento del ACV isquémico agudo. El tenecteplase constituye una nueva alternativa de tratamiento en esta enfermedad al ofrecer mejor perfil farmacológico, mayor eficacia con mejores desenlaces mayores, porcentajes de recanalización, y con seguridad similar a la del alteplase. La posibilidad de desabastecimiento temporal de alteplase con disponibilidad de tenecteplase en Colombia abre la posibilidad de su uso en ACV isquémico agudo.

SUMMARY Alteplase is the only one fibrinolytic currently authorized in Colombia for the treatment of acute ischemic stroke. Tenecteplase constitutes a new treatment alternative in this disease by offering a better pharmacological profile, greater efficacy with better outcomes: like higher recanalization percentages and with similar safety profile. The possibility of a temporary shortage of alteplase with availability of tenecteplase in Colombia opens the possibility of its use in acute ischemic stroke.

Efectividad de la analgesia controlada por el paciente en el dolor agudo y crónico después de cirugía cardiaca: estudio prospectivo / Effectiveness of patient-controlled analgesia in acute and chronic pain after cardiac surgery: a prospective study

INTRODUCCIÓN: La intensidad del dolor postoperatorio moderado-intenso después de una cirugía cardiaca (CC) varía, según los estudios, de un 45 a un 85 %. No existe evidencia sobre cuál es la pauta analgésica óptima en el postoperatorio de estos pacientes. El objetivo de este estudio es evaluar la efectividad de la aplicación de un protocolo analgésico multimodal, basado en la analgesia controlada por el paciente (PCA) con morfina, en pacientes sometidos a CC con circulación extracorpórea (CEC). PACIENTES Y MÉTODOS: Estudio prospectivo de todos los pacientes sometidos a CC con CEC, durante los primeros 3 días del postoperatorio (DPO). Se incluyeron 102 pacientes en dos periodos, noviembre de 2016, con analgesia convencional (AC) y enero-febrero de 2017 con PCA. RESULTADOS: El dolor en reposo se mantuvo controlado (mediana escala numérica < 3). Se registró un 27 % de pacientes con dolor moderado e intenso. No hubo diferencias en la intensidad del dolor entre los pacientes con AC y los de PCA. El grupo de PCA precisó menos analgesia de rescate (63 vs. 44 %, p = 0,0487). La incidencia de dolor crónico postquirúrgico fue de un 39 % a los tres meses y un 3 % al año. El dolor y la ansiedad preoperatorios se correlacionaron con la intensidad del dolor dinámico (r = 0,287, p = 0,03). CONCLUSIONES: La PCA con opioides a demanda y analgesia multimodal es una alternativa efectiva después de la CC. Se obtiene un buen control del dolor postoperatorio sin incrementar los efectos adversos y precisando menos analgesia de rescate administrada por enfermería

INTRODUCTION: The intensity of postoperative moderate/intense pain after cardiac surgery (CC), varies according to the different studies, from 45 % to 85 %. There is no evidence about which is the optimal analgesic regimen in the postoperative period. The main objective of this study is to evaluate the effectiveness of the application of a multimodal analgesic protocol, based on patient-controlled analgesia (PCA) with morphine, in patients undergoing cardiac surgery with extracorporeal circulation (ECC). PATIENTS AND METHODS: Prospective observational study of all patients undergoing CS with ECC, during the first 3 days postoperatively. There were included 102 patients in two periods, first, in November 2016 with conventional analgesia and second, in January - February 2017 with PCA. RESULTS: The pain at rest was controlled (median numerical scale <3). An average of 27 % of moderate and intense pain was recorded. There was no difference in pain intensity between patients with CA and those with PCA. The PCA group required less rescue analgesia in the first postoperative days (63 % vs. 44 % p = 0.0487). The incidence of Post-surgical Chronic Pain was 39 % at three months, and 3 % at one year. There was a correlation between preoperative pain and anxiety with the intensity of the dynamic pain (r = 0.287, p = 0.03). CONCLUSIONS: PCA with on-demand opioids and multimodal analgesia is an effective alternative after cardiac surgery. Good control of postoperative pain is obtained without increasing adverse effects, and requiring less rescue analgesia administered by the nursing staff

Patient Management Assisted by a Neural Network Reduces Mortality in an Intermediate Care Unit.

INTRODUCTION: Mortality risk prediction for Intermediate Respiratory Care Unit's (IRCU) patients can facilitate optimal treatment in high-risk patients. While Intensive Care Units (ICUs) have a long term experience in using algorithms for this purpose, due to the special features of the IRCUs, the same strategics are not applicable. The aim of this study is to develop an IRCU specific mortality predictor tool using machine learning methods. METHODS: Vital signs of patients were recorded from 1966 patients admitted from 2007 to 2017 in the Jiménez Díaz Foundation University Hospital's IRCU. A neural network was used to select the variables that better predict mortality status. Multivariate logistic regression provided us cut-off points that best discriminated the mortality status for each of the parameters. A new guideline for risk assessment was applied and mortality was recorded during one year. RESULTS: Our algorithm shows that thrombocytopenia, metabolic acidosis, anemia, tachypnea, age, sodium levels, hypoxemia, leukocytopenia and hyperkalemia are the most relevant parameters associated with mortality. First year with this decision scene showed a decrease in failure rate of a 50%. CONCLUSIONS: We have generated a neural network model capable of identifying and classifying mortality predictors in the IRCU of a general hospital. Combined with multivariate regression analysis, it has provided us with an useful tool for the real-time monitoring of patients to detect specific mortality risks. The overall algorithm can be scaled to any type of unit offering personalized results and will increase accuracy over time when more patients are included to the cohorts.

Importancia del manejo especializado en el destete prolongado / The Importance of Highly Specific Management in Prolonged Weaning

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Priorities to reduce the burden of stroke in Latin American countries.

The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.

Self-reported walking and associated factors in the Spanish population with chronic obstructive pulmonary disease.

BACKGROUND: The level of physical activity among individuals with chronic obstructive pulmonary disease (COPD) is associated with the disease severity and prognosis. The aim of this study was to describe the prevalence of self-reported walking at least 150 min per week and the associated factors among the Spanish population with COPD. METHODS: Analyses were based on data drawn from the 2009 European Health Interview Survey in Spain (2009 EHIS). Twenty-two thousand one hundred eighty-eight subjects participated in the survey (response rate of 96.5%). Participants were classified according to international physical activity recommendations. The prevalence of walking among participants with and without COPD (≥40 years old) was described. Univariate and multivariate logistic regression models were used to study the association of walking with socio-demographic and health outcome variables. RESULTS: Of the participants with COPD, 55.0% reached the minimum walking recommendations compared to 59.9% of the general population. The level of walking physical activity of the participants with COPD differed according to sex, age, educational level, area of residence, living as a couple, self-rated health status, mental health, body mass index and hospital admissions. In the multivariate analysis, being male, < 65 years old, living in an area with ≥50,000 inhabitants, no diagnosed depression or anxiety and self-reported good to very good health were factors significantly associated with walking ≥150 min per week. CONCLUSIONS: Sex, age, area of residence, mental disorders and self-rated health are associated with weekly walking time in the Spanish population with COPD.

Ataque cerebrovascular isquémico: fisiopatología desde el sistema biomédico y su equivalente en la medicina tradicional china / Stroke: pathophysiology from the biomedical system perspective and its equivalent in the traditional Chinese medicine

En la actualidad, el ataque cerebrovascular (ACV) es una de las principales causas de muerte a nivel mundial. Desde su comprensión fisiopatológica, este es desencadenado por la hipoxia tisular cerebral, que produce una alteración funcional y estructural de la red celular y no celular interconectada, la cual está conformada por la unidad neurovascular y la matriz extracelular. En respuesta al daño, esta red activa y dirige el proceso de reparación tisular. A pesar de lo anterior, el ACV no se limita a una perspectiva molecular, sino que es parte de la historia de vida del paciente que la padece e integra su aspecto físico, emocional y mental. Desde esta visión, la necesidad en el enfoque y tratamiento puede ser suplida por otros sistemas médicos como la medicina tradicional china, que considera los signos y síntomas del ACV como el resultado de una desarmonía gestada y perpetuada por causas medioambientales, emocionales, mentales y en los hábitos de vida.

[Budesonide/formoterol in the treatment of COPD]. / Budesónida/formoterol en el tratamiento de la EPOC.

Two large, 12-month clinical trials have been performed with budesonide-formoterol in patients with stable COPD and have shown clear data on the efficacy of this combination in improving pulmonary function, symptoms and health-related quality of life and in reducing the number of exacerbations. Before these trials, information was already available on the efficacy of both monocomponents in this disease, although the main clinical data obtained with formoterol and budesonide separately in the treatment of COPD come from the respective branches of these drugs in the two large clinical trials described in the present article. Improvement in pulmonary function variables [forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF)] was always greater with the combination of budesonide-formoterol. The scores obtained in quality of life questionnaires were also more favorable in the combination treatment branches as early as the first week of treatment and persisted at 12 months of follow-up. Improvement in symptoms and in the use of reliever medication was also greater in the combination branch. The frequency of mild and severe exacerbations, as well as the use of oral corticosteroids, was lower in the budesonide-formoterol branch. The time to first exacerbation was also more prolonged in this group. The present review discusses the main findings on the efficacy of the combination of budesonide-formoterol in stable COPD.

Budesónida/formoterol en el tratamiento de la EPOC / Budesonide/formoterol in the treatment of COPD

Existen dos grandes ensayos clínicos realizados con la combinación de budesónida-formoterol en la EPOCestable a largo plazo que han mostrado unos claros datos acerca de la eficacia de esta combinación sobre lamejoría de la función pulmonar, los síntomas, la calidad de vida relacionada con la salud y sobre la reduccióndel número de exacerbaciones. Previamente a estos estudios, ya existía información acerca de la eficacia desus monocomponentes sobre esta misma enfermedad, aunque los principales datos clínicos obtenidos conformoterol y budesónida por separado en el tratamiento de la EPOC provienen del estudio de las respectivasramas de estos fármacos en los dos grandes ensayos clínicos que se describen en este artículo.Con respecto a la mejoría encontrada en las variables de función pulmonar (FEV1, FVC y PEF), siempre eramayor con la combinación de budesónida-formoterol. La puntuación obtenida en los cuestionarios de calidadde vida también fue más favorable en las ramas de tratamiento combinado ya desde la primera semana detratamiento y mantenida hasta los 12 meses de seguimiento, así como en la mejoría de los síntomas y en eluso de medicación de rescate. La frecuencia de exacerbaciones leves y graves, así como el uso de corticoidesorales, fue menor en el grupo tratado con budesónida-formoterol. De igual modo, el tiempo transcurridohasta la primera exacerbación también fue más prolongado en este mismo grupo.En esta revisión se ponen de manifiesto los principales hallazgos demostrados acerca de la eficacia de la combinaciónde budesónida-formoterol en la EPOC estable(AU)

Two large, 12-month clinical trials have been performed with budesonide-formoterol in patients with stableCOPD and have shown clear data on the efficacy of this combination in improving pulmonary function,symptoms and health-related quality of life and in reducing the number of exacerbations. Before these trials,information was already available on the efficacy of both monocomponents in this disease, although the mainclinical data obtained with formoterol and budesonide separately in the treatment of COPD come from therespective branches of these drugs in the two large clinical trials described in the present article.Improvement in pulmonary function variables [forced expiratory volume in one second (FEV1), forced vitalcapacity (FVC) and peak expiratory flow (PEF)] was always greater with the combination of budesonideformoterol.The scores obtained in quality of life questionnaires were also more favorable in the combinationtreatment branches as early as the first week of treatment and persisted at 12 months of follow-up.Improvement in symptoms and in the use of reliever medication was also greater in the combination branch.The frequency of mild and severe exacerbations, as well as the use of oral corticosteroids, was lower in thebudesonide-formoterol branch. The time to first exacerbation was also more prolonged in this group.The present review discusses the main findings on the efficacy of the combination of budesonide-formoterolin stable COPD(AU)

Marcadores pronósticos en la EPOC. Papel de la comorbilidad / Prognostic markers of COPD. Role of comorbidity

Una enfermedad crónica como la enfermedad pulmonar obstructiva crónica (EPOC) debe tener necesariamentemarcadores que pueden infl uir en su evolución o historia natural. El marcador mejor estudiado hasido el volumen espiratorio forzado en el primer segundo (FEV1), que clásicamente se ha considerado comoel mejor indicador pronóstico de la enfermedad. Junto a este parámetro hay otras variables que tambiénhan demostrado tener valor pronóstico. Se conoce la existencia de diferentes patrones evolutivos en la enfermedad,pero todavía se ha de reconocer que esta enfermedad es una desconocida desde el punto devista de la carencia de datos existentes acerca de su historia natural y de la incapacidad de predecir los casoscon mayor o menor progresión. Junto al FEV1 hay otros marcadores fi siopatológicos de la enfermedad,como el estado del intercambio de gases, el atrapamiento aéreo o la presencia de una hipertensión pulmonar.En este artículo se revisan las características de éstos, así como las de otros, clasifi cados en otros 2grandes grupos. Por un lado, el de los marcadores clínicos, como son el estado nutricional, la capacidad deejercicio, el índice BODE, que combina 4 parámetros (fi siopatológicos y clínicos) simultáneos y la presenciao no de excerbaciones frecuentes. Por otra parte, el de los marcadores biológicos potencialmente implicadosen la EPOC, como la proteína C reactiva, el estrés oxidativo y los mediadores que originan cambios enel músculo esquelético.La EPOC también predispone a la aparición de otras enfermedades asociadas o comorbilidades, que llegan apresentarse con más frecuencia por el hecho de tener una EPOC y que igualmente condicionan el pronósticode esta enfermedad(AU)

A chronic disease such as chronic obstructive pulmonary disease (COPD) will inevitably have biologicalmarkers infl uencing its natural history or progression. The most extensively studied marker is forcedexpiratory volume in 1 second (FEV1), classically recognized as the best prognostic indicator of the disease.Other physiopathological variables are also known to have prognostic value. The course of COPD showsseveral distinct patterns but data are lacking on the natural history of this disease and the ability to predictwhich patients will show greater or lesser progression. In addition to FEV1, there are other physiologicalmarkers of disease progression, such as gas interchange, air trapping, and pulmonary hypertension. Thepresent article reviews the characteristics of all these markers, as well as those of two other categories:clinical markers, such as nutritional status, exercise capacity, the BODE index, which combines fourphysiopathological and clinical parameters, and the occurrence or absence of frequent exacerbations.Finally, a group of biological markers, potentially implicated in COPD, such as C-reactive protein, oxidativestress and other variables affecting changes in skeletal muscle, are described.COPD also predisposes affected individuals to the presence of other associated diseases or comorbidities,which can occur more frequently because of the presence of COPD itself and can potentially infl uence theoutcome of this disease(AU)