Cross-cultural adaptation and validation of the RhinAsthma Patient Perspective (RAPP) in Spanish

OBJECTIVE: the RhinAsthma Patient Perspective (RAPP) is the only available tool to assess HRQoL in daily practice. The aim of this study is to cross-culturally validate the RAPP in Spanish. METHODS: The RAPP was translated into Spanish. Adult patients receiving usual care for asthma and allergic rhinitis (AR) were recruited consecutively and assessed twice with a four-week interval between visits to test the psychometric properties of the questionnaire. RESULTS: 149 patients (62.8% female) with a mean age of 37.7 years completed the study. Exploratory and confirmatory factor analysis confirmed the uni-dimensional structure of the questionnaire. Internal consistency (0.73 at visit 1; 0.87 at visit 2), convergent and discriminant validity (p < .05 at both visits) were satisfactory. Reliability was confirmed by an ICC of 0.69 and a CCC of 0.74. Responsiveness was supported by a significant association with VAS (r = 0.28, p < 0.003) and ACT (r = -0.35, p < 0.01). The minimal clinical difference (MID) value in the analyzed population was 2. CONCLUSIONS: The Spanish version of RAPP was demonstrated to have satisfactory psychometric properties and is a valid, reliable and responsive tool for the assessment of asthma and AR HRQoL in clinical practice

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Cross-cultural adaptation and validation of the RhinAsthma Patient Perspective (RAPP) in Spanish.

OBJECTIVE: the RhinAsthma Patient Perspective (RAPP) is the only available tool to assess HRQoL in daily practice. The aim of this study is to cross-culturally validate the RAPP in Spanish. METHODS: The RAPP was translated into Spanish. Adult patients receiving usual care for asthma and allergic rhinitis (AR) were recruited consecutively and assessed twice with a four-week interval between visits to test the psychometric properties of the questionnaire. RESULTS: 149 patients (62.8% female) with a mean age of 37.7 years completed the study. Exploratory and confirmatory factor analysis confirmed the uni-dimensional structure of the questionnaire. Internal consistency (0.73 at visit 1; 0.87 at visit 2), convergent and discriminant validity (p<.05 at both visits) were satisfactory. Reliability was confirmed by an ICC of 0.69 and a CCC of 0.74. Responsiveness was supported by a significant association with VAS (r=0.28, p<0.003) and ACT (r=-0.35, p<0.01). The minimal clinical difference (MID) value in the analyzed population was 2. CONCLUSIONS: The Spanish version of RAPP was demonstrated to have satisfactory psychometric properties and is a valid, reliable and responsive tool for the assessment of asthma and AR HRQoL in clinical practice.

Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN).

Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 µm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician's considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.

Inmunización en prematuros / Inmunization in preterm newborns

La OMS (Organización Mundial de la Salud) define como prematuro a los neonatos vivos que nacen antes de la 37 semana de gestación, contada ésta a partir del primer día de la fecha de la última regla. En España en 1995 el porcentaje de recién nacidos con menos de 2500 gramos fue del 7,4 per cent, del 1,2 per cent en los de menos de 1500 gramos; y del 0,6 per cent en los de menos de 1000 gramos. El recién nacido es más susceptible a las infecciones y de ahí la importancia de su vacunación. Aunque la respuesta inmune a las vacunas puede estar disminuida en algunos niños pretérmino, y puesto que en los niños prematuros no aumenta la incidencia de efectos adversos relacionados con la vacuna; se recomienda iniciar su vacunación a la edad cronológica habitual y no se debe reducir las dosis de vacunas. En la práctica conviene realizar pequeñas matizaciones con respecto a ciertas vacunas como describimos en este artículo (AU)

Programa de intervención paliativo del sentimiento de soledad en el anciano

El presente estudio surge ante la necesidad de reducir un 'sentirse solo' que implica situación dolorosa y no deseada acompañada en muchos casos de apatía, desinterés por la vida, vacío existencial, autismo profundo y otros graves trastornos emocionales y psicológicos en los que puede caer el anciano disminuyendo así su satisfacción personal. Basándonos en la idea de Solón 'no hay mayor deleite que envejecer aprendiendo', se aplicó un programa de enriquecimiento personal y social a través de charlas-coloquio a lo largo de 15 sesiones, una por semana de una hora y media de duración, fomentando sentimientos positivos y alegría de vivir, propiciando participación activa, real y posibilitando un lugar de encuentro. El programa se aplicó a un grupo de 27 personas mayores autónomas de una residencia geriátrica perteneciente al ERA del Principado de Asturias. El resultado del programa es el aumento de la satisfacción personal, reencontrando sentido a la vida, afán por seguir aprendiendo, tolerancia, comunicación, así como disminución de apatía, pesimismo, negatividad y reducción de miedos subjetivos (AU)

Agenesis of the gallbladder.

Agenesis of the gallbladder is rare. Three groups have been identified: those with multiple fetal anomalies, asymptomatic cases, and symptomatic cases. Right upper quadrant pain is present in 90% of the cases, nausea and vomiting in 60%, and jaundice in 35%. Operative strategy is aimed at thorough exploration to locate an aberrant gallbladder. We treated a 72-year-old woman with right upper quadrant pain, nausea, and vomiting but no fever or jaundice. Physical examination revealed right upper quadrant tenderness without rebound. The white blood cell count was 10,300/mm3. Total bilirubin level was 1.6 mg/dL. Ultrasonography revealed one gallstone and an enlarged common bile duct. Laparoscopic cholecystectomy was converted to open technique after failure to locate the gallbladder. On intraoperative cholangiogram, no gallbladder was identified. A T-tube was placed.

Asthma mortality in Latin America.

There are not enough data concerning asthma mortality in Latin America. The Latin American Society of Allergy and Immunology coordinated this project to provide reliable data for gaining knowledge about our present situation, which is a condition indispensable to changing it. The following countries participated in this study: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, Peru, Uruguay and Venezuela. A uniform protocol was designed in Santa Fe, Argentina. Asthma mortality rates were analyzed in accordance with two variables: age-adjusted rates (5-34) and total death rates. The total population studied was 107, 122, 529 inhabitants. The highest death rates were found in Uruguay and Mexico (5.63), and the lowest in Paraguay (0.8) and Colombia (1.35). Age-adjusted (5-34) rates were higher in Costa Rica (1.38) and lower in Chile (0.28). Regarding sex, the analysis of the information provided by seven countries showed a predominance of females (51.8%) over males (48.18%). In the southern Latin American countries such as Chile, Uruguay, Paraguay and Argentina, which have marked climatic differences, deaths occurred mainly in the winter. It is important to emphasize that, in most countries, deaths from asthma occurred at home: Chile (60.7%), Argentina (63.4%) and Paraguay (88%). However, in Uruguay, 58.6% occurred during hospitalization. Mortality rates from bronchial asthma are high in most of the Latin American countries studied, even though further studies are needed. Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that can be severe and sometimes fatal. The health ministries of each country do not believe asthma is a significant issue. Therefore, we should provide them with sound epidemiological studies to convince them to change their attitude toward this disease.

[Physiopathology of chronic rhinosinusitis]. / Fisiopatología de la rinosinusitis crónica.

The inflammatory response in the upper airways secondary to viral or bacterial infection is frequent cause of medical attention and rhinosinusitis a common complication, changes in local and systemic immunity could facilitate the presence of sinusitis. Mediators derived from eosinophil could be also an important factor to develop nasal inflammation.

[Chronic rhinosinusitis: predominant symptoms in children under 14 years of age who were seen at the Regional Center for the Prevention and Treatment of Allergic Diseases]. / Rinosinusitis crónica, síntomas predominantes en menores de 14 años que acudieron al Centro Regional para la Prevención y el Tratamiento de las Enfermedades Alérgicas.

Chronic rhinosinusitis occurs to 5% of the population with upper respiratory infections. The objective of this study is to know the main symptoms in a pediatric population younger than 14 years with the diagnosis of chronic rhinosinusitis, to know age and sex distribution and evolution. We did a medical history, physical examination, nasal cytology, skin tests and sinus X rays in each of 100 patients. Results the main symptoms were: cough, halitosis, postnasal discharge, fever, headache, sore throat, facial sensitivity and periorbital edema. This findings predominated in males and the average evolution time was 1-2 years.

[Prevalence of rhinosinusitis. Statistics: January-December 1993]. / Prevalencia de rinosinusitis. Estadística enero-diciembre 1993.

UNLABELLED: The rhinosinusitis es becoming a more common diagnosis in the practice of the allergist, in this retrospective langencial study of one year (1993) we found this disease occurred in the 42% of the total consultation demanding our service. There was not difference by sex, and by age were more prevalent under 15 years (57%). ETIOLOGY: the allergic represented 57% of patients infectious in 25% and both in 18%. Mites were the most frequent antigen found positive buy skin test.

First laparoscopic splenectomy performed in Mexico.

At Mexico City General Hospital, a 32-year-old female with autoimmune hemolytic anemia associated with cholelithiasis underwent elective laparoscopic cholecystectomy and splenectomy. The gallbladder and the spleen were delivered intact through a 7-cm extension of the umbilical trocar site. The patient was discharged in excellent condition. We describe the technique of laparoscopic splenectomy and suggest new advantages for the laparoscopic approach to surgery of the spleen.

[Asthma mortality in the state of Nuevo León, México]. / Mortalidad por asma en el estado de Nuevo León, México.

Definition of asthma has radically changed in the last few years. It has been given great importance to the its inflammatory component that can become irreversible. It is not clear yet the cause of the increase in prevalence and mortality of asthma observed in developed countries despite an increase in the number and efficacy of the therapeutic resources. There is still much to do on studying of the statistics on prevalence and mortality rate of the undeveloped countries. In Latin America, asthma prevalence, in 1983 was reported in 3.5% in seven countries. We reviewed the death certificates in the state of Nuevo León, México, in the 1980's decade, and compared the total death rate with those attributed to asthma, according to the diagnostics criteria code 493 from the International Classification of Diseases. We also reviewed the clinical records of patients admitted to a general hospital (University Hospital of Monterrey, Nuevo Leon, Mexico) as well as the autopsy reports from the same time period. General mortality rate, as well as the mortality rate due to respiratory diseases (asthma, emphysema, chronic bronchitis and others) was unchanged (5.5 x 100,000 people), despite an increase of 100% in the size of the population. Asthma prevalence has increased from 1.2% in 1979 to 2.5% in 1989 (approximately 75,000 cases). From the 1,114 autopsies done in the University Hospital in the 1980's decade, none could be attributed to an asthma death. It is mandatory that other states in this country report parallel studies to ours, so we can have reliable data on prevalence and mortality rates of asthma. In doing so, we can learn the distribution and consequences of this disease.

[Determination of the eosinophil count in nasal mucus. Comparison of 2 techniques]. / Determinación de la cuenta de eosinófilos en moco nasal. Comparación de dos técnicas.

We compared swab and scraping (Rhino-probe) technics in the nasal cytology obtention for eosinophils count in 36 patients with a range of 2-46 years old (mean age 18.6 years) with diagnosis of Allergic Rhinitis. The eosinophil count with swab technic was between 0-79 cells with average of 6.5 cells and in the scraping (Rhino-probe) was in a rate of 0-100 cells with a average of 13.4 cells. Of the 36 patients with Rhinitis seen at our clinic, 13 (36%) of positive with swab and 19 (53%) with scraping technics (Rhino-probe) with percent differential of 17%. The comparison between the eosinophils count with both technics was p less than 0.05 for scraping (Rhino-probe) technic.