Caracterización del asma grave no controlada en adultos mayores de 60 años

Introducción: Los pacientes mayores de 60 años suelen tener un asma más grave, menos controlada y peor función pulmonar que los jóvenes. Objetivo: Caracterizar a los pacientes mayores de 60 años con asma grave no controlada. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y transversal en el Hospital Neumológico Benéfico Jurídico en el período comprendido entre enero del 2020 y enero del 2021. Resultados: Edad predominante 60-69 años (76,5 %). Mujeres (61,8 %). Antecedentes familiares de asma o alergia (64,7 %). Asma de larga evolución (85,3 %). Asma asociada a obesidad y mal control (55,9 %). Reversibilidad del VEF1 (volumen espiratorio forzado en el primer segundo) después de la aplicación del broncodilatador (26,5 %). Adherencia al tratamiento (61,8 %). El riesgo futuro de resultados adversos fue bajo en el 58,8 %, es el principal factor, el mal control actual en el 100 %. Conclusiones: El asma grave no controlada en mayores de 60 años es más frecuente en el sexo femenino, los pacientes suelen tener antecedentes familiares de asma o alergia, presentar asma de larga evolución, obesidad asociada al mal control, disminución de la reversibilidad del VEF1 con la aplicación del broncodilatador, mala adherencia al tratamiento y el mal control actual como riesgo futuro de la enfermedad.

Introduction: Patients older than 60 years tend to have more severe, less controlled asthma and worse lung function than younger people. Objective: To characterize patients older than 60 years with severe uncontrolled asthma. Methods: A descriptive, prospective and cross-sectional observational study was carried out at Benéfico Jurídico Pneumological Hospital from January 2020 to January 2021. Results: The age group 60-69 years (76.5%) predominated. Women also predominated (61.8%), as well as family history of asthma or allergy (64.7%), and long-standing asthma (85.3%). Asthma associated with obesity and poor control was 55.9%. The reversibility of the forced expiratory volume in the first second (FEV1) after the application of the bronchodilator was 26.5%. The adherence to treatment was 61.8%. The future risk of adverse results was low (58.8%), which is the main factor, the current poor control in 100%. Conclusions: Severe uncontrolled asthma in people over 60 years of age is more frequent in women, patients usually have family history of asthma or allergy, there is long-term asthma. It was observed that obesity is associated with poor control, the decreased FEV1 reversibility with the application of the bronchodilator, poor adherence to treatment and poor current control as a future risk of the disease.

Evaluación de la respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos / Evaluation of the acute response to the bronchodilator in overweight and obese asthmatic patients

Introducción: La obesidad está asociada al uso frecuente de medicación de rescate y padecer asma de mayor gravedad. Los obesos asmáticos tienen menor reactividad bronquial, sin embargo, existe información limitada sobre la magnitud de la reversibilidad aguda al broncodilatador (RAB). Objetivo: Evaluar la magnitud de respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos. Métodos: Se realizó un estudio descriptivo transversal con 49 pacientes asmáticos sobrepesos y obesos atendidos en consulta externa del Hospital Neumológico Benéfico Jurídico (enero 2017˗ enero 2018) y se constató mediante espirometría la respuesta aguda al broncodilatador. Resultados: Predominó la edad (40-59 años), mayor asociación de padecer asma, poca mejoría con la aplicación del broncodilatador. El sexo femenino (20-59 años) presentó mayor número que el masculino y menor reversibilidad al broncodilatador. Los pacientes con antecedentes patológicos familiares de asma o atopia representaron 73,5 por ciento del total. El 76,5 por ciento de los obesos no presentó mejoría con la aplicación del broncodilatador. Predominó la categoría de gravedad persistente moderada. Conclusiones: El sexo femenino tiene más riesgo de padecer asma y no tener mejoría al aplicar el broncodilatador. Los obesos mayores de 40 años tienen mayor riesgo de no presentar reversibilidad aguda al broncodilatador. Los antecedentes patológicos familiares de asma o atopia y personales de otras enfermedades no predisponen a menor reversibilidad aguda al broncodilatador. La gravedad del asma no influye en la reversibilidad aguda al broncodilatador(AU)

Introduction: Obesity is associated with the frequent use of rescue medication and suffering from more severe asthma. Obese asthmatics have less bronchial reactivity, however, there is limited information on the magnitude of acute bronchodilator reversibility. Objective: To assess the magnitude of the acute response to the bronchodilator in overweight and obese asthmatic patients. Methods: A cross-sectional descriptive study was carried out in 49 overweight and obese asthmatic patients seen in the outpatient clinic at Benéfico Jurídico Pneumologic Hospital from January 2017 to January 2018, and the acute response to bronchodilator was verified by spirometry. Results: Age predominated (40-59 years), greater association of suffering from asthma, and little improvement with the use of bronchodilator. The female sex (20-59 years) showed greater number than the male and less reversibility to bronchodilator. Patients with family pathological history of asthma or atopy represented 73.5 percent of the total. 76.5 percent of the obese did not show improvement with the use of bronchodilator. The category of moderate persistent severity predominated. Conclusions: The female sex has greater risk of suffering from asthma and has no improvement when applying bronchodilator. Obese individuals over 40 years of age have higher risk of not having acute reversibility to the bronchodilator. Family pathological history of asthma or atopy and personal history of other diseases do not predispose to less acute reversibility of bronchodilator. The severity of asthma does not influence acute reversibility to bronchodilator(AU)

Tratamiento de la periimplantitis. Explantación atraumática y nuevo tratamiento con implantes. Reversibilidad de la oseointegración / Treatment of peri-implantitis. Atraumatic explantation and new treatment with implants. Reversibility of osseointegration

La periimplantitis se define como la patología inflamatoria e irreversible que afecta al hueso periimplantario y le hace perder soporte y función al implante según la definición del European Workshop on Periodontology (EWOP). La prevalencia estimada de la periimplantitis es de 28 a 77%. Los diferentes protocolos de abordaje de la periimplantitis nos ofrecen diversas posibilidades: destoxificación de la superficie y regeneración, limpieza mecánica y resección del tejido inflamado, extracción del implante, entre otros. El principal problema de los tratamientos regenerativos es limpiar y desintoxicar correctamente la superficie del implante expuesto, ya que al tratarse de superficies generalmente muy rugosas, las bacterias del medio bucal las colonizan con mucha facilidad y es prácticamente imposible eliminar por completo el biofilm. El protocolo de tratamiento para la periimplantitis se basa en un algoritmo de tratamiento, en el que se retiran los implantes gravemente afectados por periimplantitis de forma atraumática, lo cual garantiza la conservación del lecho al 100% al no retirarse volumen óseo, y cuándo deben utilizarse las trefinas, pues las que se utilizan en el protocolo únicamente rompen la unión ósea de los primeros milímetros sin retirarlo. En el siguiente caso clínico mostramos el retratamiento de un caso de periimplantitis en el que se ha realizado una nueva rehabilitación implantosoportada (AU)

Periimplantitis is defined as the inflammatory and irreversible pathology that affects the peri-implantary bone and causes it to lose support and function to the implant as defined by the European Workshop on Periodontology (EWOP). The estimated prevalence of periimplantitis figures ranging from 28 to 77%. The different protocols for approaching periimplantitis offer different possibilities: detoxification of the surface and re-generation, mechanical cleaning and resection of inflamed tissue and extraction of the implant mainly. The main problem with regenerative treatments is to correctly clean and detoxify the surface of the exposed implant, since as these are generally highly rough surfaces, bacteria in the oral environment colonise them very easily and it is practically impossible to completely eliminate the biofilm. This treatment algorithm, in which implants severely affected by periimplantitis are removed atraumatically, guarantees the conservation of the bed at 100% since no bone volume is removed and trephines must be used, since those used in the protocol only break the bone union of the first few millimetres, without removing it. In the following clinical case, we show the re-treatment of a case of peri-implantitis where a new implant-supported rehabilitation has been performed (AU)

Post-bronchodilator Reversibility of FEV1 and Eosinophilic Airway Inflammation in COPD.

INTRODUCTION: The relationship between bronchodilator responsiveness and eosinophilic airway inflammation has not been well documented in COPD. It has been investigated in this retrospective study. This issue has grown in importance due to increasing interest in the asthma-COPD overlap syndrome. METHODS: 264 stable COPD patients with no past history of asthma were retrospectively analyzed. Correlation analyses between FEV1 reversibility and sputum eosinophil levels were conducted. Sputum eosinophil levels were dichotomized using FEV1 reversibility cut-off points (>0.4L and >15% vs. >0.2L and >12%) and compared. The effectiveness of FEV1 reversibility to predict sputum eosinophilia (>3%) was analyzed with a logistic regression and a ROC analysis. RESULTS: 82 (31.1%) patients with higher FEV1 reversibility values (0.14 vs. 0.11L, P=.01) presented sputum eosinophilia. FEV1 reversibility was weakly correlated with the sputum eosinophil level (r=0.162, P=.008). Patients with FEV1>0.4L and >15% increment had higher sputum eosinophil levels (6.11 vs. 1.02%, P=.049) whereas the level did not differ when dichotomized by FEV1 increment >0.2L and >12%. Very positive FEV1 reversibility (>0.4L and >15%) predicted sputum eosinophilia after adjustment forage, baseline FEV1 and FVC (OR: 4.262, P=.029). In the ROC analysis, the AUC was 0.58 (P=.034), and FEV1 increment>0.4L and >15% had a positive predictive value of 63.6% and an overall accuracy of 70.1%. CONCLUSIONS: FEV1 reversibility was weakly correlated with sputum eosinophil levels in COPD. Positive FEV1 reversibility (>0.4L and >15%) is moderately successful in predicting sputum eosinophilia (>3%).

Switching from tenofovir containing regimens to boosted protease inhibitor monotherapy: Impact on renal function.

OBJECTIVE: To evaluate the effect on creatinine clearance (CG-CrCl, Cockcroft-Gault equation) of switching to boosted protease inhibitor (PI) monotherapy in patients receiving a triple drug antiretroviral regimen containing TDF. METHODS: All patients who had received a TDF-containing regimen for at least one year and had been switched to PI monotherapy were included. A rapid decrease in CG-CrCl during exposure to TDF was defined as a decrease in CG-CrCl at least five times higher than the expected due to age (0.4ml/min/year by the years of exposure to TDF). In this subgroup of patients, we considered improvement if the last value of CG-CrCl on PI monotherapy was 10% higher than the last value of CG-CrCl before switching to PI monotherapy. A multivariate logistic regression was constructed to identify factors associated to renal improvement after switching to bPI monotherapy. RESULTS: 64 patients included. The median (IQR) annual change in CG-CrCl during PI monotherapy was significantly lower than the median (IQR) annual change while exposed to TDF [-0.9 (-4.7 to +2.8) ml/min vs. -4 (-8 to -1) ml/min, p=0.001]. 44 patients experienced a rapid decline during TDF exposition. After switch to PI monotherapy, 15/44 (34%, 95% CI: 21-50%) had an improved CG-CrCl and 16/44 (36%, CI 23-52%) experienced a further decline in CG-CrCl. The only variable associated to CG-CrCl improvement was a more rapid CG-CrCl decline in the last year of exposure to TDF. CONCLUSION: Switching to PI monotherapy partially reversed CG-CrCl decrease associated to TDF use, especially in patients with a more rapid decline while receiving TDF.

Reversibilidad mandibular de la rigidez cadavérica por medios químicos en un modelo de rata / Reversibilidade mandibular da rigidez cadavérica por meios químicos num modelo de rato / Mandibular reversibility of the cadaverous stiffness by chemical means in a rat model

El principal problema que recae sobre el odontólogo en la toma de evidencias post mortem es la apertura bucal, limitada por el fenómeno de rigidez cadavérica el cual inicia a las 3 horas después de la muerte, siendo éste un fenómeno que persiste hasta ser destruido por los procesos autolíticos tardíos de descomposición, a partir de las 36 horas post mortem. Objetivo. Se estudió la posibilidad de acelerar la reversión de la rigidez cadavérica mandibular por medio de sustancias químicas para facilitar la apertura bucal. Materiales y métodos. Se encaminó al uso de sustancias que produzcan la alteración del pH, quelación del calcio intramuscular o proteólisis del complejo actina-miosina de los músculos masticatorios que presenten rigidez cadavérica en ratas Wistar. Resultados. Se determinó que el tiempo de establecimiento de la rigidez cadavérica mandibular en el modelo de rata, fue de 2,5 horas. A las 3,5 horas, una vez establecida la rigidez, se realizaron infiltraciones con EDTA (20 mM), NaHCO3 (50 æM), Na2CO3 (50 æM) y papaína (10 æM) encontrándose que las soluciones de NaHCO3 y Na2CO3 incrementaron significativamente (p<0,05) la velocidad de reversión (mm/h) desde las 5 h, en un 108% y un 100%, respectivamente. A partir de este ensayo se duplicó la concentración de NaHCO3 y se preparó una mezcla de NaHCO3 y Na2CO3 (1:1) sin encontrar diferencias significativas con los ensayos con NaHCO3 y Na2CO3. Conclusión. La solución de NaHCO3 (50 æM) logró revertir la apertura bucal suficiente para la toma de evidencia entre las 5- 5,5 horas...

Mandibular reversibility of the cadaverous stiffness by chemical means in a rat model. The main problem that a dentist faces when collecting postmortem evidence is the buccal opening, which is limited by the cadaverous stiffness phenomenon that begins 3 hours after death. This phenomenon persists until it is destroyed by the late autolytic processes of decomposition, after 36 hours postmortem.Objective. To analyze the feasibility of accelerating the reversion of the mandibular cadaverous stiffness by means of chemical substances to facilitate the buccal opening. Materials and methods. We assessed substances capable of altering the pH, chelatingintramuscular calcium or inducing proteolysis of the actin-myosin complex of the masticatory muscles with cadaverous stiffness in Wistar rats. Results. We found that mandibular cadaverous stiffness in Wistar rats appears after 2.5 hours of death. After 3.5 hours, once the rigidity was established, we carried out infiltrations with EDTA (20 mM), NaHCO 3 (50 µM), Na2CO3 (50 µM) and papain (10 µM).NaHCO3 and Na2CO3 solutions significantly increased (p<0.05) the reversion speed (mm/h) from hour 5, in 108% and 100%, respectively.Based on the results of this assay, we doubled the concentration of NaHCO3 and assessed a 1:1 mixture of NaHCO3 and Na2CO3 without finding significant differences with the NaHCO3 and Na2CO3 prior assays. Conclusion. NaHCO3 solution (50 µM) allows a reversal of buccal opening enough to collect evidence between 5 and 5.5 hours...

Reversibilidade mandibular da rigidez cadavérica por meios químicos num modelo de rato. O principal problema que tem o dentista na toma de evidencias post-mortem é a apertura bucal, limitada pelo fenômeno de rigidez cadavérica, o qual se inicia às 3 horas depois da morte; este fenômeno persiste hasta ser destruído pelos processos autolíticos tardios de decomposição, a partir das 36 horas post-mortem.Objetivo. Estudou-se a possibilidade de acelerar a reversão da rigidez cadavérica mandibular através de substâncias químicas para facilitara apertura bucal. Materiais e métodos. Foram empregadas substâncias que produzem alteração do pH, quelação do cálcio intramuscular ou proteólises do complexo actina-miosina dos músculos mastigatórios que apresentam rigidez cadavérica em ratos Wistar. Resultados.Estimou-se o tempo de estabelecimento da rigidez cadavérica mandibular no modelo de rato, em 2,5 horas. Às 3,5 horas, logo de estabelecida a rigidez, realizaram-se infiltrações com EDTA (20mM), NaHCO3 (50 µM), Na2CO3 (50 µM) e papaína (10 µM), encontrandoque as soluções de NaHCO3 e Na2CO3 incrementaram significativamente (p<0,05) a velocidade de reversão (mm/h) desde as 5h, num 108% e um 100%, respectivamente. A partir deste ensaio duplicou-se a concentração de NaHCO3 e preparou-se uma mistura de NaHCO3 e Na2CO3 (1:1) sem obter diferenças significativas com os ensaios com NaHCO3 e Na2CO3. Conclusão. A solução de NaHCO3 (50 µM)reverteu a apertura bucal suficientemente para a toma de evidencias entre as 5- 5,5 horas...