Severe asthma: adding new evidence - Latin American Thoracic Society.

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL-1 for mepolizumab and above 400 cells·µL-1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL-1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.

Burnout in mental health professionals: the roles of psychological flexibility, awareness, courage, and love / El burnout en los profesionales de salud mental: el papel de la flexibilidad psicológica, la conciencia, la valentía y el amor

The predominant model of burnout posits three dimensions: emotional exhustion (EE), depersonalization (D), and (a lack of) personal accomplishment (PA). To date, contextual behavioral approaches have explored the role of psychological flexibility within this model of burnout but has not focused on the role of interpersonal variables, such as suggested by the Awareness, Courage, and Love (ACL) model of Functional Analytic Psychotherapy. In this study, 269 Spanish mental health workers completed a questionnaire study exploring the unique contribution of ACL, over and above psychological flexibility, to understanding burnout. Results indicated that psychological flexibility predicted all three dimensions of burnout. Regarding ACL, love was the strongest predictor of D over and above psychological flexibility and all three ACL dimensions contributed to PA prediction. We briefly present a contextual-behavioral model that integrates these findings with implications for improving interventions to reduce burnout in mental health practitioners

El modelo predominante del burnout asume tres dimensiones: agotamiento emocional (AE), despersonalización (D) y (falta de) logro personal (LP). Hasta la fecha, enfoques conductuales-contextuales han explorado el papel de la flexibilidad psicológica en el burnout, pero no el rol de variables interpersonales como las del modelo Consciencia, valentía y amor (ACL, por sus siglas en inglés) de la psicoterapia analítica funcional. En este estudio, 269 trabajadores españoles de salud mental cumplimentaron un formulario que exploraba la contribución del ACL, más allá de la flexibilidad psicológica, para comprender el burnout. Los resultados principales muestran que la flexibilidad psicológica predice las tres dimensiones del burnout. Con respecto al modelo ACL, el amor fue el predictor más fuerte de D, después de la flexibilidad psicológica; las tres dimensiones del ACL contribuyen a predecir el LP. En este trabajo se presenta brevemente un modelo conductual-contextual que integra estos hallazgos y sus implicaciones para mejorar las intervenciones para reducir el burnout en profesionales de salud mental

Single-Dose Bioavailability for Prophylactic Coverage in Patients Undergoing Dental Implant Surgery.

PURPOSE: The use of antibiotic prophylaxis in dental implant surgery is a routine dental practice to prevent implant failure. Current systematic reviews have yet to confirm the effectiveness of antibiotic treatment at reducing postoperative infection rates in implant procedures. The aim of this study was to quantify amoxicillin plasma levels at the peripheral venous blood and at the surgical implant site in patients undergoing dental treatment. MATERIALS AND METHODS: A prospective study was conducted. Patients undergoing dental implant surgery were selected, and preoperative doses of 1 g of amoxicillin, in the form of an oral tablet, were administered 1 hour prior to implant surgery. The blood samples (1.5 mL) were collected from both the venous and implant sites. Data on the antibiotics were measured using high-pressure liquid chromatography. The quantification method was validated for linearity, selectivity, and detection limits. Statistical analysis of plasma antibiotic was performed, comparing both samples and the age, height, weight, and body mass index (BMI) (Wilcoxon test, P < .05; STATA v.10.0). RESULTS: Thirty-two patients (mean age: 56.28 ± 12.2 years; range: 31 to 79 years; 20 men) were selected. Both blood samples were taken at a mean 1.16 ± 0.37 hours after antibiotic intake. The mean amoxicillin concentration at the implant site reached 5 ± 2.63 µg/mL (range: 2.04 to 11.18 µg/mL), while the venous blood level was 4.21 ± 2.12 µg/mL (range: 1.6 to 9.98 µg/mL) (P = .33). No correlations were observed between age, height, weight, and BMI with antibiotic plasma levels. CONCLUSION: These findings demonstrate that plasma concentrations of a prophylactic dose of amoxicillin are higher than the minimum inhibitory concentration needed to prevent the common dental bacteria involved in peri-implantitis and periodontal diseases.

Percepcion categorial y productividad como características de la conducta verbal: un análisis crítico desde el punto de vista del control discriminativo múltiple / Categorical ´perception and productivity as specific characteristic of verbal behavior: a critical analysis from a multiple discriminative control point of view

Aunque muchas de las funciones del lenguaje humano aparecen también en la conducta de organismos no humanos, las características de percepción categorial y productividad son aún consideradas específicas del ámbito lingüístico o, al menos, específicas de la conducta humana. En este trabajo se presenta algunos resultados experimentales procedentes de la literatura y obtenidos con diferentes especies como ejemplos de percepción categorial y de productividad. Tales resultados pueden ser analizados desde el punto de vista de la psicológia del aprendizaje, mediante la aplicación del principio de control discriminatorio múltiple. Esto sugiere la existencia de mecanismos comunes entre la conducta verbal y no verbal presentes en distintas especies