Estudio comparativo de efectividad entre la Hipnosis y la intervención Cognitivo-Conductual para la Deshabituación Tabáquica / Comparative study of effectiveness between Hypnosis and Cognitive-Behavioral intervention for Smoking Cessation

Introducción: El consumo de tabaco es la primera causa de muerte evitable. A muchos fumadores les gustaría dejar el hábito. Aun así, a pesar de la eficacia demostrada de las intervenciones, muchos no están dispuestos a realizar un intento debido a las altas tasas de recaída y al miedo a los efectos secundarios de los tratamientos empleados, inclinándose a probar métodos alternativos.Objetivo: Conocer si la intervención avanzada individual (multicomponente cognitiva-conductual) es más efectiva que la intervención con hipnoterapia en pacientes fumadores, como tratamiento para dejar de fumar.Metodología: Estudio cuasiexperimental. Se incluyeron pacientes fumadores con antecedentes de patología respiratoria. Fueron asignados, según su preferencia, a un grupo de intervención avanzada individual en tabaquismo (grupo A) - al que se realizó una terapia multicomponente para dejar de fumar- o a un grupo de hipnoterapia (grupo B) en el que se realizó hipnosis para dejar de fumar.Todos los pacientes recibieron el tratamiento farmacológico y las pautas de actuación habituales que se utilizan en las consultas externas para tratar la enfermedad.Resultados: Se encontraron diferencias significativas en la cesación del consumo de tabaco a los 6 meses, encontrándose valores inferiores tanto en el abandono como en la disminución del consumo en los pacientes a los que se les realizó hipnoterapia versus terapia multicomponente (p 0,023 y p 0,031 respectivamente). Conclusiones: La intervención para el abandono del tabaco que incorpora la hipnosis no ha demostrado ser tan eficaz como la terapia multicomponente en la población estudiada. (AU)

Introduction: Tobacco use is the number one preventable cause of death. Many smokers would like to kick the habit. Still, despite the proven efficacy of the interventions, many are reluctant to try due to high relapse rates and fear of side effects of the treatments used, and are inclined to try alternative approaches.Objetive: To know if the individual advanced intervention (cognitive-behavioural multicomponent) is more effective than the intervention with hypnotherapy in smokers, as a treatment to quit smoking.Methodology: Quasi-experimental study. Smokers with a history of respiratory pathology were included. They were assigned, according to their preference, to an advanced individual smoking cessation intervention group (group A) - which underwent multicomponent therapy to quit smoking - or to a hypnotherapy group (group B) in which hypnosis was performed to quit smoking. of smoking.All patients received the pharmacological treatment and the usual action guidelines that are used in outpatient clinics to treat the disease.Results: Significant differences were found in the cessation of tobacco consumption at 6 months, with lower values both in quitting and in the reduction of consumption in patients who underwent hypnotherapy versus multicomponent therapy (p 0.023 and p 0.031, respectively).Conclusions: Smoking cessation intervention incorporating hypnosis has not been shown to be as effective as multicomponent therapy in the population studied. (AU)

Magnet ingestion knows no borders: A threat for Latin American children.

INTRODUCTION AND AIMS: The ingestion of foreign bodies, such as magnets, is a potentially lethal accident that affects children and is associated with bleeding and gastrointestinal perforation, as well as death. There are no Latin American reports in the literature on cases of magnet ingestion in children. Our aim was to establish whether said ingestion has been seen by pediatric endoscopists and gastroenterologists in Latin America, to determine the scope of that potential threat in their patient populations. MATERIALS AND METHODS: We collected data regarding endoscopies performed on children in Latin America, within the time frame of 2017-2019, through questionnaires that were distributed to pediatric endoscopists at the 2nd World Congress of Gastrointestinal Endoscopy (ENDO 2020). The questionnaires provided information on foreign body location, the presence and number of ingested magnets, and the description of complications and surgical interventions. RESULTS: Our cohort from 12 Latin American countries reported 2,363 endoscopies due to foreign body ingestion, 25 (1.05%) of which were the result of having swallowed one or more magnets. Mean patient age was 5.14 years (SD 2.5) and 10 (40%) of the cases were girls. Three (12%) of the patients presented with severe complications and 2 (8%) cases required surgery. CONCLUSIONS: Our preliminary study suggests that the ingestion of magnets is not common in Latin American countries, but said cases are frequently associated with complications. Constant monitoring of the incidence of such cases is extremely important, so that through education and awareness of those events, life-threatening complications in children can be prevented.

Magnet ingestion knows no borders: A threat for Latin American children. / La ingestión de imanes no conoce fronteras: una amenaza para los niños latinoamericanos.

INTRODUCTION AND AIMS: The ingestion of foreign bodies, such as magnets, is a potentially lethal accident that affects children and is associated with bleeding and gastrointestinal perforation, as well as death. There are no Latin American reports in the literature on cases of magnet ingestion in children. Our aim was to establish whether said ingestion has been seen by pediatric endoscopists and gastroenterologists in Latin America, to determine the scope of that potential threat in their patient populations. MATERIALS AND METHODS: We collected data regarding endoscopies performed on children in Latin America, within the time frame of 2017-2019, through questionnaires that were distributed to pediatric endoscopists at the 2nd World Congress of Gastrointestinal Endoscopy (ENDO 2020). The questionnaires provided information on foreign body location, the presence and number of ingested magnets, and the description of complications and surgical interventions. RESULTS: Our cohort from 12 Latin American countries reported 2,363 endoscopies due to foreign body ingestion, 25 (1.05%) of which were the result of having swallowed one or more magnets. Mean patient age was 5.14years (SD2.5) and 10 (40%) of the cases were girls. Three (12%) of the patients presented with severe complications and 2 (8%) cases required surgery. CONCLUSIONS: Our preliminary study suggests that the ingestion of magnets is not common in Latin American countries, but said cases are frequently associated with complications. Constant monitoring of the incidence of such cases is extremely important, so that through education and awareness of those events, life-threatening complications in children can be prevented.

Probiotic Properties of Alcaligenes faecalis Isolated from Argyrosomus regius in Experimental Peritonitis (Rat Model).

A strain of Alcaligenes faecalis A12C (A. faecalis A12C) isolated from Argyrosomus regius is a probiotic in fish. Previous experiments showed that A. faecalis A12C had inhibitory effects on the growth of multidrug-resistant bacteria. We aimed to confirm whether A. faecalis A12C is safe and has adequate intestinal colonization in experimental rats, and evaluate its efficacy in an animal model of peritonitis. We used 30 male rats, randomly divided into 6 groups (n = 5): three groups (HA7, HA15, HA30) received A. faecalis A12C in drinking water (6 × 108 CFU/mL) for 7 days, and three control groups received drinking water only. All groups were evaluated at 7, 15, and 30 days. Survival after A. faecalis A12C administration was 100% in all groups. Mild eosinophilia (1.5%, p < 0.01) and increased aspartate aminotransferase (86 IU/L, p < 0.05) were observed in HA7, followed by progressive normalization. No histological signs of organ injury were found. We observed significant E. coli decline in faeces, parallel to an increase in A. faecalis A12C at 7 days. E. coli had a tendency to recover initial values, while A. faecalis A12C disappeared from the intestinal microbiota at 30 days. To evaluate its efficacy against peritonitis, we studied two additional groups of animals: IA group pretreated with A. faecalis A12C before E. coli intra-abdominal inoculation, and IC group inoculated with no A. faecalis A12C. We found an increase in C-reactive protein, alanine aminotransferase, urea, and eosinophils in IC animals when compared with IA. Peritonitis was more evident in IC than in IA animals. Our findings suggest that A. faecalis A12C altered clinically relevant parameters in sepsis and was associated with a lesser spread of infection.

Análisis de factores psicológicos en pacientes con asma grave (estudio PSICOASMA) / Analysis of psychological factors in patients with severe asthma (PSICOASMA study)

OBJETIVOS: estudiar factores psicológicos en pacientes con asma grave y evaluar su relación con el control del asma. METODOLOGÍA: estudio prospectivo con inclusión de pacientes, diagnosticados de asma bronquial grave, revisados en consultas monográficas, participantes en el estudio de intervención psicológica (PSICOASMA). Se analizaron datos clínicos, cuestionario de control del asma (ACT), espirometría, inflamación (FENO). Se estudiaron alteraciones psicológicas con el cuestionario de ansiedad rasgo y estado (STAI-R y E), el inventario de depresión de BECK (BDI), cuestionario de Nijmegen. Se consideró alterado una puntuación en percentil >50 en el cuestionario STAI, Síndrome Hiperventilación si presentaban Nijmegen>23. RESULTADOS: Fueron incluidos 103 asmáticos graves, de edad 51,6 (13,7), mayoritariamente mujeres (79,6%). El 78,6% presentaban mal control del asma (ACT<20).Presentaban alterados test STAI-E, STAI-R el 50,5% y 68%, respectivamente y Nijmegen 47,5%. Respecto al nivel de depresión, según BDI, presentaron alteraciones leves, moderadas e intensas en el 31%, 25,2% y 11,6%, respectivamente. Se encontraron diferencias significativas en el control del asma medido por ACT entre los pacientes que presentaban o no alterados los test de ansiedad; STAI-E (p <0,05), STAI- R (p <0,01); depresión (p <0,01) o Nijmegen (p <0,01), estando peor controlados los que tenían alteración en los test psicológicos. No se encontraron diferencias en parámetros funcionales ni cifras de FENO. CONCLUSIONES: encontramos niveles elevados de ansiedad y depresión en pacientes con asma grave. Presentaban disnea funcional casi la mitad de los pacientes. Estas alteraciones psicológicas están relacionadas con el mal control de la enfermedad. Es importante y necesaria la evaluación psicológica en pacientes con asma grave

OBJECTIVES: to study the psychological factors in patients with severe asthma and evaluate their relationship with asthma control. METHODS: a prospective study including patients diagnosed with severe bronchial asthma who were examined in specialized clinics and who participated in the PSICOASMA psychological intervention study. The clinical data, asthma control test (ACT), spirometry and inflammation (FeNO) were analyzed. Psychological changes were studied using the State-Trait Anxiety Inventory (STAI-r and STAI-e), the Beck Depression Inventory (BDI) and the Nijmegen Questionnaire. A percentile score of >50 on the STAI was considered altered, and hyperventilation syndrome was determined for Nijmegen >23. RESULTS: 103 primarily female (79.6%) severely asthmatic patients were included with an average age of 51.6 (13.7). 78.6% showed poor asthma control (ACT <20). 50.5% and 68% showed altered STAI-e and STAI-r results, respectively, and 47.5% showed altered Nijmegen results. With regard to the degree of depression, according to the BDI, 31% of patients showed mild changes, 25.2% moderate changes and 11.6% intense changes. Significant differences were found in asthma control measured by ACT between patients with or without altered results in the anxiety test; STAI-e (p <0.05), STAI-r (p <0.01); depression questionnaire (p <0.01) and Nijmegen Questionnaire (p <0.01), with those showing alteration in the psychological tests being more poorly controlled. No differences were found in functional parameters or FeNO figures. CONCLUSIONS: We found high levels of anxiety and depression in patients with severe asthma. Nearly half of patients showed functional dyspnea. These psychological changes are related to the poor control of the disease. Psychological evaluation is important and necessary in patients with severe asthma

Causas de fallecimiento tras una media de 14 años de seguimiento en 1110 pacientes con asma (cohorte estudio perinasma) / Causes of death after an average follow-up of 14 years in 1110 patients with asthma (perinasma cohort study)

OBJETIVO: estudiar las causas de muerte en pacientes diagnosticados con asma en consultas especializadas tras una media de 14 años de seguimiento. METODOLOGÍA: se realizó un seguimiento (1998 - 2016) de 1.110 pacientes diagnosticados por primera vez de asma en consultas monográficas de asma bronquial. Se contactó telefónicamente con los pacientes. En caso de fallecimiento, buscamos la causa de muerte, según los informes de éxitus. Evaluamos estas causas en el plazo temporal referido. Los datos se expresan en % y se realizó análisis estadístico, estudiando las diferencias cualitativas con prueba de chi cuadrado, así como de las medias (DE), mediante t-student. RESULTADOS: del total estudiado, 690 pacientes (62,2%) eran mujeres (edad media 37,8 (17,6)) años y 420 (37,8%) hombres (edad media 29,5 (13,9) años, (p <0,01). Un 64,6% eran atópicos, 348 (31,4%) diagnosticados sólo de asma y 762 (68,6%) de asma con rinitis. En el periodo evaluado habían fallecido un total de 54 personas (4,9%), 46 mujeres (7,14%) y 8 hombres (1,9%). Las causas de fallecimiento fueron: 22 casos por neoplasias (40,7%), 9 casos de enfermedades del sistema circulatorio (16,6%), 2 casos por enfermedad neurodegenerativa (3,7%), 1 caso por infección (1,8%), 1 caso por asma e insuficiencia respiratoria (1,8%), 1 otras causas (1,8%) y 17 no conocido (31,4%). CONCLUSIONES: la causa más frecuente de fallecimiento de nuestros pacientes asmáticos fueron las neoplasias. El número de fallecimientos por enfermedades del sistema circulatorio fue bajo, inferior a la población general. Sólo hubo un caso recogido de fallecimiento por crisis de asma

OBJECTIVE: to study the cause of death in patients diagnosed with asthma in specialized outpatient clinics after an average follow-up of 14 years. METHODS: 1110 patients diagnosed with asthma for the first time in clinics specializing in bronchial asthma were monitored from 1998 to 2016. Patients were contacted by phone. In case of death, cause of death was determined according to the death certificate. These causes were evaluated during the abovementioned time period. The data is expressed as % and a statistical analysis was performed, studying the qualitative differences using the chi-square test as well as standard deviation using the student's t-test. RESULTS: of all patients studied, 690 (62.2%) were women (average age: 37.8 [17.6]) and 420 (37.8%) were men (average age: 29.5 [13.9]) (p <0.01). 64.6% were atopic, 348 (31.4%) were diagnosed only with asthma and 762 (68.6%) with asthma and rhinitis. During the evaluation period, a total of 54 patients died (4.9%): 46 women (7.14%) and 8 men (1.9%). The causes of death were: 22 cases due to neoplasm (40.7%), 9 cases due to circulatory system disease (16.6%), 2 cases due to neurodegenerative disease (3.7%), 1 case due to infection (1.8%), 1 case due to asthma and respiratory distress (1.8%), 1 case due to other causes (1.8%) and the cause of death was unknown in 17 patients (31.4%). CONCLUSIONS: the most frequent cause of death in our asthmatic patients was neoplasm. The number of deaths due to circulatory system disease was low, below the general population. Only one case of death due to asthma attack was recorded

Deshabituación tabáquica a largo plazo. Estudio de 1.639 pacientes incluidos en programa de intervención psicofarmacológico tras 12 años de seguimiento / Long-term tobacco cessation. A study of 1639 patients included in a sychopharmacological intervention program after 12 years of follow-up

Objetivos: evaluar la situación de abstinencia tras una media de 12 años en pacientes que realizaron un programa de intervención psicofarmacológica. Metodología: se incluyeron pacientes tratados en una Unidad Especializada de Tratamiento del Tabaquismo con terapia psicológica asociada, o no, a tratamiento farmacológico. El seguimiento inicial fue de 1 año. Se dividió en dos grupos: aquéllos pacientes en los que se objetivó abstinencia (cooximetría (CO) <5 ppm) tras el año de seguimiento (grupo A) y aquéllos pacientes no abstinentes (grupo B). Los pacientes fueron llamados por teléfono tras un periodo de 12 años de media y se comprobó la abstinencia. En caso de indicar que no fumaban, se invitó a que acudieran a nuestras consultas para confirmarlo con CO. Se consideró abstinencia confirmada (AC) si presentaban CO <5 ppm. En caso de no acudir, se indicó situación de abstinencia no confirmada (ANC). Se consideró fracaso (F) si el paciente indicaba que fumaba. Resultados: se estudiaron 1.639 pacientes (366 del grupo A y 1.273 del grupo B). A largo plazo, en el grupo A presentaron AC el 50,5% de los pacientes, ANC 11,7%, F el 20,8%, no fueron localizados el 13,9% y fallecieron el 3,6%. En el grupo B presentaron AC 5,8%, ANC 12,6%, F 45%, no localizados 29,7%, fallecidos 6,7% (p <0,01 entre ambos grupos, excepto ANC). Conclusiones: los pacientes que dejan el tabaco tras un año de seguimiento mantienen la abstinencia a largo plazo en más de la mitad de los casos

Objectives: to evaluate abstinence status after an average of 12 years in patients who underwent a psychopharmacological intervention program. Methods: the study included patients treated at a specialized tobacco cessation unit who received pharmacological treatment with or without associated psychological therapy. The initial follow-up lasted 1 year. Patients were divided into two groups: those who showed abstinence (CO-oximetry <5 ppm) after a year of followup (group A) and non-abstinent patients (group B). Patients were contacted by phone after an average of 12 years to confirm abstinence. If they indicated they did not smoke, they were invited to our clinics to confirm this with COoximetry. A CO-oximetry result of <5 ppm was considered confirmed abstinence. If patients did not visit the clinic, their status was recorded as unconfirmed abstinence. Status was considered failure if the patient indicated they smoked. Results: 1639 patients were studied (366 in group A and 1273 in group B). In the long run, abstinence was confirmed in 50.5% of patients, unconfirmed in 11.7%, 20.8% were recorded as failure, 13.9% could not be contacted and 3.6% had died in group A. In group B, 5.8% were recorded as confirmed abstinence, 12.6% as unconfirmed abstinence, 45% as failure, 29.7% could not be contacted and 6.7% had died (p <0.01 between both groups, except unconfirmed abstinence). Conclusions: patients who cease tobacco use after a year of follow-up maintain long-term abstinence in more than half of cases

Influence of Traditional Management and Environmental Variables on Mediterranean Saproxylic Beetle Assemblages.

Mediterranean oak forests of the Iberian Peninsula host a great diversity of saproxylic beetles. For centuries, humans have carried out traditional management practices in this area, at both habitat and tree level, causing changes in forest structure. The aim of this study was to evaluate the anthropic effect of these traditional practices on saproxylic beetle diversity by measuring a set of environmental variables related to forest structure at both plot and tree level. Fauna was collected using window traps over a period of 12 mo. Multiple regression procedures showed which variables significantly affected the diversity of the studied assemblage. Our results demonstrated that the different metrics used to assess the diversity of assemblages responded variably depending on the management strategies applied and the level at which they were carried out. Certain management practices that disrupted the landscape from its natural state, such as the introduction of livestock or the local removal of particular trees, maximized species richness but, nevertheless, had a negative effect on the rest of diversity metrics analyzed. However, other practices such as pollarding, which involves the suppression of the main branch of the tree, had a positive effect on all diversity metrics evaluated as it promoted the formation of potential microhabitats for saproxylic fauna. We concluded that not all types and degrees of traditional forest management favor saproxylic beetle diversity and that different diversity metrics should be taken into consideration in future strategies for the protection and conservation of this fauna.

Fenotipos inflamatorios, según celularidad del esputo inducido, en asmaticos no tratados con corticoides / Inflammatory phenotypes, based on cellularity of induced sputum in asthmatic patients treated without corticosteroids

OBJETIVOS: nuestro objetivo fue examinar en los 4 fenotipos ya descritos: eosinofílico (Eos), neutrofílico (Neu), mixto y paucigranulocítico (Pau), según muestras de esputo inducido, las diferencias en parámetros de edad, índice de masa corporal (IMC), agudizaciones, test de control del asma (ACT), FEV1 y reversibilidad, así como niveles de óxido nítrico exhalado (FeNO). MÉTODO: estudio descriptivo, de abril de 2011 a septiembre 2014, con inclusión de forma consecutiva de pacientes con asma bronquial sin tratamiento con corticoides inhalados (CI). Se les realiza esputo inducido y se clasificó según celularidad obtenida. Se relacionó cada uno de los cuadro grupos obtenidos con datos clínicos, como nivel del control del asma (Test ACT), número de agudizaciones en el año previo del estudio funcional respiratorio, que incluye datos de espirometría, test de broncodilatación, medición de óxido nítrico exhalado y test de metacolina, según algoritmo GEMA para el diagnostico de asma y test de sensibilidad alérgica (prick test y/o ELISA). RESULTADOS: se obtuvo una muestra adecuada en el 60% de los pacientes, sin efecto adverso alguno. Se incluyeron, finalmente, 55 pacientes asmáticos. Se clasificaron según la celularidad del esputo: 12 pacientes, como Eos, 12 como Neu, 15 como mixto y, finalmente, 16 en el grupo Pau. Encontramos más agudizaciones en el grupo Neu en el año previo. Eos-Neu (p 002); Neu-Mix (p < 0,009); Neu-Pau (p < 0,005); Mix- Pau (p <0,01). Los niveles de FeNO tendieron a ser superiores en los pacientes con eosinofilia, sin significación estadística. CONCLUSIONES: la inducción del esputo es una técnica segura y que permite diferenciar el componente inflamatorio del asma. La presencia de neutrofília se asocia a peor comportamiento clínico

OBJECTIVES: our objective was to examine four, already described phenotypes: eosinophilic (Eos), neutrophilic (Neu), mixed and paucigranulocitic (Pau), based on induced sputum samples, the differences in age parameters, body mass index (BMI), exacerbations, asthma control test (ACT), FEV1 and reversibility, as well as exhaled nitric oxide (FeNO) levels. METHOD: a descriptive study, from April 2011 to September 2014,including consecutive patients with bronchial asthma that was not treated with inhaled corticosteroids(IC). Induced sputumwas taken and classified based on the cellularity obtained. Each of the four groups obtained was related to clinical data, such as asthma control test (ACT Test) level, number of exacerbations in the year prior to the respiratory function study, which included spirometry data, bronchodilation test, measurement of exhaled nitric oxide levels andmethacholine test, following GEMA algorithm to diagnose asthma and allergic sensitivity test (prick test and/or ELISA). RESULTS: an adequate sample was obtained in 60% of the patients, with no adverse effect.Finally, 55 asthmatic patients were included. They were classified according to the cellularity of the sputum: 12 patients, as Eos, 12 as Neu, 15 as mixed and finally, 16 in the Pau group.We encountered that in the previous year, more exacerbations were found in the Neu group: Eos-Neu (p 002); Neu-Mix (p < 0.009); Neu-Pau (p < 0.005); Mix- Pau (p < 0.01). FeNO levels tended to be higher in patients witheosinophilia, but without being statistically significant. CONCLUSIONS: induced sputum is a safe technic to differentiate the inflammatory component of asthma. Thepresenceofneutrophilia is associated with a poorer clinical outcome

Estudio comparativo de los efectos secundarios de las pruebas de provocación bronquial para el diagnóstico de asma bronquial / Comparative study of the secondary effects of bronchial provocation testing todiagnose bronchialasthm. Asthma

INTRODUCCIÓN: según el algoritmo diagnóstico de la Guía Española de Manejo del Asma (GEMA), el diagnóstico de asma bronquial debe objetivarse mediante la realización de pruebas de provocación bronquial, ante la negatividad de las previas. Recientemente, se han introducido sustancias como el manitol, por lo que sería importante establecer los criterios de indicación y la seguridad para los pacientes, en relación con sustancias usadas habitualmente, como la metacolina. OBJETIVO: analizar la presencia de efectos secundarios y la tolerancia de los pacientes a las pruebas de provocación bronquial con metacolina y manitol para el diagnóstico de asma bronquial. MATERIAL Y MÉTODO: se analizaron 108 pacientes con sospecha clínica de asma bronquial, nunca estudiados y sin tratamiento previo. A todos se le realizaron, con un intervalo de 24 horas, ambas pruebas diagnósticas en orden aleatorio. Se excluyeron aquellos con algún criterio de contraindicación para la realización de espirometría, fumadores de >10 paquetes/año y aquellos con tratamiento reciente con corticoides inhalados u orales. Se recogieron los efectos adversos en cada paciente y se analizó si existían diferencias significativas por el test Chi cuadrado y test exacto de Fisher. RESULTADOS: el 88,9% de los pacientes presentaron algún tipo de efecto secundario en el test de manitol (más frecuente tos y disnea), frente al 52,8% en el test de metacolina. Independientemente de la positividad de ambas pruebas, se objetivó mayor frecuencia de tos, náuseas y cefalea durante la realización del test de provocación con manitol frente al de metacolina. CONCLUSIONES: hemos objetivado, en los mismos pacientes, una peor tolerancia a la prueba de provocación con manitol frente a la metacolina no relacionada con la positividad de la prueba

INTRODUCTION: Based on the diagnostic algorithm by GEMA (Guía Española de Manejo del Asma or Spanish Asthma Management Guide), the diagnosis for bronchial asthma must be confirmed through bronchial provocation testing, in the light of negative prior tests. Recently, substances such as mannitol have been introduced, in which case, it would be important to establish indication and safety criteria for patients with regards to usually used substances such as methacholine. OBJECTIVE: Analyze secondary effects and patient tolerance to bronchial provocation testing with methacholine and mannitol to diagnose bronchial asthma. Material and METHOD: 108 patients were analyzed, who were clinically suspected of having bronchial asthma, but never studied nor had they any prior treatment. All patients underwent, within a 24-hour interval, both diagnostic tests in random order. Those with some type of contraindication criteria to perform the spirometry were excluded, as were smokers of >10 packets/ year and those recently treated with inhaled or oral corticoids. The adverse effects in each patient were collected and analyzed whether or not there were significant differences based on a Chi Square Test and Fisher Extract Test. RESULTS: 88.9% of the patients presented some type of secondary effect in the test with mannitol (most frequently coughing and dyspnea), compared to 52.8% in the methacholine test. Independently of the positivity of both tests, greater coughing, nausea and headache were observed during the provocation test when mannitol was used instead of methacholine. CONCLUSIONS: We confirm that in the same patients, there is worse tolerance during the provocation test when mannitol is used than when methacholine is used. This fact is not linked to the positivity of the test

Estudio de pacientes con sospecha de asma bronquial remitidos desde Atención Primaria. Análisis del diagnóstico final y utilidad del test de broncodilatación / Studying patients with possible bronchial asthma. Analysis of the final diagnosis and the usefulnessof bronchodilatort testing

INTRODUCCIÓN: el asma es un trastorno inflamatorio crónico de la vía aérea que cursa con obstrucción e hiperrespuesta bronquial y no existe un 'patrón oro' para su diagnóstico. OBJETIVO: estudiar, según el algoritmo diagnóstico de GEMA, la utilidad del test broncodilatador (BD), las características (clínicas, funcionales, parámetros de inflamación) según el resultado del test y las diferencias de los pacientes diagnosticados de asma de aquéllos con otros diagnósticos finales ('pseudoasmas'). METODOLOGÍA: se incluyeron pacientes derivados a consultas especializadas de Neumología con sospecha clínica de asma. Se recogieron datos clínicos y se realizó espirometría con test BD y determinación de niveles de óxido nítrico exhalado (FENO). Cuando el test BD fue negativo, se efectuó prueba de provocación con metacolina o manitol. Los pacientes fueron revisados al mes y a los 6 meses para confirmar el diagnóstico de asma. RESULTADOS: se estudiaron 133 pacientes (edad media 35,6 [11]). Fueron 92 los diagnosticados de asma bronquial y 41 (30,8%) de otras patologías, siendo el goteo nasal posterior la más frecuente. De los 92 asmáticos, presentaron test BD positivo 61 (66,3% de los asmáticos, 45,8% del total). En los 31 casos con test BD negativo, el diagnóstico se hizo por prueba de provocación. Los pacientes con prueba BD positiva presentaban mayor gravedad, afectación funcional y peor control del asma, mayor consumo acumulado de tabaco, habiendo una mayor proporción de hombres. Los casos con test negativo presentaron valores de FENO >30 ppb en el 19% de los casos. CONCLUSIONES: en pacientes previamente no tratados, la prueba broncodilatadora es positiva en un porcentaje alto, siendo aquéllos con patología más grave y peor control. En los casos en que es negativa, puede ser útil la determinación de niveles de FENO. Más de un 30% de pacientes derivados con sospe-cha de asma, finalmente fueron diagnosticados de otras pato-logías, entre las que destaca el goteo nasal posterior

INTRODUCTION: asthma is the chronic inflammation of the airways that presents bronchial obstruction and hyper-response. There is no 'golden rule' to diagnose this disease. OBJECTIVE: Based on the GEMA (Spain's Guideline for Asthma Management) diagnostic algorithm, the usefulness of the bronchodilator test (BD) was studied, as were the circumstances (clinical, functional, inflammatory parameters) based on test results and the differences between patients diagnosed with asthma and those with another final diagnosis (Pseudo-asthma). METHODOLOGY: this study included patients who were thought to have asthma and referred to a respiratory specialist. Clinical data was collected and a spirometry performed with a bronchodilator (BD) test; fractional exhaled nitric oxide (FENO) levels were determined. When the BD test was negative, a methacholine or mannitol challenge test was performed. Patients were seen again after a month and then after six months to confirm the asthma diagnosis. RESULTS: 133 patients were studied (mean age 35.6[11]). 92 were diagnosed with bronchial asthma and 41 (30.8%) with other pathologies; post-nasal drip being the most frequent. Of the 92 patients with asthma, 61 had a positive BD test (66.3% of those with asthma, 45.8% of the total). Of the 31 cases with a negative BD test, the diagnosis was reached using the challenge test. Patients with a positive BD test showed greater severity, with functional affection and poorer asthma control, a greater accumulated prevalence of tobacco, with males being a higher percentage. Cases with a negative test presented FENO values >30 ppb in 19% of the cases. CONCLUSIONS: in previously untreated patients, the BD test was positive in a higher percentage of patients, with them showing more serious pathologies and worse control. In negative cases, it could be useful to determine the FENO level. More than 30% of the referral patients suspected of having asthma were, in the end, diagnosed with other pathologies, including post-nasal drip

CCR5 deficiency predisposes to fatal outcome in influenza virus infection.

Influenza epidemics affect all age groups, although children, the elderly and those with underlying medical conditions are the most severely affected. Whereas co-morbidities are present in 50% of fatal cases, 25-50% of deaths are in apparently healthy individuals. This suggests underlying genetic determinants that govern infection severity. Although some viral factors that contribute to influenza disease are known, the role of host genetic factors remains undetermined. Data for small cohorts of influenza-infected patients are contradictory regarding the potential role of chemokine receptor 5 deficiency (CCR5-Δ32 mutation, a 32 bp deletion in the CCR5 gene) in the outcome of influenza virus infection. We tested 171 respiratory samples from influenza patients (2009 pandemic) for CCR5-Δ32 and evaluated its correlation with patient mortality. CCR5-Δ32 patients (17.4%) showed a higher mortality rate than WT individuals (4.7%; P = 0.021), which indicates that CCR5-Δ32 patients are at higher risk than the normal population of a fatal outcome in influenza infection.

Factores predictivos de exacerbaciones graves en una cohorte de pacientes con asma bronquial seguidos durante un año (estudio fusión) / Predictive factors for serious exacerbations in a cohort of patients with bronchial asthma during a one-year

INTRODUCCIÓN: las exacerbaciones graves del asma son eventos importantes que influyen en el control de la enfermedad, según el concepto actual de riesgo futuro. OBJETIVO: estudiar los factores predictivos de exacerbación grave en una cohorte de pacientes con asma bronquial, seguidos en consultas externas extrahospitalarias. METODOLOGÍA: desde los años 2007 a 2010 se incluyeron en el estudio a pacientes >12 años con asma bronquial, que fueron seguidos en cuatro visitas (basal, a los 4, 8 y 12 meses). Se recogieron parámetros clínicos (gravedad de la enfermedad, control de síntomas [test ACT], control según GINA, atopia), funcionales (espirometría con test broncodilatador), inflamatorios (determinación de la fracción exhalada de óxido nítrico-FeNO), exacerbaciones graves, definidas como aquéllas que necesitaron ciclo de esteroides orales, visitas a urgen-cias u hospitalizaciones por asma. Se compararon los datos de pacientes que presentaron alguna exacerbación grave con aquéllos que no lo presentaron en análisis univariante. Poste-riormente, los factores con significación <0,1 fueron incluidos en análisis multivariante por regresión logística binaria. RESULTADOS: Finalizaron el seguimiento un total de 330 pa-cientes, mayoritariamente con asma leve persistente y mode-rada (más del 80%), mujeres (casi el 70%) y atópicos (más del 76%). Presentaron una exacerbación grave durante el segui-miento el 8% de todos los pacientes (n = 27). En el análisis univariante encontramos diferencias significativas en la dosis equivalente de esteroides inhalados, gravedad basal del asma y exacerbaciones graves previas. En el análisis multivariante encontramos como factor principal predictivo las exacerba-ciones previas y en el análisis a los 4 meses, además, cerca de la significación, los valores de ACT. CONCLUSIONES: el principal factor predictivo de exacerbaciones graves futuras es el antecedente de exacerbaciones graves pre-vias. Durante el seguimiento, también encontramos como posi-ble factor a considerar el grado de control estimado por el ACT

INTRODUCTION: Severe exacerbations of asthma are important events influencing the control of the disease ,according to the current concept of future risk .OBJECTIVE: To study the predictors of severe exacerbation in a cohort of patients with bronchial asthma , followed in outpatient .METHODOLOGY: In the years 2007 to 2010 were included patients > 12 years with asthma who were followed in four visits (baseline, 4, 8 and 12 months). We studied Clinical parameters (disease severity, symptom control [ACT test] control accor-ding to GINA, atopy), function (spirometry with broncho-dilator test )inflammatory (fraction of exhaled nitric oxide FeNO), severe exacerbations, defined as those requiring syste-mic corticosteroids, emergencies or hospitalizations for asth-ma. Were compared patients who had a severe exacerbation with those who did not with univariate analysis. Subsequently, factors with significance <0.1 were included in Multivariate analysis by binary logistic regression.RESULTS: Finished follow-up 330 patients ,mostly with mild persistent asthma and moderate (over 80 %), mostly women (almost 70 %) and atopics (over 76 %). During follow-up pre-sented a severe exacerbation 8% of all patients (n = 27). The univariate analysis showed a significant differences in equiva-lent dose inhaled steroid, asthma severity and previous severe exacerbations. Multivariate analysis found as the main predic-tive factor was previous exacerbations. Analysis at 4 months, showed ACT values near signification.CONCLUSIONS: The main predictor of serious future exacerba-tions is the history of previous severe exacerbations. During follow-up, we also found a possible factor to consider the de-gree of control estimated by ACT

Identification, by RT-PCR, of eight novel I2-conotoxins from the worm-hunting cone snails Conus brunneus, Conus nux, and Conus princeps from the eastern Pacific (Mexico).

Marine snails of the genus Conus (∼500 species) are tropical predators that produce venoms for capturing prey, defense and competitive interactions. These venoms contain 50-200 different peptides ("conotoxins") that generally comprise 7-40 amino acid residues (including 0-5 disulfide bridges), and that frequently contain diverse posttranslational modifications, some of which have been demonstrated to be important for folding, stability, and biological activity. Most conotoxins affect voltage- and ligand-gated ion channels, G protein-coupled receptors, and neurotransmitter transporters, generally with high affinity and specificity. Due to these features, several conotoxins are used as molecular tools, diagnostic agents, medicines, and models for drug design. Based on the signal sequence of their precursors, conotoxins have been classified into genetic superfamilies, whereas their molecular targets allow them to be classified into pharmacological families. The objective of this work was to identify and analyze partial cDNAs encoding precursors of conotoxins belonging to I superfamily from three vermivorous species of the Mexican Pacific coast: C. brunneus, C. nux and C. princeps. The precursors identified contain diverse numbers of amino acid residues (C. brunneus, 65 or 71; C. nux, 70; C. princeps, 72 or 73), and all include a highly conserved signal peptide, a C-terminal propeptide, and a mature toxin. All the latter have one of the typical Cys frameworks of the I-conotoxins (C-C-CC-CC-C-C). The prepropeptides belong to the I2-superfamily, and encode eight different hydrophilic and acidic mature toxins, rather similar among them, and some of which have similarity with I2-conotoxins targeting voltage- and voltage-and-calcium-gated potassium channels.

Evidence for protein-mediated fatty acid efflux by adipocytes.

AIM: The hormonally controlled mobilization and release of fatty acids from adipocytes into the circulation is an important physiological process required for energy homeostasis. While uptake of fatty acids by adipocytes has been suggested to be predominantly protein-mediated, it is unclear whether the efflux of fatty acids also requires membrane proteins. METHODS: We used fluorescent fatty acid efflux assays and colorimetric assays for free fatty acids and glycerol to identify inhibitors with effects on fatty acid efflux, but not lipolysis, in 3T3-L1 adipocytes. We assessed the effect of these inhibitors on a fibroblast-based cell line expressing fatty acid transport protein 1, hormone-sensitive lipase and perilipin, which presumably lacks adipocyte-specific proteins for fatty acid efflux. RESULTS: We identified 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS) as an inhibitor of fatty acid efflux that did not impair lipolysis or the cellular exit of glycerol but lead to an accumulation of intracellular fatty acids. In contrast, fatty acid efflux by the reconstituted cellular model for fatty acid efflux was responsive to lipolytic stimuli, but insensitive to DIDS inhibition. CONCLUSION: We propose that adipocytes specifically express an as yet unidentified DIDS-sensitive protein that enhances the efflux of fatty acids and therefore may lead to novel treatment approaches for obesity-related disorders characterized by abnormal lipid fluxes and ectopic triglyceride accumulation.

Tasa de hospitalización y características de los pacientes ingresados por asma durante el 2009 en un hospital universitario de tercer nivel / Hospitalization rate and characteristics of patients admitted with asthma during 2009 in a tertiary-care University Hospital

Introducción: La tasa de ingresos por asma es criterio para medir la calidad de la asistencia sanitaria, dado que la mayoría de las agudizaciones pueden tratarse de forma ambulatoria. El objetivo del estudio es valorar el número y las características (..) (AU)

Introduction: The rate of hospital admissions for asthma is a criterion for measuring the quality of health care, since the majority of exacerbations can be treated on an outpatient basis. The aim of the study (..) (AU)

Role of emerging respiratory viruses in children with severe acute wheezing.

BACKGROUND: Acute wheezing episodes are frequently associated with respiratory viral infections in children. However, the role of the recently described respiratory viruses is not yet fully understood. OBJECTIVE: The main objective of this study was to estimate the frequency of human metapneumovirus (HMPV), human bocavirus (HBoV), and 14 other respiratory viruses in hospitalized children with acute wheezing. METHODS: A prospective study was conducted on children <14 years old, admitted with an acute expiratory wheezing episode from September 2005 to June 2008. Viruses were detected in nasopharyngeal aspirates by polymerase chain reaction. Clinical data were prospectively recorded. RESULTS: A viral pathogen was identified in 444 (71%) out of 626 hospitalized acute wheezing episodes. Respiratory syncytial virus (RSV) was the most frequently detected (27%), followed by rhinovirus (24%), adenovirus (17.8%), HBoV (16%), and HMPV (4.7%). The rate of viral detection was significantly higher in infants (77.3%), than in older children (59.8%) (P < 0.001). RSV and HBoV were more prevalent in infants (P < 0.001) than in older children. CONCLUSION: The most prevalent viruses found in severe acute wheezing episodes were RSV and rhinovirus not only in childhood, but also in infancy. However, other emerging viruses such as HBoV and metapneumovirus also play an important role in wheezing episodes.

[Assessment of nutritional interventions and hygiene and health habits in a cohort of primary school students]. / Evaluación de dos intervenciones nutricionales y de hábitos de higiene y salud en una cohorte de alumnos de enseñanza primaria.

OBJECTIVE: To quantify by means of the so-called "Healthy lifestyle pyramid" and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. MATERIALS AND METHOD: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. RESULTS: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. CONCLUSIONS: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood.

Evaluación de dos intervenciones nutricionales y de hábitos de higiene y salud en una cohorte de alumnos de enseñanza primaria / Assessment of nutritional interventions and hygiene and health habits in a cohort of primary school students

Objetivo: Cuantificar tras dos intervenciones educacionales, con la denominada ‘Pirámide de estilo de vida saludable’, los cambios en ingesta, actividades diarias y hábitos de higiene y salud, a corto y largo plazo, en una cohorte de niños sanos. Material y métodos: Es un estudio longitudinal prospectivo con una evaluación basal de hábitos dietéticos y de vida, y dos evaluaciones posteriores tras las dos intervenciones educacionales. Resultados: Participaron 52 niños, con una media de 7,9 años y el 15,4% eran obesos. Hubo una reducción estadísticamente significativa en la ingesta de leche entera, tanto a corto como a largo plazo. Fue significativo a corto plazo la reducción en la ingesta de embutidos y un aumento de frutas. Hubo una reducción significativa en ingesta de dulces, a corto plazo. Hubo significación estadística en lavado de manos, a corto y a largo plazo, al igual que el baño en la playa tras comer. También lo hubo en lograr una postura adecuada y no nadar muy adentro, ambos a largo plazo; y por último a corto plazo, en no utilizar campos de deporte inadecuados. La frecuencia con que practican deportes, a largo plazo, tuvo un incremento significativo y también lo hubo en el número de ejercicios semanales, a corto plazo. Conclusiones: Los niños hicieron tras dos intervenciones educacionales modificaciones significativas de sus hábitos de salud a corto, o largo plazo lo que contribuye a modificar factores de riesgo de enfermedad en la vida adulta (AU)

Objective: To quantify by means of the so-called ‘Healthy lifestyle pyramid’ and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. Materials and method: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. Results: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. Conclusions: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood (AU)

A new set of molecular markers for the genotyping of Babesia bovis isolates.

Babesia bovis is a tick-borne apicomplexan pathogen that remains an important constraint for the development of cattle industries worldwide. The existence of different strains and subpopulations has long been described in this hemoparasite. However, few molecular markers have been reported for strain genotyping and characterization. Minisatellite sequences show high levels of variation and therefore provide excellent tools for both the genotyping and population genetic analysis. In this work we report a set of five molecular markers containing minisatellites that showed a variable degree of polymorphism in several American strains. We have used a bioinformatics approach to search for marker sequences contained in open reading frames. Five genes were chosen and primers were designed in conserved regions flanking the repeat region. Two of the genes were the previously described Bv80/Bb-1 and TRAP. The other three genes were named p200, Antigen 3 and Desmoyokin. Amplification by PCR, sequencing and comparative analysis of 11 strains from Argentina, Brazil, Uruguay, Mexico and USA determined that the tandem repeats varied in number and sequence among the isolates. Genome analysis of the five markers revealed that they were single copy and distributed across the four B. bovis chromosomes. When the new markers were analyzed in an experimental infection, absolute sequence conservation was found, indicating the stability of these markers during the course of infection. These markers were also stable during three syringe passages through calves. The application of this panel of molecular markers could provide new molecular tools for the genotyping of B. bovis isolates and analysis of changes in parasite populations following vaccination.