Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score.

BACKGROUND: The objective of this study was to determine whether the concomitant presence of poor health status (COPD Assessment Test, CAT ≥ 10 points) and low exercise tolerance (6-Minute Walking Test, 6MWT < 350 m) is associated with worse clinical characteristics in patients with COPD. In addition, we aimed to develop a readily applicable diagnostic model to discriminate COPD patients with these conditions. METHODS: A cross-sectional multicenter study involving 208 stable COPD patients (FEV1/FVC < 0.7, smoking history of at least 10 pack-years, and chronic respiratory symptoms) was carried out. The outcome measures were the 6MWT, CAT score, 5-repetition sit-to-stand test (5STS) and modified Medical Research Council Dyspnea Scale (mMRC). Patients were categorized into three groups: no condition (6MWT ≥ 350 m and CAT < 10 points), one condition (6MWT < 350 m or CAT ≥ 10 points), and both conditions (6MWT < 350 m and CAT ≥ 10 points). RESULTS: A total of 26 patients (12,5%) presented both conditions. These patients experienced a higher degree of dyspnea (p = 0.001), smoking pack-years (p = 0.011), severe obstruction (p = 0.006), and time on 5STS (p = 0.001). The probability of having both conditions directly increased with the time spent on the 5STS (ß=0.188; p = 0.010) and the degree of dyspnea (ß=1.920; p < 0.001) (R2=0.413). The scoring system, using the 5STS and dyspnea as surrogate measures, demonstrated adequate calibration between the predicted and observed risk (linear R2=0.852). CONCLUSIONS: COPD patients with concurrent conditions have worse clinical status. The diagnostic model developed to discriminate these patients shows good internal validation.

The role of cultural competency training to address health disparities in surgical settings.

BACKGROUND: Disparities in health care delivered to marginalized groups are unjust and result in poor health outcomes that increase the cost of care for everyone. These disparities are largely avoidable and health care providers, have been targeted with education and specialised training to address these disparities. SOURCES OF DATA: In this manuscript we have sought out both peer-reviewed material on Pubmed, as well as policy statements on the potential role of cultural competency training (CCT) for providers in the surgical care setting. The goal of undertaking this work was to determine whether there is evidence that these endeavours are effective at reducing disparities. AREAS OF AGREEMENT: The unjustness of health care disparities is universally accepted. AREAS OF CONTROVERSY: Whether the outcome of CCT justifies the cost has not been effectively answered. GROWING POINTS: These include the structure/content of the CCT and whether the training should be delivered to teams in the surgical setting. AREAS TIMELY FOR DEVELOPING RESEARCH: Because health outcomes are affected by many different inputs, should the effectiveness of CCT be improvement in health outcomes or should we use a proxy or a surrogate of health outcomes.

Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

OBJECTIVE: This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS: This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS: Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION: The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Impact of COVID-19 pandemic on HbA1c management and results in pediatric and adult outpatients with diabetes.

Objectives: Diabetes mellitus intensify the risks and complications related to COVID-19 infection. A major effect of the pandemic has been a drastic reduction of in-person visits. The aim of this study was to evaluate the impact of the COVID-19 pandemic on HbA1c management and results among pediatric and adult outpatients with diabetes, considering the laboratory and point-of-care testing (POCT) HbA1c measurements. Methods: Observational retrospective study including patients from pediatric and adult diabetes units was conducted. HbA1c results obtained in the laboratory and POCT over 3 years (2019-2021) were collected from the laboratory information system. Results: After the lockdown, the number of HbA1c plummeted. Children returned soon to routine clinical practice. The number of HbA1c increased gradually in adults, especially in POCT. Globally, HbA1c results were lower in children compared with adults (p<0.001). HbA1c values in children (p<0.001) and adults (p=0.002) decreased between pre-pandemic and post-pandemic periods, though lower than the HbA1c reference change value. The percentage of HbA1c results above 8% remained stable during the study period. Conclusions: Continuous glucose monitoring and a telemedicine have been crucial, even allowing for improvements in HbA1c results. During the lockdown, patients with better metabolic control were managed in the laboratory whereas patients with poorer control or a severe clinical situation were attended in diabetes units by POCT. Adults returned to pre-pandemic management slowly because they were more susceptible to morbidity and mortality due to COVID-19. Coordination among all health professionals has been essential to offering the best management, especially in difficult scenarios such as the COVID-19 pandemic.

Iodotyrosines Are Biomarkers for Preclinical Stages of Iodine-Deficient Hypothyroidism in Dehal1-Knockout Mice.

Background: Iodine is required for the synthesis of thyroid hormone (TH), but its natural availability is limited. Dehalogenase1 (Dehal1) recycles iodine from mono- and diiodotyrosines (MIT, DIT) to sustain TH synthesis when iodine supplies are scarce, but its role in the dynamics of storage and conservation of iodine is unknown. Methods: Dehal1-knockout (Dehal1KO) mice were generated by gene trapping. The timing of expression and distribution was investigated by X-Gal staining and immunofluorescence using recombinant Dehal1-beta-galactosidase protein produced in fetuses and adult mice. Adult Dehal1KO and wild-type (Wt) animals were fed normal and iodine-deficient diets for 1 month, and plasma, urine, and tissues were isolated for analyses. TH status was monitored, including thyroxine, triiodothyronine, MIT, DIT, and urinary iodine concentration (UIC) using a novel liquid chromatography with tandem mass spectrometry method and the Sandell-Kolthoff (S-K) technique throughout the experimental period. Results: Dehal1 is highly expressed in the thyroid and is also present in the kidneys, liver, and, unexpectedly, the choroid plexus. In vivo transcription of Dehal1 was induced by iodine deficiency only in the thyroid tissue. Under normal iodine intake, Dehal1KO mice were euthyroid, but they showed negative iodine balance due to a continuous loss of iodotyrosines in the urine. Counterintuitively, the UIC of Dehal1KO mice is twofold higher than that of Wt mice, indicating that S-K measures both inorganic and organic iodine. Under iodine restriction, Dehal1KO mice rapidly develop profound hypothyroidism, while Wt mice remain euthyroid, suggesting reduced retention of iodine in the thyroids of Dehal1KO mice. Urinary and plasma iodotyrosines were continually elevated throughout the life cycles of Dehal1KO mice, including the neonatal period, when pups were still euthyroid. Conclusions: Plasma and urine iodotyrosine elevation occurs in Dehal1-deficient mice throughout life. Therefore, measurement of iodotyrosines predicts an eventual iodine shortage and development of hypothyroidism in the preclinical phase. The prompt establishment of hypothyroidism upon the start of iodine restriction suggests that Dehal1KO mice have low iodine reserves in their thyroid glands, pointing to defective capacity for iodine storage.

Development of the ESEx index: a tool for predicting risk of recurrent severe COPD exacerbations.

Background: In chronic obstructive pulmonary disease (COPD), multiple recurrent severe exacerbations that require hospitalization can occur. These events are strongly associated with death and other clinical complications. Objectives: We aimed to develop a prognostic model that could identify patients with COPD that are at risk of multiple recurrent severe exacerbations within 3 years. Design: Prospective cohort. Methods: The derivation cohort comprised patients with stable, moderate-to-severe COPD. Multivariable logistic regression analyses were performed to develop the final model. Based on regression coefficients, a simplified index (ESEx) was established. Both, model and index, were assessed for predictive performance by measuring discrimination and calibration. Results: Over 3 years, 16.4% of patients with COPD experienced at least three severe recurrent exacerbations. The prognostic model showed good discrimination of high-risk patients, based on three characteristics: the number of severe exacerbations in the previous year, performance in the five-repetition sit-to-stand test, and in the 6-minute-walk test. The ESEx index provided good level of discrimination [areas under the receiver operating characteristic curve (AUCs): 0.913]. Conclusions: The ESEx index showed good internal validation for the identification of patients at risk of three recurrent severe COPD exacerbations within 3 years. These tools could be used to identify patients who require early interventions and motivate patients to improve physical performance to prevent recurrent exacerbations.

Resultados del taller para residentes de ginecoobstetricia en reparación de episiotomías y desgarros obstétricos / Results of workshop for obstetrics and gynecology residents on episiotomy and injury obstetric tear repair

Resumen OBJETIVO: Evaluar los conocimientos, satisfacción y nivel de confianza de los médicos residentes de Ginecología y Obstetricia luego de haber participado en un taller de simulación de reparación de episiotomías y desgarros perineales severos. MATERIALES Y MÉTODOS: Estudio observacional y transversal efectuado en residentes de la especialidad de Ginecología y Obstetricia en junio del 2022. Se aplicaron cuestionarios de conocimientos antes y después del taller, una encuesta de satisfacción y nivel de confianza, así como una lista de cotejo para valorar el desempeño en la ejecución de la técnica de reparación de episiotomías y desgarros. Se utilizó estadística descriptiva y prueba de t pareada para la comparación antes y después de las muestras relacionadas. Se consideró significancia estadística una p < 0.05. RESULTADOS: Se incluyeron 37 médicos residentes de todos los grados académicos. La media de la evaluación preprueba fue de 14.89 ± 0.54 puntos y 15.81 ± 0.41 puntos en la posprueba (p = 0.233). Durante la práctica de reparación de la episiotomía, 34 de los 37 residentes reconocieron estructuras anatómicas y todos seleccionaron adecuadamente el material de sutura. En el taller de desgarros perineales 25 de 37 reconocieron las estructuras anatómicas y todos, menos uno, seleccionaron adecuadamente el material. CONCLUSIONES: El taller con modelos animales de simulación tiene un alto grado de satisfacción y nivel de confianza; sin embargo, en este estudio no se observó mejoría en los conocimientos. Este efecto positivo en los médicos en vías de especialización permite identificar, de manera oportuna, las lesiones del esfínter anal, llevar a cabo una correcta reparación y, en consecuencia, disminuir la incidencia de disfunciones asociadas con el traumatismo obstétrico perineal.

Abstract OBJECTIVE: To assess the knowledge, satisfaction and level of confidence of Gynaecology and Obstetrics residents after participating in a simulation workshop on episiotomy and severe perineal tear repair. MATERIALS AND METHODS: Observational and cross-sectional study carried out in residents of the speciality of Gynaecology and Obstetrics in June 2022. Knowledge questionnaires were administered before and after the workshop, a satisfaction and confidence level survey, as well as a checklist to assess the post-workshop episiotomy and tear repair technique. Descriptive statistics and paired t-test were used for pre- and post-test comparison. A p < 0.05 was considered statistically significant. RESULTS: Thirty-seven resident physicians of all academic grades were included. The mean pre-test assessment was 14.89 ± 0.54 points and 15.81 ± 0.41 points at post-test, p = 0.233. During episiotomy repair practice, 34 of the 37 residents recognized anatomical structures and all selected suture material appropriately. In the perineal tears workshop 25 of 37 recognized anatomical structures and all but one selected material appropriately. CONCLUSIONS: The workshop with simulation animal models has a high satisfaction and confidence level; however, no improvement in knowledge was observed in this study. This positive effect on trainee doctors allows early identification of anal sphincter injuries, correct repair and consequently a decrease in the incidence of dysfunction associated with perineal obstetric trauma.

Tratamiento del síndrome de vejiga hiperactiva mediante estimulación transcutánea bilateral del nervio tibial posterior / Treatment of overactive bladder syndrome by bilateral transcutaneous posterior tibial nerve stimulation

Resumen OBJETIVO: Determinar si la estimulación transcutánea bilateral del nervio tibial posterior disminuye los síntomas de la vejiga hiperactiva y mejora la calidad de vida. MATERIALES Y MÉTODOS: Estudio de cohorte simple, retrospectivo, efectuado en pacientes atendidas en la clínica de Urología Ginecológica del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes en la Ciudad de México, del 8 de octubre de 2021 al 14 de julio de 2022 a quienes se aplicó terapia de electroestimulación bilateral transcutánea del nervio tibial posterior para tratar el síndrome de vejiga hiperactiva.Parámetros de estudio: severidad, calidad de vida y diario miccional en las sesiones 1, 6 y 12. Para la comparación al inicio y al final del tratamiento se utilizó estadística descriptiva y prueba de t pareada; la p < 0.05 se consideró estadísticamente significativa. RESULTADOS: Se estudiaron 25 pacientes: 23 con disminución del puntaje en el cuestionario de calidad de vida King's Health de 24.5 entre las sesiones 1 y 12 (p < 0.001). La disminución del puntaje de severidad de síntomas (Overactive Bladder Symptom Severity [OABSS]) fue de 16.6 entre las sesiones 1 y 12 (p < 0.001). Se observó mejoría significativa en todos los parámetros del diario miccional. CONCLUSIÓN: En esta muestra, la estimulación transcutánea bilateral del nervio tibial posterior disminuyó de manera importante los síntomas de vejiga hiperactiva y mejoró la calidad de vida.

Abstract OBJECTIVE: To determine whether bilateral transcutaneous stimulation of the posterior tibial nerve reduces symptoms of overactive bladder and improves quality of life. MATERIALS AND METHODS: Simple, retrospective, cohort study carried out in patients attended at the gynaecological urology clinic of the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes in Mexico City, from 8 October 2021 to 14 July 2022 to whom bilateral transcutaneous electrostimulation therapy of the posterior tibial nerve was applied to treat overactive bladder syndrome. Study parameters: severity, quality of life and voiding diary in sessions 1, 6 and 12. Descriptive statistics and paired t-test were used for comparison at baseline and at the end of treatment; p < 0.05 was considered statistically significant. RESULTS: Twenty-five patients were studied: 23 with a decrease in King's Health quality of life score of 24.5 between sessions 1 and 12 (p < 0.001). The decrease in symptom severity score (OABSS) was 16.6 between sessions 1 and 12 (p < 0.001). Significant improvement was observed in all voiding diary parameters. CONCLUSION: In this sample, bilateral transcutaneous posterior tibial nerve stimulation significantly decreased overactive bladder symptoms and improved quality of life.

Validation of the Spanish Activity Questionnaire in COPD (SAQ-COPD) in Patients with Chronic Obstructive Pulmonary Disease.

Purpose: The Spanish Activity Questionnaire in COPD (SAQ-COPD) is a short, simple physical activity (PA) measurement instrument for patients with chronic obstructive pulmonary disease (COPD). In this study, we analyzed its validity and sensitivity to change. Methods: Prospective scale validation study. An accelerometer (DynaPort MoveMonitor®) and the Yale Physical Activity Survey (YPAS) were used as reference standards. The analyses examined the criterion validity (Spearman correlations), internal consistency (Cronbach's alpha), factorial structure, test-retest reliability (intraclass correlation coefficient, ICC), sensitivity to change and receiver operating characteristic (ROC) curve to classify patients with low PA. Results: A total of 300 patients diagnosed with COPD were analyzed (73% males, mean age 66 ± 8 years, 40.3% with severe airflow limitation). Cronbach's alpha was 0.60 and Spearman's correlations with accelerometer measurements of PA [number of steps, metabolic equivalents (MET), physical activity level (PAL)] and YPAS ranged from 0.37 to 0.53 (all p < 0.001). ICC was 0.69 (95% CI 0.61-0.74) and the area under the ROC curve to identify low PA was 0.65 (95% confidence interval: 0.58-0.73). Significant variations in SAQ-COPD scores were found between groups defined by YPAS for change. Conclusion: The SAQ-COPD questionnaire is a valid instrument for classifying PA in patients with COPD. Correlations with other instruments provide criterion validity and also demonstrate good sensitivity to change.

The prognosis of pre-frail chronic obstructive pulmonary disease patients for hospitalizations and mortality depends on their level of functional physical performance.

OBJECTIVE: To determine if pre-frail Chronic obstructive pulmonary disease (COPD) patients with poor and non-poor performance in the five-repetition sit-to-stand test (5-STS) had a worse prognosis for hospitalization and mortality at 2 years and for mortality at 5 years than non-frail patients. METHODS: We prospectively included patients with stable COPD, between 40 and 80 years, from a hospital in Spain. Patients were classified according their performance on the 5-STS test and level of frailty. Timing, number of hospitalizations, length of stay, and timing and rate of mortality were outcome measures. Patients were followed for 2 years for exacerbations and for 5 years for mortality. Kaplan-Meier curves and univariate and multivariate Cox proportional-hazard analyses, ANOVA tests and univariate and multivariate linear and logistic regression models were used. RESULTS: Of the 125 patients included, 25.6% were pre-frail with poor performance, 57% pre-frail with non-poor performance, and 17.4% non-frail with non-poor performance. Pre-frail patients with poor performance had a higher number of hospitalizations (adjusted beta: 0.49; 95% CI: 0.01-0.96), mortality rates (odds ratio: 11.33; 95% CI: 1.15-110.81), and risk at 5 years (adjusted hazard ratio: 8.77; 95% CI: 1.02-75.51) than non-frail patients. Pre-frail patients with poor performance also had worse prognoses than non-frail patients with respect to length of hospital stays (increased by 4.16 days) and timing to first hospitalization (HR: 6.01) in unadjusted models, but not when adjusted. CONCLUSION: The COPD prognosis of pre-frail patients with respect to the number of exacerbations with hospitalization and the timing and rate of mortality is dependent of functional performance.

Improving the Reliability Between the BODE Index and the BODS Index in Which the 6-Min Walk Test Was Replaced with the Five-Repetition Sit-to-Stand Test.

Purpose: The BODS index has been confirmed to have predictive properties similar to the original BODE index for mortality in COPD. We evaluated the agreement between the BODS index and the BODE and explored with an updated BODS how this agreement could be improved and its ability to correctly discriminate individual participants' mortality in a prospective cohort study. Patients and Methods: We included prospectively a consecutive sample of 137 patients with COPD, between 40 and 80 years, during 2014 and followed for 5 years (2014-2019) in the Pneumology section of a public university hospital in Spain. They participated in the baseline data collection, which included BODE- and BODS-related measurements and prognostic factors, and were followed up for 5-year mortality. We used Bland-Altman plots and the kappa coefficient to analyze the agreement between both the original and updated BODS and the BODE index, and we used the areas under ROC curves (AUC) to compare their discriminative abilities for 5-year all-cause mortality. Results: The original BODS index scores and quartiles had weak agreement with the BODE index, and our updated BODS strengthened these agreements (a small, statistically nonsignificant mean bias [<0.03] with LoAs<2 points, and a substantial Kappa coefficient [k =0.63; IC 95%: 0.53-0.73]). In addition, the updated BODS index scores had better summarized ability than the BODS index in discriminating participants' mortality during the following 5 years (AUC: 0.768 versus 0.736; p=0.04). Conclusion: The updated BODS index scores and quartiles may provide prognostic information similar to that provided by the BODE index in COPD. Future research should focus on index improvement through external validation, as well as the assessment of safety and effectiveness in clinical practice by means of impact studies.

Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma.

To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.

Pulmonary Oncocytoma Located at the Intermediate Bronchus Diagnosed by Bronchial Biopsy / Oncocitoma pulmonar localizado en bronquio intermediario diagnosticado mediante biopsia bronquial

No disponible

Prognostic value of the five-repetition sit-to-stand test for mortality in people with chronic obstructive pulmonary disease.

BACKGROUND: Prognostic studies suggest that some musculoskeletal and functional capacity tests are independently associated with mortality in chronic obstructive pulmonary disease (COPD), but comparing their prognostic value is difficult because of differences in the selected covariates for regression modelling in those studies. OBJECTIVES: To assess the prognostic value of five musculoskeletal and functional capacity tests in predicting mortality risk in patients with COPD after adjusting for existing and confounding prognostic factors and to compare their ability to correctly discriminate the mortality of individual participants using the 6-min walk test (6MWT). We hypothesized that the examined tests have different prognostic value. METHODS: Prospective and longitudinal study. A total of 137 patients with stable COPD (mean [SD] age 67 [8.33] years; 87% male) were recruited from a hospital in Spain during 2014 and followed for 5 years (2014-2019). No one refused and only one was lost to follow-up. The outcome measure was 5 year all-cause mortality. RESULTS: A total of 37 patients died within 5 years. All musculoskeletal tests were associated with 5 year all-cause mortality in Cox proportional-hazards regression models. However, only the five-repetition sit-to-stand test (5-STS) score was an independent prognostic factor (hazard ratio 1.04 per sec, 95% confidence interval 1.01-1.08) after adjusting for history of heart disease, number of previous severe exacerbations, and dyspnoea. This model explained 50.7% of the variance in mortality. This test exhibited similar discriminative ability as the 6MWT for 5 year mortality (area under the receiver operating characteristic curve: 0.741vs 0.722; p = 0.92), and a highly prognostic cut-off for discriminating (15.98 s). This cut-off had higher likelihood ratios (LRs) than the 6MWT cut-off (∼350 m), especially for negative LRs (1/LR-: 7.69vs 2.00). CONCLUSIONS: The 5-STS is an objective measure for predicting mortality in patients with COPD and has good discriminative ability, with a cut-off for discriminating survival slight better than the 6MWT. The prognostic value of the other tests remains to be confirmed.

Problemas de salud en niños y adolescentes durante la pandemia ocasionada por la COVID-19

Introducción: La COVID-19, enfermedad que alcanzó categoría de pandemia en marzo de 2020, transformó todas las esferas de la vida y en consecuencia afectó la salud biopsicosocial de los niños y adolescentes. Objetivo: Identificar los problemas de salud que afectan a niños y adolescentes en una emergencia epidemiológica. Métodos: Investigación realizada entre julio y noviembre de 2020. Se utilizaron como fuente de información primaria revistas científicas y tesis de grado. Como fuente de información secundaría se utilizaron las bases de datos SciELO, Elsevier, ONU, Lilacs, Latindex. Los términos y palabras clave empleadas en la búsqueda fueron: COVID-19, salud emocional, trastornos del sueño, obesidad, tecnologías de la información y la comunicación, prevención. Resultados: Se definieron los problemas de salud de los niños y se describen como factores de riesgo la discapacidad y el uso de las tecnologías de información y comunicación. Se establecieron medidas de prevención. Conclusiones: El confinamiento aumenta la ansiedad, soledad, tristeza, desesperación en los niños, afectaciones del sueño e intentos de suicidio en adolescentes. La discapacidad infantil presenta una alta vulnerabilidad. El uso desmedido de tecnologías de la comunicación y la información por niños durante la pandemia constituye un factor de riesgo, que puede generar entre otros problemas, la obesidad. Los padres y cuidadores son los responsables de modificar el estilo de vida de niños y adolescentes y diseñar nuevas estrategias para preservar su salud.

Introduction: COVID-19, a disease that reached pandemic status in March 2020, transformed all spheres of life and consequently affected the biopsychosocial health of children and adolescents. Objective: To identify health problems that may affect children and adolescents in an epidemiological emergency. Methods: Research conducted between July and November 2020. Scientific journals and theses were used as a primary source of information. As a secondary source of information, the databases SciELO, Elsevier, ONU, Lilacs, Latindex were used. The terms and keywords used in the search were: COVID-19, emotional health, sleep disorders, obesity, information and communication technologies, prevention. Results: Children's health problems were defined and disability and the use of information and communication technologies were described as risk factors. Prevention measures were implemented. Conclusions: Confinement increases anxiety, loneliness, sadness, despair in children, sleep impairments and suicide attempts in adolescents. Childhood disability is highly vulnerable. The excessive use of communication and information technologies by children during the pandemic is a risk factor, which can generate, among other problems, obesity. Parents and caregivers are responsible for modifying the lifestyle of children and adolescents and designing new strategies to preserve their health.

Effectiveness of Non-Presential Individualized Exercise Training PrOgram(NIETO) in Lower Limb Physical Performance in Advanced COPD.

Muscle training, a component of pulmonary rehabilitation (PR), improves the physical performance of patients with chronic obstructive pulmonary disease (COPD). Despite the existing evidence, the traditional center-based PR model is applied to a small percentage of patients and presents numerous problems of accessibility, adherence, and costs. This study presents a home model of simple muscle training, non-presential, monitored by telephone and individualized, according to the severity of the COPD. In addition, to evaluate the results, simple tests associated with the physical performance of the lower limbs, previously validated in COPD, have been used, such as the four-meter walk, speed test (4MGS) and the five-repetition test sitting and standing (5STS). The objective was to evaluate whether the Individualized Non-Presential Exercise Training PrOgram (NIETO) induces improvements in the 4MGS, 5STS and quadriceps muscle strength (QMS) tests in outpatients with advanced COPD (FEV1 ≤ 50%). After one year, the QMS was significantly higher in the intervention group (IG) than in the control group (CG) (2.44 ± 4.07 vs. 0.05 ± 4.26 kg; p = 0.009). The 4MGS and 5STS tests were significantly shorter in IG than in CG (-0.39 ± 0.86 vs. 0.37 ± 0.96 s; p = 0.001) and (-1.55 ± 2.83 vs. 0.60 ± 2.06 s; p = 0.001), respectively. A home model of simple muscle training monitored by telephone such as NIETO, can improve 4MGS, 5STS, and quadriceps strength tests in outpatients with advanced COPD.

Pancreatic Metastasis from Malignant Melanoma: Not All That Glitters Is Gold.

Pancreatic adenocarcinoma is the most common malignancy of the pancreas; on rare occasions, metastatic tumors are present. Differentiating a primary neoplasm from a metastatic one is important for ensuring adequate treatment for the patient. We present a case of metastatic melanoma to the pancreas. A 60-year-old man presented with a history of weight loss, vague abdominal pain, jaundice, and pruritus. Laboratory tests showed increased total bilirubin, with a direct fraction predominance, as well as increased alkaline phosphatase and gamma glutamyl transferase. Imaging studies revealed a mass in the head of the pancreas. Endoscopic ultrasound (EUS)-guided fine needle biopsy was performed, and histologic examination confirmed the diagnosis of metastatic melanoma. This case report illustrates the invaluable use of EUS-guided tissue acquisition in the study of pancreatic solid lesions to obtain an accurate diagnosis. Melanomas should always be part of a differential diagnosis when evaluating patients with pancreatic masses.

The five-repetition sit-to-stand test is a predictive factor of severe exacerbations in COPD.

BACKGROUND: Although the six-minute-walk test (6MWT) has been used to predict chronic obstructive pulmonary disease (COPD) exacerbations, additional research is necessary to identify more rapid, simpler tests that are directly associated with exacerbations, such as the five-repetition sit-to-stand (5STS) test and 4-m gait speed (4MGS) test. AIMS: To determine the ability of the 5STS and 4MGS tests in predicting severe exacerbations in stable COPD over the following year, and to assess the ability of the best prognostic test to identify patients at high risk of hospital admission correctly. METHODS: This prospective study included 137 patients with stable COPD. Multiple logistic regression models were constructed to assess whether the 6MWT, 5STS, and 4MGS tests were associated with severe exacerbations in the year following the test. Receiver-operating characteristic curves and the area under the curve (AUC) were evaluated to determine the accuracy of each test for identifying patients with severe exacerbations. RESULTS: Scores of <350 m for the 6WMT and ⩽2 for the 5STS test were associated with severe exacerbations in the model adjusted for age and the number of exacerbations in the previous year. The 5STS test and the 6MWT had very similar predictive and discriminative abilities. Odds ratios were 3.20 (95% confidence interval [CI] 1.14-8.96) and 3.84 (95% CI 1.14-12.94) and AUCs were 0.793 (95% CI 0.704-0.882) and 0.783 (95% CI 0.686-0.879), respectively. CONCLUSIONS: The 5STS test predicted the risk of severe exacerbation within the following year among patients with COPD. The 5STS test could replace the 6MWT for identifying patients at high risk of hospital admission.