Correction to: Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective.

Following publication of the original article [1], we have been notified of the below corrections to the 5th paragraph in the Discussion section.

Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective.

BACKGROUND: A head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV1) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature. METHODS: This analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum. RESULTS: UMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO. CONCLUSION: UMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting ß2-agonist (LAMA/LABA) treatments can be considered cost effective in Spain.

Diagnostic performance of the measurement of nitric oxide in exhaled air in the diagnosis of COPD phenotypes.

INTRODUCTION: COPD is a highly heterogeneous disease that has a serious impact on affected populations. Patients share some of the features of bronchial asthma, often summarized under the term ACOS (asthma-COPD overlap syndrome). The objective of this study is to evaluate the utility of the measurement of nitric oxide in exhaled air (FENO50) in the diagnosis of COPD phenotypes. MATERIAL AND METHODS: The study comprised cross-sectional observation of patients receiving assistance during a respiratory outpatient visit. Patient data was collected on lung function, FENO, questionnaires scoring CAT®(COPD Assessment Test), and COPD clinical phenotype. RESULTS: 192 patients were studied: 103 with COPD; 16 healthy non-smokers; 30 healthy smokers; and 43 asthmatics. COPD patients were grouped by phenotype: 34 non exacerbators (33.0%); 22 ACOS (21.3%); 13 frequent exacerbators with emphysema (12.6%); and 34 frequent exacerbators with chronic bronchitis (33.0%). ACOS patients showed significantly higher FENO50 values compared to the others after adjustments for confounding factors. FENO50 demonstrated greater diagnostic accuracy than the bronchodilator test (BT) in the diagnosis of ACOS and COPD phenotypes (AUC 0.79 vs 0.74), with an optimal cut-off value of 19 ppb (sensitivity 0.68, specificity 0.75). CONCLUSIONS: Patients with COPD have different levels of FENO50 depending on the COPD phenotype. FENO50 measurement provides better diagnostic accuracy than BT, with an optimal cut-off value of 19 ppb.

Chronic melatonin treatment improves obesity by inducing uncoupling of skeletal muscle SERCA-SLN mediated by CaMKII/AMPK/PGC1α pathway and mitochondrial biogenesis in female and male Zücker diabetic fatty rats.

Melatonin acute treatment limits obesity of young Zücker diabetic fatty (ZDF) rats by non-shivering thermogenesis (NST). We recently showed melatonin chronically increases the oxidative status of vastus lateralis (VL) in both obese and lean adult male animals. The identification of VL skeletal muscle-based NST by uncoupling of sarcoendoplasmic reticulum Ca2+-ATPase (SERCA)- sarcolipin (SLN) prompted us to investigate whether melatonin is a SERCA-SLN calcium futile cycle uncoupling and mitochondrial biogenesis enhancer. Obese ZDF rats and lean littermates (ZL) of both sexes were subdivided into two subgroups: control (C) and 12 weeks orally melatonin treated (M) (10 mg/kg/day). Compared to the control groups, melatonin decreased the body weight gain and visceral fat in ZDF rats of both sexes. Melatonin treatment in both sex obese rats restored the VL muscle skin temperature and sensitized the thermogenic effect of acute cold exposure. Moreover, melatonin not only raised SLN protein levels in the VL of obese and lean rats of both sexes; also, the SERCA activity. Melatonin treatment increased the SERCA2 expression in obese and lean rats (both sexes), with no effects on SERCA1 expression. Melatonin increased the expression of thermogenic genes and proteins (PGC1-α, PPARγ, and NRF1). Furthermore, melatonin treatment enhanced the expression ratio of P-CaMKII/CaMKII and P-AMPK/AMPK. In addition, it rose mitochondrial biogenesis. These results provided the initial evidence that chronic oral melatonin treatment triggers the CaMKII/AMPK/PGC1α axis by upregulating SERCA2-SLN-mediated NST in ZDF diabetic rats of both sexes. This may further contribute to the body weight control and metabolic benefits of melatonin.

Techno-Economic Comparison of Integration Options for an Oxygen Transport Membrane Unit into a Coal Oxy-Fired Circulating Fluidized Bed Power Plant.

The inclusion of membrane-based oxygen-fired combustion in power plants is considered an emerging technology that could reduce carbon emissions in a more efficient way than cryogenic oxygen-fired processes. In this paper, a techno-economic assessment was developed for a 863 MWel,net power plant to demonstrate whether this CCS technique results in a reduction in efficiency losses and economic demand. Four configurations based on oxygen transport membranes were considered, while the benchmark cases were the air combustion process without CO2 capture and a cryogenic oxygen-fired process. The type of driving force through the membrane (3-end or 4-end), the point of integration into the oxy-fuel combustion process, the heating system, and the pollutant control system were aspects considered in this work. In comparison, the efficiency losses for membrane-based alternatives were lower than those in the cryogenic oxygen-fired process, reaching savings of up to 14% net efficiency. Regarding the specific energy consumption for CO2 capture, the configuration based on the oxygen transport membrane unit with 4-end mode and hot filtration presented 1.01 kWel,net,·h/kgCO2 captured with 100% CO2 recovery, which is an improvement of 11% compared with the cases using cryogenic oxygen. Comparing economic aspects, the specific investment costs for cases based on the oxygen transport membrane unit varied between 2520 and 2942 $/kWel,net·h. This was between 39.6 and 48.2% above the investment for the reference case without carbon capture. However, its hypothetical implantation could suppose a savings of 10.7% in terms of investment cost compared with cryogenic oxygen-based case. In terms of the levelized cost of electricity and the cost of CO2 avoidance, the oxygen transport membrane configurations achieved more favorable results compared with the cryogenic route, reaching savings up to 14 and 38%, respectively. Although oxygen transport membrane units are currently not mature for commercial-scale applications, the results indicated that its application within carbon capture and storage technologies can be strongly competitive.

Magnetic-field-synchronized wireless modulation of neural activity by magnetoelectric nanoparticles.

The in vitro study demonstrates wirelessly controlled modulation of neural activity using magnetoelectric nanoparticles (MENPs), synchronized to magnetic field application with a sub-25-msec temporal response. Herein, MENPs are sub-30-nm CoFe2O4@BaTiO3 core-shell nanostructures. MENPs were added to E18 rat hippocampal cell cultures (0.5 µg of MENPs per 100,000 neurons) tagged with fluorescent Ca2+ sensitive indicator cal520. MENPs were shown to wirelessly induce calcium transients which were synchronized with application of 1200-Oe bipolar 25-msec magnetic pulses at a rate of 20 pulses/sec. The observed calcium transients were similar, in shape and magnitude, to those generated through the control electric field stimulation with a 50-µA current, and they were inhibited by the sodium channel blocker tetrodotoxin. The observed MENP-based magnetic excitation of neural activity is in agreement with the non-linear M - H hysteresis loop of the MENPs, wherein the MENPs' coercivity value sets the threshold for the externally applied magnetic field.

Characterization of emissions of condensable particulate matter under real operation conditions in cement clinker kilns using complementary experimental techniques.

Historically, the emission of particles from clinker kiln stacks has been one of the main environmental concerns in cement manufacturing processes. Up to now, environmental regulations have only focused on determining and controlling filterable particulate matter (FPM) in industrial emission sources. However, in recent years a growing interest in determining and analysing condensable particulate matter (CPM) has been evidenced due to the significant and established contribution of CPM to total emissions of particulate matter (PM). In this work, total PM (FPM + CPM) emissions from a clinker kiln in a cement manufacturing process have been characterized. A series of tests were performed to simultaneously collect FPM and CPM using a sampling train patented by University of Seville. The results showed very low level of emissions compared to regulatory limits. The average FPM and CPM concentrations obtained in the kiln were in the same order of magnitude, at 3.4 mg/Nm3 and 2.8 mg/Nm3, respectively. The CPM analysed was predominantly inorganic and represented 46% of total PM emissions. In addition, a microscopic morphological analysis was carried out on the samples and confirmed the presence of CPM with a size of less than 2 µm, as well as establishing the principal constituent elements of the same. The main element components were Al, Ca, Fe, Si, C and O. Compounds such as CaCO3, alite, ferrite and dolomite were detected with analytical characterization techniques, such as infrared spectroscopy (FTIR) analysis and X-ray diffraction (XRD), providing a better understanding of the sources of contamination within CPM.

[Bronchiectasis following colectomy in a patient with ulcerative colitis and factor V Leiden mutation]. / Bronquiectasias tras colectomía en paciente con colitis ulcerosa y mutación del factor V Leiden.

For some years it has been known that lung disease may be present in patients with inflammatory bowel disease (IBD). Diseases of the central airway, bronchi, and lung parenchyma are among the most common forms of lung involvement in IBD patients. Bronchiectasis is frequent and almost always appears after the onset of disease and in close association with inflammatory activity. However, reports of the appearance of bronchiectasis following colectomy for an exacerbation of IBD have been rare. We present the case of a 36-year-old man with severe ulcerative colitis who, following a total colectomy, developed bilateral bronchiectasis 12 months after surgery and for whom both preoperative and postoperative computed tomography scans were available.

[Chronic thromboembolic pulmonary hypertension associated with endomyocardial fibrosis of the right ventricle]. / Hipertensión pulmonar tromboembólica crónica asociada a fribrosis endomiocárdica del ventrículo derecho.

Chronic thromboembolic pulmonary hypertension is a rare sequela to an acute untreated or recurrent pulmonary embolism. The mechanisms that underlie the failure to resolve the thrombus are still uncertain. As most patients are not diagnosed until a relatively late stage, little is known about the course of their illness. We report the case of a 51-year-old woman who had previously been diagnosed with and operated on for endomyocardial fibrosis of the right ventricle and who developed chronic thromboembolic pulmonary hypertension several years later.

Seguridad y tolerancia de la prueba de provocación bronquial con manitol inhalado en la EPOC leve- moderada / Safety and tolerance of the inhaled mannitol bronchial provocation test in mild-moderate COPD

INTRODUCCIÓN: la prueba de provocación bronquial con manitol inhalado (Osmohale(R)) es un test indirecto de medición de la hiperrespuesta bronquial. Se desconoce su utilidad clínica en pacientes con EPOC y su perfil de seguridad en pacientes con EPOC leve-moderado. MATERIAL Y MÉTODOS: estudio observacional prospectivo en el que participaron pacientes con EPOC leve-moderado, atendidos ambulatoriamente durante la fase de estabilidad de su enfermedad. Para todos los pacientes se recogieron los datos de función pulmonar y puntuación del cuestionario CAT. Se sometió a los pacientes a un test de provocación bronquial comercializado (Osmohale(R)). RESULTADOS: participaron en el estudio 72 pacientes con EPOC leve-moderado. En un 26% de los participantes se demostró la existencia de HRB. No hubo ningún abandono de la prueba por efectos adversos. La prueba fue bien tolerada por los pacientes, con la tos como efecto secundario más frecuentemente comunicado. La prueba fue segura, con una caída media del FEV1 del 10% y un tiempo medio de realización de la misma de 27 minutos. CONCLUSIONES: la prueba de provocación bronquial con manitol inhalado es un procedimiento seguro y bien tolerado en pacientes con EPOC leve-moderado

INTRODUCTION: bronchial provocation test with inhaled mannitol (Osmohale(R)) is and indirect approach to the measurement of bronchial hyperresponsiveness (BHR). Neither its clinical utility in COPD nor the secutiry profile en mild to moderate COPD patients is well kwon. MATERIAL AND METHODS: this was an observational prospective study enrrolling mild to moderate COPD patients in an outpatient setting during stability period. Data about lung fuction and CAT questionaire were collected from all patients. Aproved bronchial provocation test (Osmohale (R)) was performed. RESULTS: 72 mild to moderate COPD patients were included. BHR could be assesed in 26% of the sample. There was no drop out due to adverse events. The test was well tolerated, with cough being the most reported adverse event. The test was safe, with a mean FEV1 drop of 10% and a mean performance time of 27 minutes. CONCLUSIONS: bronchial provocation test with inhaled manitol is a safe and well tolerated procedure in mild to moderate COPD patients

Hallazgos radiológicos y correlación con la evolución clínica en pacientes ingresados con infección por gripe A (H1N1) / Radiological findings and correlation with the clinical development in patients who were hospitalized due to an H1N1 flu infection

OBJETIVO: analizar si distintas variables radiológicas y de presentación clínica de los pacientes hospitalizados por infección por Influenza H1N1 se asocian con la gravedad del cuadro y ayudan a predecir su pronóstico. MATERIAL Y MÉTODOS: estudio observacional retrospectivo, en el que se incluyeron pacientes hospitalizados por infección confirmada por Influenza AH1N1 durante las epidemias de los años 2009-2010 y 2010-2011. Para cada paciente se recogieron variables sociodemográficas, de presentación clínica y características radiológicas. Las variables continuas se presentan como media ± DE y las variables dicotómicas se presentan como frecuencias. Para la comparativa de variables continuas hemos utilizado la prueba de la T de Student y para las variables dicotómicas la χ2, considerando un nivel de significación estadísticas para p < 0,05. Se realizó un análisis multivariante para obtener las variables que predecían el resultado principal (ingreso en UCI y/o muerte durante el ingreso), mostrando los resultados de los intervalos de confianza al 95% para la OR. RESULTADOS: durante los períodos de estudio ingresaron en nuestro centro 98 pacientes con infección confirmada por Influenza AH1N1, con una edad media (± DE) de 42,45 (± 16,35), siendo un 53,1% de los mismos varones, de los que un 16,3% precisó ingreso en UCI, con una mortalidad durante el mismo del 6,1%. La comorbilidad más frecuente fue el asma bronquial (28,6%), seguida de la EPOC (11,2%) y con sólo un 3,1% del total con embarazo. En cuanto a las características radiológicas al ingreso, un 26,8% presentaba un estudio normal, un 38,8% un infiltrado bilateral y un 24,5% un infiltrado unilateral. Los pacientes que sufrieron el resultado principal se diferenciaban por un mayor porcentaje de varones, de embarazadas, infiltrados bilaterales al ingreso, peor SpO2 y un mayor porcentaje de pacientes con enfermedad complicada. El análisis multivariante demostró que la única variable que se asociaba de forma significativa a la evolución favorable fue la SpO2 (OR por cada -1% de SpO2 1,521, p < 0,001), con una tendencia a la significación estadística para la presencia de infiltrados unilaterales (OR 8,243, p = 0,134). CONCLUSIONES: la evolución desfavorable de la infección por Influenza AH1N1 que precisa ingreso hospitalario puede ser determinada por el grado de insuficiencia respiratoria presente al ingreso

OBJECTIVE: to examine whether different radiological and clini cal variables of patients hospitalized with H1N1 influenza in fection are associated with disease severity and help predicting prognosis. MATERIAL AND METHODS: a retrospective observational study, which included patients hospitalized for influenza AH1N1 confirmed infection during 2009 - 2010 and 2010 -2011 epidemics. For each patient, sociodemographic, clinical, and radiographic features were registered. Continuous variables are presented as mean ± SD, and dichotomous variables are presented as frequencies. For the comparison of continuous variables we used the T-Student test, and 2 for dichotomous variables, considering a statistical significance level of p < 0.05. Multivariate analysis was performed looking for variables that predicted the primary outcome (ICU admission and/or death during hospitalization), showing the results of the confidence intervals at 95% for the OR. RESULTS: during the study periods 98 patients with confirmed Influenza AH1N1 infection were admitted to our hospital, with a mean age (± SD) of 42,45 (± 16,35) years, 53,1% male, 16,3% requiring ICU admission and total hospital mortality of 6,1%. The most frequent comorbidity was bronchial asthma (28,6%) followed by COPD (11,2%), and pregnancy (3,1%). Regarding the radiological characteristics at admission, 26,8% had a normal study, 38,8% bilateral infiltrates and 24,5% unilateral infiltrates. Patients who met the primary outcome differed by a higher percentage of males, pregnant, bilateral infiltrates on admission, worse SpO2 and a higher percentage of complicated disease. Multivariate analysis showed that the only variable that was significantly associated with the outcome was the SpO2 (OR for every -1% SpO2 1,521, p < 0,001), with a trend toward statistical significance for unilateral infiltrates (OR 8,243, p = 0,134). CONCLUSIONS: influenza AH1N1 infection associated with ICU admission and/ or mortality during hospital admission may be determined by the degree of respiratory failure present at the ED

La enfermedad renal crónica en el niño y el cuidado de enfermería / Chronic kidney disease in children and nursing care / Resumo da doença crônica renal em crianças e os cuidados de enfermagem

[{"text": "La enfermedad renal es un problema de salud pública en el mundo. Se estima que aproximadamente el 30% de los \r\npacientes pediátricos que ingresan al servicio de cuidado intensivo presenta enfermedad renal crónica (ERC), la cual \r\nprovoca diferentes alteraciones tanto en el niño como en sus cuidadores. Esta revisión expone las principales alte\r\n-\r\nraciones que presenta el niño con ERC, su tratamiento y las actividades que se desarrollan durante el cuidado de \r\nenfermería con el fin de lograr disminuir complicaciones y evitar cambios negativos en su calidad de vida.", "_i": "es"}, {"text": "Kidney disease is a worldwide public health problem; it is \r\nestimated that approximately 30% of pediatric patients \r\nadmitted to intensive care service have chronic kidney \r\ndisease (CKD), a disease that causes different alterations \r\nin both the child and their caregivers.\r\nA revision was performed to show the main abnormalities \r\nin the child with CKD, and the treatment and activities \r\nthat are develop during nursing care in order to be able \r\nto decrease complications and avoid negative changes in \r\ntheir quality of life.", "_i": "en"}, {"text": "A doença renal é um problema de saúde pública no \r\nmundo inteiro, estima-se que aproximadamente 30% \r\ndos pacientes pediátricos internados nas unidades de \r\ntratamento intensivo tem doença crônica renal (DCR), \r\numa doença que provoca diversas alterações tanto na \r\ncriança como em seus cuidadores.\r\nA revisão das principais mudanças na criança portando \r\nDCR, o tratamento e as principais ações para os cuidados \r\nde enfermagem, são apresentados a fim de diminuir as \r\ncomplicações e prevenir mudanças negativas em suas \r\nqualidades de vida.", "_i": "pt"}]

Prevalencia de diabetes tipo 2 y obesidad en comunidades Pehuenches, Alto Biobio / Prevalence of type 2 diabetes and obesity in Pehuenches communities, Alto Biobio

Aim: To determine prevalence of diabetes mellitus type 2 (DM2) and obesity (overweight) in the commune of Alto Biobio, where people are mostly pehuenches indigenous. Methodology: This study are part of the "Küme Mongüen Pehuenche" ("Good Pe-huenche Health") project, designed to determine the prevalence of cardiovascular diseases and the associated risk BMI and fasting blood glucose according to MINSAL. Results: Sample of 400 individuals, 213 women and 322 men (58 half-blood). General prevalence of obesity was 30.5% (42.5% overweight), mostly in women and 45 to 64 years old people. Prevalence of DM2 in pehuenches was 0.76% compared to 6.41% for non-pehuenches, with no differences by sex or nutritional status. Conclusions: In agreement with the literature, pehuenches show a low prevalence of DM2 despite high rates of obesity, situation that could change due to westernization of life-style, as it happened in mapuche population.

Objetivo: Determinar la prevalencia de diabetes tipo 2 (DM2) y obesidad (sobrepeso) en la comuna de Alto Biobio, mayoritariamente pehuenches. Metodología: Estudio en el marco del proyecto "Küme Mogüen Pehuenche" ("Buena Salud Pehuenche") destinado a determinar la prevalencia y factores asociados a enfermedades cardiovasculares en esta población. Se evaluó el IMC y la glicemia en ayuna mediante los criterios del MINSAL. Resultados: Muestra de 400 individuos, 213 mujeres y 322 pehuenches (58 mestizos). La prevalencia de obesidad general fue 30,5% (42,5% sobrepeso), mayoritaria en mujeres e individuos de 45 a 64 años. La prevalencia de DM2 en pehuenches fue 0,76% y 6,41% en occidentales, sin diferencias por sexo o estado nutricional. Conclusiones: En concordancia con la literatura, la población indígena pehuenche muestra una baja prevalencia de DM2 a pesar de los altos índices de obesidad, pero que podría cambiar producto de la occidentalización de los estilos de vida, como ocurrió en población mapuche.

Estado nutricional de preescolares de la comuna Alto Biobio y su relación con características etnodemográficas / Nutritional status of preschool Alto Bio-Bio commune and their relationship to characteristics etnodemográficas

Aim: To describe the nutritional status of preschool children of Alto Bio Bio from year 2007 to 2009. Methods: Retrospective descriptive study of the universe of preschools children who were nutritionally evaluated. Data was obtained from the "Healthy Child Control" anthropometric parameters WIH and HIA according to WHO reference and ethno demographic variables were determined. Results: 1144 preschools were evaluated which were 65.7 percent pehuenches and 52.3 percent women. Obesity prevalence was 8.15 percent, 8.66 percent and 17.17 percent in pehuenches, mestizos and westerns respectively. There was a greater risk for malnutrition in mestizos followed by pehuenches. Obesity was higher in boys (10.6 percent) and weight deficit was higher in girls (5.3 percent). Stunting was higher in men (25.3 percent). Conclusions: Coinciding with previous studies we found a tendency to short stature and malnutrition in pehuenches and to obesity in westerns, outcomes associated with extreme poverty in the community.

Objetivo: Describir el estado nutricional de preescolares de la comuna Alto Biobio durante el período 2007 2009. Metodología: Estudio retrospectivo descriptivo del universo de preescolares evaluados nutricionalmente. La información se obtuvo del tarjetón de control de niño sano. Se determinaron los parámetros antropométricos P/T y T/E según referencia OMS y variables etnodemo-gráficas. Resultados: Fueron evaluados 1.144 preescolares, 65,7 por ciento correspondían a pehuenches y 52,3 por ciento eran mujeres. La prevalencia de obesidad fue 8,15 por ciento, 8,66 por ciento y 17,17 por ciento en pehuenches, mestizos y occidentales respectivamente; teniendo mayor riesgo de desnutrición en la etnia mestiza seguida por la pehuenche. La obesidad fue mayor (10,6 por ciento) en varones, y el déficit de peso fue mayor en las niñas (5,3 por ciento). La talla baja fue mayor en los varones (25,3 por ciento). Conclusión: Coincidentemente con estudios previos, encontramos una mayor tendencia a la desnutrición con talla baja en pehuenches y a obesidad con talla normal en occidentales, resultados asociados a la extrema pobreza de la comuna.

Prevalencia de comorbilidades en pacientes con EPOC / Prevalence of comorbidity in patients with COPD

Objetivo: Estudiar la prevalencia de comorbilidades en pacientes con EPOC estables, en Andalucía y Extremadura, y analizar su relación con el consumo de recursos sanitarios, grado de obstrucción al flujo aéreo y calidad de vida. Material y métodos: Estudio con dos fases, una primera prospectiva transversal multicéntrica concurrente de pacientes con EPOC estables, reclutados en seis hospitales de Andalucía y Extremadura. Se recogieron datos demográficos, funcionales respiratorios, índice de comorbilidad de Charlson, índice BODE, escala hospitalaria de ansiedad y depresión y cuestionario específico de calidad de vida (SGRQ). Se recogió la existencia de comorbilidad a través de la historia clínica del paciente y entrevista detallada. Una segunda fase prospectiva longitudinal de un año para estudiar el consumo de recursos sanitarios. Resultados: Se incluyeron 164 pacientes, el 83,5% varones, con edad media de 65,7 años, y FEV1 medio de 48,1%. Las prevalencias de comorbilidades mas frecuentes en nuestros pacientes fueron de cardiopatía isquémica 9,8%, insuficiencia cardiaca 6,1%, enfermedad vascular periférica 6,1%, enfermedad cerebrovascular 4,9%, diabetes mellitus 12,8%, neoplasias 10,9%, hepatopatía 10,4%, ansiedad 15,2% y depresión 14%. No se observó asociación significativa entre la prevalencia de comorbilidades o el índice de comorbilidad de Charlson y la necesidad de asistencia sanitaria, calidad de vida o función pulmonar. Conclusiones: la prevalencia de comorbilidades en pacientes con EPOC estable en Andalucía y Extremadura es elevada. La existencia de comorbilidad fue independiente del deterioro de la función pulmonar, de la necesidad de asistencia a urgencias o ingresos hospitalarios y del deterioro de la calidad de vida (AU)

Objective: To Study the prevalence of comorbidity in patients with stable COPD, in Andalusia and Extremadura and to analyze its relationship with the consumption of healthcare resources, degree of airway obstruction and quality of life. Material and methods: Two phase study: the first was a transversal, multi-center, prospective study, concurrent with stable COPD patients, recruited from six hospitals in the regions of Andalusia and Extremadura (Spain). Demographic data was collected, as well as respiratory function, Charlson comorbidity index, BODE index, hospital scale for anxiety and depression and specific quality of life questionnaire). The existence of comorbidity was assessed through patient clinical history and detailed interview. The second phase was a longitudinal, one year prospective study to review the use of healthcare resources. Results: 164 patients were included, of which 83.5% were males with an average age of 65.7 years, and an average FEV1 of 48.1%. The most frequent prevalence of comorbidity in our patients was ischemic heart disease 9.8%, cardiac insufficiency 6.1%, peripheral vascular disease 6.1%, cerebrovascular disease 4.9%, diabetes mellitus 12.8%, neoplasm 10.9%, hepatopathy 10.4%, anxiety 15.2% and depression 14%. No significant association was observed between the prevalence of comorbidities or Charlson comorbidity Index and the need for healthcare, the quality of living or pulmonary function. Conclusions: the prevalence of comorbidities in patients with stable COPD in the regions of Andalusia and Extremadura is high. The existence of comorbidity was independent on the deterioration of pulmonary function, the need for emergency healthcare or admittance to hospital and deterioration of living quality (AU)