Tropical high altitude and severe asthma in adults: house dust mite sensitization and phenotypic distribution.

BACKGROUND: There is a lack of information on house dust mite (HDM) sensitization and phenotype distribution in patients with severe asthma (SA) living permanently at high-altitude (HA) in tropical regions, which may be different. OBJECTIVE: The aim of this study was to characterize adults with SA in a tropical high altitude city (2,640 m): Bogotá, Colombia. MATERIAL AND METHODS: This observational cross-sectional study included severe asthmatic outpatients (n = 129) referred to the ASMAIRE program of the Fundación Neumológica Colombiana in Bogotá (2,640 m). Clinical history, spirometry, total IgE, blood eosinophils, and skin prick test (SPT), including HDM allergens, were performed. Phenotype definitions: Allergic/atopic (AA): IgE ≥100 IU/mL and/or at least one positive SPT; eosinophilic (EOS): blood eosinophils ≥300 cells/µL; type 2-high: AA and/or EOS phenotype; type 2-low: non-AA/non-EOS phenotype (IgE <100 IU/mL, negative SPT, and blood eosinophils <300 cells/µL). RESULTS: A total of 129 adults with SA were included, 79.8% female. Phenotype distribution: AA: 61.2%; EOS: 37.2%; type 2-high: 72.1%; type 2-low: 27.9%. Among AA patients, HDM sensitization was present in 87% and 34.9% were non-eosinophilic. There was a significant overlap between the phenotypes. CONCLUSIONS: In contrast to non-tropical high-altitude regions, we found a high frequency of HDM sensitization in patients with AA phenotype living in a tropical high-altitude city. We also found a discrete lower frequency of EOS phenotype with no other significant differences in the phenotypic distribution compared to that described at low altitudes. We propose that tropical location may modify the effect of high altitude on HDM concentrations and allergenicity.

Prevalence of genetic mutations in alpha-1 antitrypsin deficiency (aatd) in patients with chronic obstructive pulmonary disease in Colombia.

BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder associated mainly with pulmonary emphysema and Chronic Obstructive Pulmonary Disease (COPD). All individuals with COPD regardless of age or ethnicity should be tested for AATD, but in Colombia its prevalence in unknown. MAIN OBJECTIVE: To determine the prevalence of the genetic mutations, present in AATD in adult patients with COPD in Colombia, using a genotyping test on cells from the oral mucosa. METHODS: This was a multicentre, observational, cross-sectional study which included adult patients attending seven COPD care centres in Colombia. Demographic data, medical history, including history of exposure to smoking and biomass smoke, most recent spirometry, pharmacological and non-pharmacological treatment received, serum AAT levels, and mutations detected by the genotyping test were recorded for all the recruited patients. For the comparison of variables between the groups with and without mutation, we used the X2 test for the qualitative variables and the Student's t-test or Mann-Whitney U test according to their distribution. MAIN FINDINGS: We collected a sample of 1,107 patients, the median age was 73.8 years (87.6-79.9). Mutations were documented in 144 patients (13.01%), the majority had the M/S mutation (78.50%), followed by M/Z (9.72%). One patient had a ZZ mutation and two patients had null alleles. In total, 23 patients had mutations associated with serum AAT deficiency (levels below 60 mg/dl). CONCLUSIONS: Genetic mutations were documented in 13.01% of patients with COPD in Colombia and 2.07% were AATD-related, showing that there is a significant number of underdiagnosed patients.

Effect of pulmonary hypertension on exercise capacity and gas exchange in patients with chronic obstructive pulmonary disease living at high altitude.

BACKGROUND: Pulmonary hypertension (PH) is associated with decreased exercise tolerance in chronic obstructive pulmonary disease (COPD) patients, but in the altitude the response to exercise in those patients is unknown. Our objective was to compare exercise capacity, gas exchange and ventilatory alterations between COPD patients with PH (COPD-PH) and without PH (COPD-nonPH) residents at high altitude (2640 m). METHODS: One hundred thirty-two COPD-nonPH, 82 COPD-PH, and 47 controls were included. Dyspnea by Borg scale, oxygen consumption (VO2), work rate (WR), ventilatory equivalents (VE/VCO2), dead space to tidal volume ratio (VD/VT), alveolar-arterial oxygen tension gradient (AaPO2), and arterial-end-tidal carbon dioxide pressure gradient (Pa-ETCO2) were measurement during a cardiopulmonary exercise test. For comparison of variables between groups, Kruskal-Wallis or one-way ANOVA tests were used, and stepwise regression analysis to test the association between PH and exercise capacity. RESULTS: All COPD patients had a lower exercise capacity and higher PaCO2, A-aPO2 and VD/VT than controls. The VO2 % predicted (61.3 ± 20.6 vs 75.3 ± 17.9; p < 0.001) and WR % predicted (65.3 ± 17.9 vs 75.3 ± 17.9; p < 0.001) were lower in COPD-PH than in COPD-nonPH. At peak exercise, dyspnea was higher in COPD-PH (p = 0.011). During exercise, in COPD-PH, the PaO2 was lower (p < 0.001), and AaPO2 (p < 0.001), Pa-ETCO2 (p = 0.033), VE/VCO2 (p = 0.019), and VD/VT (p = 0.007) were higher than in COPD-nonPH. In the multivariate analysis, PH was significantly associated with lower peak VO2 and WR (p < 0.001). CONCLUSION: In COPD patients residing at high altitude, the presence of PH was an independent factor related to the exercise capacity. Also, in COPD-PH patients there were more dyspnea and alterations in gas exchange during the exercise than in those without PH.

Soft skills in personnel training: Report of publications in scopus, topics explored and future research agenda.

Recent research has documented the interest of organizations in training their staff in soft skills, but few studies have been found. Therefore, the objective of this research was to analyze 753 publications in the Scopus database related to soft skills in staff training during the period 1999-2021. These documents were analyzed to identify the main information, the most explored areas, and a future research agenda; all under a bibliometric and bibliographic approach with the help of RStudio and VOSviewer software. The results showed that the keywords with the most co-occurrence were personnel training (n = 110) and soft skills (n = 79). The year with the most documents was 2021 (n = 121). The country with the most publications was the United Kingdom (n = 199). Medicine is the subject area with the most documents (n = 278) and the Article is the type of document with the most studies (n = 566). Eleven areas of further exploration were identified: "Soft skills in software engineering at the higher education level", "Soft skills and communication", "Soft skills and engineering education", "Soft skills in virtual environments", "Soft skills in machine learning", "Serious games in teaching soft skills", "Soft skills for problem-based learning", "Soft skills for project management", "Soft skills and technical skills", "Project-based learning for the assessment of soft skills" and "Soft leadership skills". Five potential areas for future research were derived: soft skills in collaborative work (CSCL), soft skills in computer-aided collaborative work (CSCW), facial expressions as a mirror of soft skills, soft skills for employability and Professional Development Plan (PDP) to assess soft skills. In conclusion, this Review type document on soft skills in personnel training helped to identify the most studied topics during the evaluated period, as well as to identify the little explored topics for future research.

Effect of Altitude on Respiratory Functional Status in COVID-19 Survivors: Results from a Latin American Cohort-FIRCOV.

Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.

[Hansen's disease. Case report of tuberculoid leprosy in Chile]. / Enfermedad de Hansen. Comunicación de un caso de lepra tuberculoide en Chile.

Hansen's disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae, mainly affecting the skin and peripheral nerves. In recent years, a better control of the disease has been achieved globally. However, in Chile the incidence of leprosy has continued to increase. We present a case of a 40-year-old patient Haitian nationality with lesions and histopathology compatible with tuberculoid leprosy. We discuss the importance of education on less prevalent diseases in Chile, in conjunction with a review of the pathophysiology, clinic, and classification of Hansen's disease.

Prevalence of pulmonary hypertension in COPD patients living at high altitude.

BACKGROUND: Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA). OBJECTIVES: To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m). METHODS: Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted). RESULTS: We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients. CONCLUSIONS: The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.

Impulse oscillometry reference values and bronchodilator response in three- to five-year old children living at high altitude.

INTRODUCTION: Impulse oscillometry (IOS) is used to measure airway impedance. It is an effective tool for diagnosing and treating respiratory diseases, and it has the advantage that it does not require forced respiratory maneuvers. IOS reference values are required for each population group. OBJECTIVE: This study aimed to determine the IOS reference values and bronchodilator response in healthy preschool children living in Bogotá, Colombia. METHODS: We performed a cross-sectional study in preschool children who had no history of respiratory disease; 96 children fit the parameters for testing to determine normal values according to the American Thoracic Society and European Respiratory Society criteria. RESULTS: Values for respiratory resistance (Rrs) and reactance (Xrs) at 5, 10, and 20 Hz, respiratory impedance (Zrs, and resonance frequency (Fres) were established. Height was the most influential independent variable for IOS values; an increase in height led to a reduction in Rrs5 and Rrs20 and an increase in Xrs5. After the administration of 400 mcg of salbutamol the values for Rrs5(-17.48%), Rrs20(-8.63%), Fres (-10.68%), and area of reactance (-35.44%) were reduced, meanwhile Xrs5 (15.35%) was increased. CONCLUSIONS: Normal IOS values before and after the administration of 400 mcg of salbutamol were determined for a population of children aged 3-5 years at 2,640 m. Reference IOS equations for these children are presented. A relative change of up to -28% and 36% after the use of salbutamol for respiratory resistance and reactance, respectively, should be considered as an upper limit of the normal range, and possible appropriate cut-off values for defining significant response for evaluating therapeutic interventions.

Validación facial, confiabilidad y comprensibilidad del cuestionario principal usado en el estudio PLATINO, Colombia 2021

Introducción: es fundamental garantizar que los instrumentos de medición al ser usados en contextos distintos a los que fueron desarrollados se ajusten en su lenguaje y compresibilidad; el cuestionario principal usado en el estudio PLATINO, en el cual se estableció la prevalencia de enfermedad pulmonar obstructiva crónica en áreas metropolitanas de Latinoamérica por la Asociación Latinoamericana del Tórax, sin incluir población colombiana. Objetivo: realizar validación facial, confiabilidad y comprensibilidad del cuestionario principal usado en el estudio PLATINO para la identificación de personas sin enfermedad respiratoria en Colombia, 2021. Metodología: estudio psicométrico que incluyó validez facial por juicio de expertos, prueba de compresibilidad y confiabilidad; la validación facial valoró la coherencia, relevancia y pertinencia de cada ítem, la aplicación del instrumento se hizo en prueba preliminar de compresibilidad, tras la cual se calculó su confiabilidad. Resultados: la validación facial obtuvo concordancia alta, requiriendo mejoras en redacción del instrumento (Kappa de Fleiss: 0,8569; p=0,000). De los 88 participantes, la mayoría eran hombres (n: 75; 85 %), con edad promedio de 23 años (DS: 6,8), el 25 % con antecedentes de enfermedad pulmonar y el 21 % de tabaquismo. La versión ajustada del cuestionario obtuvo una comprensibilidad global del 94 % y un alfa de Cronbach de 0,82. Conclusiones: se obtiene una versión abreviada y adaptada del cuestionario principal usado en el estudio PLATINO para la identificación de personas sanas respiratorias en población colombiana, con adecuadas propiedades psicométricas en términos de su validación facial, su confiabilidad y su comprensibilidad.

Introduction: It is essential to guarantee that the measurement instruments, when used in contexts other than those in which they were developed, adjust in their language and comprehensibility. The main questionnaire used in the PLATINO study was developed to establish the prevalence of Chronic Obstructive Pulmonary Disease in metropolitan areas of Latin America by the Latin American Thorax Association, without including the Colombian population. Objective: To perform face validity, reliability and comprehensibility of the main questionnaire used in the PLATINO study for the identification of people without respiratory disease in Colombia, 2021. Materials and methods: Psychometric study that included face validity by expert judgment, compressibility and reliability test. The face validity valued the coherence, relevance and pertinence of each item. The application of the instrument was made in a preliminary compressibility test after which its reliability was calculated. Results: Face validity obtained high concordance requiring improvements in the writing of the document (Fleiss Kappa: 0,8569; p=0,000). Ofthe 88 participants, the majority were men (n: 75; 85%) with a mean age of 23 years (SD: 6.8), 25% with a history of lung disease and 21% with a history of smoking. The adjusted version of the questionnaire obtained a global comprehensibility of 94% and a Cronbach's alpha of 0.82. Conclusions: An abbreviated and adapted version of the main questionnaire used in the PLATINO study for the identification of respiratory healthy people in the Colombian population was obtained with adequate psychometric properties in terms of its face validity, reliability and comprehensibility.

Introdução: é fundamental garantir que os instrumentos de medição ao ser usados em contextos diferentes aos que foram desenvolvidos se adequam em sua linguagem e compressibilidade; o questionário principal usado no estudo PLATINO se desenvolveu para estabelecer a prevalência de doença pulmonar obstrutiva crónica em áreas metropolitanas de Latino américa pela Associação Latino-americana do Tórax, sem incluir população colombiana. Objetivo: realizar validação facial, confiabilidade e compreensibilidade do questionário principal usado no estudo PLATINO para a identificação de pessoas sem doença respiratória na Colômbia, 2021. Metodologia: estudo psicométrico que inclui validez facial por juízo de expertos, teste de compressibilidade e confiabilidade; a validação facial valorou a coerência, relevância e pertinência de cada item, a aplicação do instrumento se fez em teste preliminar de compressibilidade, pela qual se calculou sua confiabilidade. Resultados: a validação facial obteve concordância alta, requirindo melhoras em redação do instrumento (Kappa de Fleiss: 0,8569; p=0,000). Dos 88 participantes, a maioria eram homens (n:75; 85 %), com idade média de 23 anos (DS: 6,8), o 25 % com antecedentes de doença pulmonar e o 21 % de tabaquismo. A versão ajustada do questionário obteve uma compreensibilidade global do 94 % e um alfa de Cronbach de 0,82. Conclusões: Obteve-se uma versão abreviada e adaptada do questionário principal usado no estudo PLATINO para a identificação de pessoas sanas sem doenças respiratórias na população colombiana, com adequadas propriedades psicométricas em termos de sua validação facial, sua confiabilidade e sua compreensibilidade.

Enfermedad de Hansen: comunicación de un caso de lepra tuberculoide en Chile / Hansen's disease: case report of tuberculoid leprosy in Chile

Resumen La enfermedad de Hansen o lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, y que afecta principalmente la piel y nervios periféricos. En los últimos años, se ha logrado un mejor control de la enfermedad en forma global. Sin embargo, en Chile la incidencia de la lepra ha ido en aumento. Presentamos el caso clínico de un paciente de 40 años, haitiano, con lesiones e histopatología compatibles con una lepra tuberculoide. Se discute la importancia en la educación sobre enfermedades menos prevalentes en Chile y se hace una revisión sobre la fisiopatología, clínica y clasificación de la enfermedad de Hansen.

Abstract Hansen's disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae, mainly affecting the skin and peripheral nerves. In recent years, a better control of the disease has been achieved globally. However, in Chile the incidence of leprosy has continued to increase. We present a case of a 40-year-old patient Haitian nationality with lesions and histopathology compatible with tuberculoid leprosy. We discuss the importance of education on less prevalent diseases in Chile, in conjunction with a review of the pathophysiology, clinic, and classification of Hansen's disease.

Microbiological characterization of severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD) in patients admitted to the ICU with or without associated pneumonia: A retrospective cross-sectional study / Caracterización microbiológica de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) ingresados a UCI con exacerbación grave o neumonía: un estudio transversal retrospective

Objective: The goal of this study was to compare the microbiology of severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring admission to the intensive care unit (ICU), in patients with pneumonia compared to those that did not have. Methods: We conducted a retrospective cross-sectional study that included patients with severe COPD exacerbation. We took microbiologic and serologic samples to study the etiology of the exacerbation and chest X-ray to see whether or not it had associated pneumonia. Results: Ninety-one patients were included in the study. 53/91 (58%) had pneumonia. The most prevalent bacteria isolated were H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), mixed flora (9.9%) and methicillin-susceptible Staphylococcus aureus (9.9%). A statistically significant difference could not be demonstrated between the two groups. We detected 24.2% of bacterial resistance in both groups, the most frequent being AMPc (13 cases). Discussion: Bacterial pneumonia in COPD patients is higher in comparison with patients with acute exacerbation. Even though we did not find a significant difference in the microbiology of the groups with or without pneumonia, there are variables such as past smoking related to having pneumonia. Patients with pneumonia also had higher severity scores.

Objetivo: Comparar la microbiología de las exacerbaciones graves de EPOC (Enfermedad Pulmonar Obstructiva Crónica) que requieren ingreso a la unidad de cuidados intensivos, con y sin neumonía Métodos: se realizó un estudio transversal retrospectivo que incluyó pacientes con exacerbación grave de EPOC que requieren ingreso a la Unidad de Cuidados Intensivos (UCI). Tomamos muestras microbiológicas y serológicas para estudiar la etiología de la exacerbación y radiografía de tórax para ver si tenía o no una neumonía asociada. Seguimos a los pacientes durante su ingreso en la UCI y evaluamos el resultado de la hospitalización. Resultados: se incluyeron 91 pacientes en el estudio. 53/91 ( 58%) tuvieron confirmación de neumonía. Las bacterias más prevalentes aisladas fueron H. influenzae (25.3%), Moraxella spp (22%), H. parainfluenza (14.3%), Serratia marcescens (13.2%), flora mixta (9.9%) y S. aureus meticilino sensible. (9.9% ). No se pudo demostrar una diferencia estadísticamente significativa entre los dos grupos. Detectamos una resistencia bacteriana del 24,2% en ambos grupos, siendo la más frecuente AMPc (13 casos). Discusión: la neumonía bacteriana en pacientes con EPOC es más alta cuando se compara con pacientes con exacerbación aguda. Aunque no encontramos una diferencia significativa en la microbiología de los grupos con o sin neumonía, existen variables como antecedente de cigarrillo asociadas a tener neumonía. Los pacientes con neumonía así mismo tuvieron mayores índices de severidad.

Hipertensión pulmonar en la enfermedad pulmonar obstructiva crónica / Pulmonary hypertension in chronic obstructive pulmonary disease

La hipertensión pulmonar (HP) es una complicación relativamente frecuente de la enfermedad pulmonar obstructiva crónica (EPOC). Su aparición en el curso clínico de la EPOC es un factor condicionante de peor pronóstico que se asocia con disminución de la sobrevida y mayor uso de recursos de salud. Aunque no hay una relación lineal bien definida, la prevalencia de HP en pacientes con EPOC aumenta a medida que es mayor el grado de obstrucción y la severidad de la enfermedad, siendo poco frecuente en casos de EPOC leve y moderada. La HP en la EPOC es, en general, leve o moderada y pocas veces afecta la función ventricular derecha. En muchos casos no es aparente en reposo y se manifiesta con el ejercicio. La HP puede llegar a ser severa o estar "fuera de proporción" para el grado de severidad de la EPOC. En esta situación debe explorarse la posibilidad de condiciones asociadas, si bien, con frecuencia, la única explicación final sea la EPOC. Poco se sabe de la prevalencia y el comportamiento de la HP en pacientes con EPOC residentes en alturas intermedias y grandes (>2.500 metros sobre el nivel del mar) que es una situación frecuente en Latinoamérica y Asia. La HP en EPOC no está relacionada exclusivamente con la hipoxia/hipoxemia y la hipercapnia. Los trastornos mecánicos propios de la EPOC (hiperinflación y presión alveolar) y la inflamación pueden prevalecer como causa de la lesión endotelial y la remodelación de la circulación pulmonar contribuyentes al aumento de la presión y la resistencia vascular pulmonar. La aparición de signos de cor pulmonale indica una condición avanzada de la HP, por lo cual esta condición debe sospecharse tempranamente cuando la disnea, la hipoxemia y el deterioro de la difusión son desproporcionados para el grado de obstrucción. La confirmación de la HP se hace mediante ecocardiografía doppler y el cateterismo derecho sólo se justifica en casos individualizados. La terapia a largo plazo con oxígeno es la única intervención que ha mostrado ser eficaz temporalmente. Los vasodilatadores convencionales no producen mejoría a mediano y largo plazo y pueden empeorar las relaciones ventilación-perfusión. De la misma forma, las nuevas terapias para HP no parecen ser una opción terapéutica salvo en los casos de "HP fuera de proporción" en los cuales otros factores diferentes de la EPOC podrían estar presentes. El desconocimiento del comportamiento de la HP en pacientes con EPOC residentes en alturas intermedias y grandes abre también un campo de investigación en el papel de las terapias con oxígeno y farmacológica en estas alturas.