Impact of climate change-related environmental factors on the allergens production and the epidemiology and severity of allergic pathologies.

BACKGROUND: Allergic disease affects up to 40% of the global adult population, a proportion that is increasing with environmental changes related to global warming. METHODS: We undertook a systematic review of the literature to identify and evaluate the current evidence of the impact of climate change-related environmental factors on the allergen production and the epidemiology and severity of allergic pathologies. PECO criteria were established and guided the literature searches of the PubMed and Cochrane databases (Jan 1, 2016 to Dec 31, 2021). Study outcomes were categorized and grouped to facilitate data synthesis. Outcomes were classified as significant (statistical significance <0.05), non-significant (p>0.05) or undetermined (p value not reported). Study quality was assessed using MMAT analysis. RESULTS: Of 195 studies, 40 were considered relevant and 9 of them provided data to be included in the data quantitative synthesis. Environmental factors, including the presence of pollutants, temperature, and drought, influenced the type, volume, and timing of exposure to local aeroallergens. The most relevant environmental factor was the presence of environmental pollutants, of which tropospheric ozone was the most frequently associated to changes in allergen production, prevalence, and severity of allergic disease. Also, several publications demonstrated the impact of environmental factors on the healthcare burden. CONCLUSIONS: Climate-change related environmental factors increased allergic disease in terms of prevalence, severity, and healthcare burden due to alterations in allergen exposure (volume and type) with the presence of pollutants such as ozone being the most commonly reported driver of such increase.

Differences in molecular sensitization profiles between a Spanish and Latin American mite allergic patients.

BACKGROUND AND OBJECTIVE: To analyze the sensitization pattern to Dermatophagoides pteronyssinus and to associate the diagnostic findings and clinical severity in 218 allergic patients from two different continents. METHODS: Mite allergic patients were recruited by the Allergology departments from Latin America (n=88: Colombia, Costa Rica and Guatemala) and Spain (N=130). All patients had allergic rhinitis with or without asthma and positive skin prick test results to D. pteronyssinus. Specific IgE levels to D. pteronyssinus, D. farinae, Der p 1, Der p 2, and Der p 23 were quantified by ImmunoCAP system (ThermoFisher Scientific). Allergenic profile was also determined by western blot. Comparative Statistical analysis was performed by GraphPad software. RESULTS: Patients recognized most frequently Der p 2 (79%) followed by Der p 1 (73%), and Der p 23 (69%) allergens. The percentage of asthmatic patients increases with the number of sensitizations however none statistically significant differences were found. Interestingly, asthmatic patients presented the highest median levels of total IgE and specific IgE levels of D. pteronyssinus and molecular allergens, mainly Der p 2. Analysing the two different populations, Spanish patients were predominantly sensitized to Der p 2 (88.46%) and Der p 1 (83.84%), whereas Latin American population were more sensitized to Der p 23. CONCLUSION: Our data support the relevance of Der p 2 in mite allergy as the major allergen, with the high number of patients sensitized to it and its importance in the development of asthma. Sensitization to Der p 23 was more important in Latin America.

Differential healthcare direct costs of asthma and chronic rhinosinusitis with nasal polyps in Catalonia (Spain).

INTRODUCTION: This study compares the direct healthcare costs associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from 2013 to 2017 in Catalonia (Spain) with a population control group without these conditions. METHODS: A population administrative database containing healthcare information was used. The database contained information on primary care, hospitalisations, and emergency care from 2013 to 2017 in Catalonia. The unit cost of each healthcare procedure was imputed using a complete list of public prices for primary care services, hospital, and speciality services. Differential costs were estimated using a finite mixture model. RESULTS: Individuals diagnosed with asthma or CRSwNP showed a higher incidence of comorbidities than the control group. Mean annual direct costs per patient were €1,102 for asthma, €1,612 for CRSwNP and €2,197 for those with both conditions. According to our estimations, differential costs were €162 - €274 for patients with asthma and €481 - €1,257 for patients with CRSwNP compared to the reference population. These costs were significantly higher when asthma and CRSwNP coexist and especially in their severe condition. CONCLUSION: This population-based study revealed that asthma and CRSwN are associated with great economic burdens for healthcare systems. These costs were significantly higher when comorbidity was present (asthma and CRSwNP) and especially in their severe condition (€4,441).

Low levels of miR-143-3p are associated with severe chronic rhinosinusitis with nasal polyps.

microRNAs (miRNAs) are small, single-stranded, non-coding RNA molecules that regulate post-transcriptional gene expression. Accumulating evidence suggests their involvement in regulating various biological and pathological processes, including inflammation. Studies have revealed distinct expression patterns of miRNAs in Chronic Rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps (1). Specifically, miR-155 and miR-21 have been observed to be upregulated in CRSwNP, increasing and attenuating the expression of pro-inflammatory cytokines, respectively (2,3). Conversely, the downregulation of miR-34, miR-449, and members of the miR-200 family has been associated with impaired ciliogenesis and the regulation of epithelial-mesenchymal transition, respectively (4,5). Nonetheless, the direct role of miRNAs in CRSwNP is still being investigated.

[Reference levels of thyroid hormones in pregnant woman from Guadalajara]. / Valores de referencia de hormonas tiroideas en la población de gestantes de Guadalajara.

INTRODUCTION: Thyroid dysfunction during gestation impacts on maternal-fetal health and may influence the neurocognitive development of the child. Thyroid physiology changes during pregnancy and requires the establishment of specific reference levels per trimester and for each population and method. The objectives of our study were to analyse thyroid function throughout pregnancy and to establish reference levels for TSH and T4L in each trimester for our population and methodology. MATERIAL AND METHODS: Prospective analytical study of 598 pregnant women from March 2018 to October 2020. TSH, T4L, T3L, ATPO and ATG were determined in all of them. A total of 151 pregnant women were excluded due to positive thyroid immunity, previous thyroid disease in treatment with levothyroxine, twin pregnancy, diagnosis of hypothyroidism and hyperthyroidism in the request or absence of some of the parameters studied, with a reference population of 447 pregnant women. RESULTS: The reference levels for TSH were 0.07-3.14mIU/L for the first, 0.66-3.21mIU/L for the second and 0.52-2.97mIU/L for the third trimester. Reference levels for T4L were 0.81-1.19ng/dL for the first, 0.71-1.07ng/dL for the second and 0.69-1.06ng/dL for the third trimester. CONCLUSIONS: The reference levels for TSH and T4L obtained in this study differ from those used for the general population, which may have led to misclassification errors and unnecessary treatment in pregnant women.

Impact of Asthma Inhalers on Global Climate: A Systematic Review of Their Carbon Footprint and Clinical Outcomes in Spain

Background: Pressurized metered-dose inhalers (pMDIs) exert an environmental impact resulting from CO2 emissions. Therapeutic alternatives with less environmental impact are widely used. Nevertheless, the choice of device and appropriate therapy should meet the clinical needs and the characteristics of the patient. Objective: The primary objective was to estimate the impact of pMDIs prescribed for any indication on annual CO2 emissions in Spain.The secondary objective was to evaluate the potential impact of switching pMDIs to dry-powder inhalers (DPIs) in patients with asthma. Methods: A systematic review of the evidence published during 2010-2021 was carried out. Average annual CO2 emissions of DPIs and pMDIs were calculated in 2 scenarios: the current situation and a hypothetical situation involving a switch from all pMDIs to DPIs. The impact of the switch on clinical outcomes was also evaluated. Results: The total value of CO2-eq/year due to DPIs and pMDIs accounted for 0.0056% and 0.0909%, respectively, of total emissions in Spain. In the event of switching pMDIs to DPIs, except those used for rescue medication, the percentages were 0.0076% and 0.0579%. The evaluation of efficacy, handling, satisfaction, safety, and use of health care resources was not conclusive. Conclusions: Current CO2 emissions by pMDIs account for a small percentage of the total CO2 footprint in Spain. Nevertheless, there is a need for research into new and more sustainable devices. Suitability and patient clinical criteria such as age and inspiratory flow should be prioritized when prescribing an inhaler (AU)

Economic Consequences of the Overuse of Short-Acting ß-Adrenergic Agonists in the Treatment of Asthma in Spain

Objective: To determine the relationship between short-acting ß-adrenergic agonist (SABA) overuse and health care resource use and costs in asthma patients in routine clinical practice. Methods: A longitudinal retrospective study was conducted in Spanish primary and specialized care centers using the BIG-PAC medical records database. The study population comprised asthma patients ≥12 years of age who attended ≥2 consultations during 2017 and had 1-year follow-up data available. The main outcomes were demographics, comorbidities, medication, and clinical and health care resource use and costs. The relationship between SABA overuse and health care costs and between asthma severity and health care costs was determined. Results: The SABA use IN Asthma (SABINA) study included 39 555 patients, with a mean (SD) age of 49.8 (20.7) years (64.2% female). The Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥3 canisters/y) was 28.7% (95%CI, 27.7-29.7), with a mean of 3.3 (3.6) canisters/y. Overall, 5.1% of patients were prescribed ≥12 canisters/y. SABA overuse was correlated with health care costs (ρ=0.621; P<.001). The adjusted mean annual cost/patient according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity was €2231, €2345, €2735, €3473, and €4243 for steps 1-5, respectively (P<.001). Regardless of asthma severity, SABA overuse yielded asignificant increase in health care costs per patient and year (€5702 vs €1917, P<.001) compared with recommended use (<2 canisters/y). Conclusion: SABA overuse yields high costs for the Spanish National Health System. Costs increased with severity of asthma (AU)

Objetivo: Determinar la relación entre la sobreutilización de agonistas beta adrenérgicos de acción corta (SABA) en pacientes con asma y el uso y coste de recursos sanitarios en la práctica clínica rutinaria. Métodos: Se realizó un estudio longitudinal retrospectivo en atención primaria y especializada en España, en el que se utilizó la base de datos de registros médicos BIG-PAC®. Se incluyeron pacientes con asma ≥12 años que asistieron a ≥2 consultas durante 2017 y con datos disponibles del seguimiento durante 1 año. Los principales resultados analizados fueron características demográficas, comorbilidades, medicaciones, y el uso y coste de recursos clínicos y sanitarios. Se determinó la relación de los costes sanitarios tanto con la sobreutilización de SABA como con la severidad del asma. Resultados: Este estudio sobre el uso de SABA en asma (SABINA, del inglés “SABA use IN Asthma”) incluyó a 39.555 pacientes, con una edad media (DE, desviación estándar) de 49,8 años (20,7); 64.2% fueron mujeres. La media del índice de comorbilidad Charlson fue 0,7 (1,0). La sobreutilización de SABA (≥3 envases/año) fue del 28,7% (IC95%: 27,7–29,7), con una media global de 3,3 envases (3,6) /año. En total, el 5,1% de los pacientes fueron prescritos con ≥12 envases/año. La sobreutilización de SABA correlacionó con los costes sanitarios (ρ = 0,621; p < 0,001). El coste medio anual/paciente según la clasificación de severidad del asma de la Global Initiative for Asthma (GINA 2019) fue de 2.231 €, 2.345 €, 2.735 €, 3.473 €, y 4.243 €, para los pasos 1-5, respectivamente (p < 0,001) (AU)

Weight Loss and Vitamin D Improve Hyporesponsiveness to Corticosteroids in Obese Asthma

Background: Obesity negatively impacts on the response of asthma patients to inhaled corticosteroids. The mechanisms underlying this impact are unknown. Objective: To demonstrate that the poor response to inhaled corticosteroids in obese asthma patients is associated with impaired anti-inflammatory activity of corticosteroids and vitamin D deficiency, both of which are improved by weight loss. Methods: The study population comprised 23 obese asthma patients (OA) (18 females; median (IQR) age 56 [51-59] years), 14 nonobese asthma patients (NOA) (11 females; 53 [43-60] years), 15 obese patients (OP) (13 females; 47 [45-60] years), and 19 healthy controls (HC) (14 females; 43 [34-56] years). Ten OA and 11 OP were evaluated at baseline (V1) and 6 months after bariatric surgery (V2). Corticosteroid response was measured using dexamethasone-induced inhibition of peripheral blood mononuclear cell (PBMC) proliferation. Lung function and serum levels of leptin, adiponectin, and vitamin D were measured at V1 and V2. Results: We found a reduced response to dexamethasone in PBMCs of OP and OA with respect to NOA and HC; this inversely correlated with the adiponectin/leptin ratio and vitamin D levels. Bariatric surgery improved corticosteroid responses in OP and OA and normalized the adiponectin/leptin ratio and vitamin D levels. Exposure of PBMCs to vitamin D potentiated the antiproliferative effects of corticosteroids. Dexamethasone and vitamin D induced similar MKP1 expression in OP and OA. (AU)

Antecedentes: La obesidad tiene un impacto negativo en la respuesta del asma a los corticosteroides inhalados por mecanismos desconocidos. Objetivo: Demostrar que la mala respuesta a los corticosteroides inhalados en pacientes obesos asmáticos se asocia con una actividad antiinflamatoria alterada de los corticosteroides, así como también a la deficiencia de vitamina D, ambos mejorados por la pérdida de peso. Métodos: 23 obesos asmáticos (OA) (18 mujeres; mediana de edad [rango intercuartílico] 56 [51-59] años), 14 asmáticos no obesos (NOA) (11 mujeres; 53 [43-60] años), 15 obesos (O) (13 mujeres; 47 [45-60] años), y 19 controles sanos (HC) (14 mujeres; 43 [34-56] años) fueron incluidos. Se evaluaron 10 pacientes OA y 11 O al inicio (V1) y seis meses después (V2) de cirugía bariátrica. La respuesta a los corticosteroides se midió mediante la inhibición con dexametasona de la proliferación de células mononucleares de sangre periférica (PBMC). La función pulmonar, los niveles séricos de leptina, adiponectina y vitamina D se midieron en V1 y V2. Resultados: Encontramos una respuesta reducida a la dexametasona en PBMC de pacientes O y OA con respecto a los NOA y HC, que se correlacionó de forma inversamente proporcional con la relación adiponectina/leptina y los niveles de vitamina D. La cirugía bariátrica mejoró las respuestas de los corticosteroides en los grupos de pacientes O y OA, y normalizó la relación adiponectina/leptina y los niveles de vitamina D. La exposición de las PBMC a la vitamina D potenció los efectos antiproliferativos de los corticosteroides. La dexametasona y la vitamina D indujeron una expresión similar de MKP-1 en los pacientes O y OA. (AU)

Impacto de las complicaciones postoperatorias en el pronóstico del cáncer gástrico / Impact of postoperative complications on the prognosis of gastric cancer

Introducción. La cirugía sigue siendo el pilar fundamental en el tratamiento del cáncer gástrico, con una tasa de morbilidad quevaría entre 18-55%. El objetivo del estudio fue analizar el impacto de las complicaciones postoperatorias en la supervivencia global(SG) del cáncer gástrico. Material y métodos. Estudio retrospectivo y unicéntrico sobre 200 pacientes intervenidos con intencióncurativa por neoplasia gástrica entre el 1 de enero del 2010 y el 31 de diciembre del 2014. Para analizar la gravedad de las complicaciones se empleó la clasificación de Clavien-Dindo (CD). Se realizó un análisis univariante y multivariante de los factores queinfluyeron en la SG, la cual fue estimada mediante el método de Kaplan-Meier. Resultados. La morbilidad postoperatoria fue del47,5%, con tasas de incidencia de complicaciones leves (CD II) del 24,5%, y de complicaciones moderadas-graves (CD III-IV) del22,5%. En el análisis multivariante de la SG se observó que las complicaciones postoperatorias afectaron de forma significativa enla mortalidad (HR 1,61 [1,09;2,42], p=0,018). Las complicaciones médicas tuvieron un impacto significativo en la supervivenciaglobal (HR 1,89 [1,20;2,96], p=0,006), pero las complicaciones quirúrgicas no pudieron ser relacionadas estadísticamente (HR1,49 [0,92;2,43], p=0,108). Conclusión. El presente estudio muestra el impacto negativo de las complicaciones médicas postquirúrgicas sobre la supervivencia global del cáncer gástrico tratado con intención curativa. (AU)

Introduction. Surgery is the cornerstone in curative treatment of gastric cancer with complication rates ranging from 18% to 55%.The aim of the study was to analyze the impact of postoperative complications on overall survival (OS) of gastric cancer. Methods.This is a retrospective study of a single-center series. Patients who underwent curative gastrectomy between January 2010 and December 2014 were included. The severity of postoperative complications was studied according to the Clavien-Dindo classification.Patients OS was estimated using the method of Kaplan-Meier. Besides, univariate and multivariate analysis of the factors influencing on OS was performed. Results. 200 patients were included. Postoperative morbidity was 47.5%, with incidence rates of mildcomplications (CD II) of 24.5% and moderate-serious complications (CD III-IV) of 22.5%. The multivariate analysis of OS showedthat postoperative complications significantly affected mortality (HR 1.61 [1.09, 2.42], p = 0.018). Medical compli-cations had animpact on OS (HR 1.89 [1.20; 2.96], p = 0.006), but surgical complications could not be statistically related (HR 1.49 [0.92; 2.43],p = 0.108). Conclusion. The present study shows the negative impact of postoperative medical complications on the overall survivalof curative gastrectomy in patients with gastric cancer. (AU)

Incidencia del aprendizaje cooperativo en educación física sobre las necesidades psicológicas básicas / Impact of Cooperative Learning on Physical Education in Basic Psychological Needs

El Aprendizaje Cooperativo (AC) se perfila como una herramienta que centra a los estudiantes en el foco principal del proceso de enseñanza y aprendizaje en el área de Educación Física (EF). El objetivo de la presente investigación fue analizar el impacto del AC en la satisfacción de las Necesidades Psicológicas Básicas (BPNES) frente a un modelo de enseñanza tradicional en estudiantes de Educación Secundaria Obligatoria (ESO). Para el análisis, se tomó una muestra total formada por 185 participantes, en el que se empleó un método cuantitativo con un diseño cuasi-experimental. Se desarrollaron seis sesiones a través retos cooperativos. Se utilizó como instrumento la Escala de Medición de las BPNES adaptada a la EF. Los resultados mostraron una mejora estadísticamente significativa en la autonomía, competencia y relaciones sociales en el grupo experimental. Una metodología activa basada en el aprendizaje cooperativo en las clases de EF mejora la satisfacción de las BPNES. (AU)

Cooperative Learning (AC) is emerging as a tool that places students at the centre of the teaching and learning process in the area of Physical Education (PE). The objective of the present investigation was to analyse the impact of AC on the satisfaction of Basic Psychological Needs (BPNES) against a traditional teaching model in students of Compulsory Secondary Education (ESO). For the analysis, a total sample consisting of 185 participants was taken, and a quantitative method with a quasi-experimental design was used. Participants experienced six sessions through cooperative challenges. The BPNES Measurement Scale adapted to PE was used as an instrument. The results showed a statistically significant improvement in autonomy, competence and social relations in the experimental group. An active methodology based on cooperative learning in PE classes improves the satisfaction of BPNES. (AU)

Usefulness of the Nasal Allergen Provocation Test in the Diagnosis of Shellfish Allergy

Background: Shellfish allergy is a major cause of food allergy and anaphylaxis worldwide. Several allergenic proteins have been described in the last few years, but the only diagnostic tool that still enables discrimination between allergic and nonallergic sensitized persons is the oral food challenge (OFC). Objective: The aim of this study was to evaluate the usefulness of the nasal allergen provocation test (NAPT) as a diagnostic tool in shellfish allergy. Methods: Forty-five patients with confirmed sensitization to shrimp by a positive skin prick test (SPT) result with a commercial shrimp extract were recruited and classified as sensitized-allergic or sensitized-nonallergic based on current tolerance to shrimp intake, the result of an OFC with a freeze-dried cooked shrimp mixture extract, or a recent history of anaphylaxis induced by shrimp ingestion. These patients and 10 controls not sensitized to shrimp underwent NAPT with a freeze-dried cooked shrimp mixture extract. The response was evaluated using acoustic rhinometry and a visual analog scale. Results: Significant differences (P=.001) were found between the sensitized-allergic group (18/20 positive NAPT, 90%) and both the sensitized-nonallergic group (2/18 positive NAPT, 11.1%) and controls (0/10 positive NAPT). NAPT enables differentiation between allergic and nonallergic persons with a sensitivity of 90%, specificity of 89%, positive predictive value of 90%, and negative predictive value of 89%. Conclusions: Our results indicate that NAPT makes it possible to differentiate between sensitized symptomatic patients and sensitized tolerant patients and could be a valuable diagnostic tool when assessing shrimp allergy (AU)

Consensus on the Definition of Control and Remission in Chronic Urticaria

The terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU (AU)

El concepto de control y remisión de la enfermedad, así como otros términos clave utilizados en la urticaria crónica (UC), como reagudización, recaída, exacerbación o recurrencia, no están totalmente aclarados en la literatura. Tampoco está bien establecido el seguimiento de la enfermedad y los objetivos del tratamiento en la práctica clínica. Tras una evaluación cualitativa de la evidencia, nos propusimos encontrar una definición consensuada de control y remisión de la UC, aclarar terminología clave, proporcionar orientación sobre cómo monitorizar la enfermedad y establecer objetivos de tratamiento en la práctica clínica. Para llegar a un consenso, se utilizó una técnica Delphi modificada. Basándose en una revisión de la literatura, un comité científico elaboró 137 aseveraciones que abordaban definiciones y términos controvertidos, el uso de Patient Reported Outcomes (PROs) y recomendaciones sobre cómo medir los objetivos terapéuticos en la UC. El cuestionario fue evaluado por 138 alergólogos y dermatólogos expertos. Se alcanzó un consenso en 105 de las 137 aseveraciones propuestas (76,6%). Los expertos estuvieron de acuerdo en que el control completo y la remisión de la CU podrían definirse como la ausencia de signos o síntomas de la enfermedad mientras se está en tratamiento y en ausencia de tratamiento, respectivamente. No se alcanzó un consenso sobre la definición de otros términos clave como reagudización, exacerbación o recurrencia. El panel estuvo de acuerdo en que el objetivo terapéutico de la CU debe ser lograr un control completo. Se establecieron los PROs que definen el grado de control de la CU (completo, bueno, parcial o ausencia de control). Además, se creó un algoritmo para la evaluación de la enfermedad. En conclusión, este trabajo ofrece definiciones y herramientas de consenso que pueden ser útiles en el manejo de los pacientes con CU (AU)

Recursos y propuestas de mejora en el manejo de la Apnea Obstructiva del Sueño en Andalucía / Resources and proposals for improvement in the management of obstructive sleep apnea in Andalusia

Título abreviado: Se exponen los recursos asistenciales del Sistema Sanitario Público de Andalucía relacionados con el diagnóstico, tratamiento y seguimiento de los pacientes con apnea obstructiva del sueño. Igualmente se describen propuestas para una optimización en el manejo de esta entidad enfatizando la necesidad de recursos y colaboración entre diferentes niveles asistenciales. Objetivo: Determinar en el Sistema Sanitario Público de Andalucía (SSPA) los recursos actuales en la apnea obstructiva del sueño (AOS) e identificar propuestas de mejora. Método: Estudio transversal, basado en encuestas realizadas en 49 hospitales del SSPA. Se registraron variables relacionadas al diagnóstico, tratamiento y seguimiento de la AOS, distinguiendo entre centros que realizaban polisomnografía y los que no. Incluimos un apartado sobre propuestas de mejora. Resultados: Un 97% de los centros realizan poligrafía y un 29% polisomnografía, y sólo el 39,5% disponen de consulta específica. La demora diagnóstica para la poligrafía es de 169 ± 163,4 días y para la polisomnografía de 173 ± 152,5 días. Se realizan un total de 1.113 ± 1.004,6 pruebas por 100.000 habitantes y año, de ellas 235 ± 166,2 son poligrafías diagnósticas. La presión eficaz se titula en un 49% con auto-CPAP y el control terapéutico lo realiza frecuentemente la empresa suministradora (77%). Entre las propuestas de mejora, destacan la falta de un protocolo de derivación y coordinación entre diferentes niveles asistenciales (90% de los encuestados), y la demora diagnóstica, atribuible en un 63% de los casos al déficit de recursos físicos y de personal. Conclusión: El número de pruebas diagnósticas aún son insuficientes y la demora diagnóstica es excesiva. Sobre todo, en el control terapéutico la empresa suministradora tiene un papel relevante. Se propone la realización de protocolos entre diferentes unidades asistenciales y aumentar los recursos actuales. (AU)

Short title: The healthcare resources of the Andalusian Public Health System related to the diagnosis, treatment and follow-up of patients with obstructive sleep apnea are presented. Proposals for optimizing the management of this entity are also described, emphasizing the need for resources and collaboration between different levels of care. Objective: Determine the current resources in the Public Health System of Andalusia (SSPA) in obstructive sleep apnea (OSA) and identify proposals for improvement. Method: Cross-sectional study, based on surveys conducted in 49 SSPA hospitals. Variables related to the diagnosis, treatment, and follow-up of OSA were recorded, distinguishing between centers that performed polysomnography and those that did not. We include a section on proposals for improvement. Results: 97% of the centers perform polygraphy and 29% polysomnography, and only 39.5% have a specific consultation. The diagnostic delay for polygraphy is 169 ± 163.4 days and for polysomnography 173 ± 152.5 days. A total of 1,113 ± 1,004.6 tests are performed per 100,000 inhabitants per year, of which 235 ± 166.2 are diagnostic polygraphs. The effective pressure is titrated in 49% with auto-CPAP and therapeutic control is frequently carried out by the supplying company (77%). Among the proposals for improvement, the lack of a protocol for referral and coordination between different levels of care (90% of those surveyed), and the diagnostic delay, attributable in 63% of cases to the lack of physical and personnel resources, stand out. Conclusion: The number of diagnostic tests are still insufficient and the diagnostic delay is excessive. Above all, in therapeutic control, the supplier company has a relevant role. It is proposed to carry out protocols between different care units and increase current resources

High Frequency of Smell and Taste Dysfunction in Health Care Professionals With COVID-19 Working in Allergy Departments

Background: Since the early stages of the novel coronavirus 2019 (SARS-CoV-2) outbreak, smell and/or taste dysfunction (STD) has beenreported in 5% to 88% of COVID-19 patients.Objective: We aimed to assess STD in health care professionals (HCPs), mainly allergists, affected by COVID-19. We carried out a survey toevaluate the association between STD and its severity and demographic characteristics, symptoms, comorbidities, and hospital admission.Methods: We designed a 15-item questionnaire comprising various sections, as follows: demographics, diagnostic characteristics, STDpatterns, medication use, and comorbidities. The questionnaire was developed using Google forms. It was distributed to members of theSpanish Society of Allergology and Clinical Immunology (SEAIC) and sent via social media to be completed by HCPs with COVID-19.Results: The survey was completed by HCPs (n=234), of whom 76.5% were aged ≤55 years and 73.5% were female. STD was detected in74.4% of respondents, of whom 95.6% reported moderate-severe impairment. Mean time until recovery of taste dysfunction was 21.6 (24.0)days in HCPs aged ≤55 years and 33.61±26.2 days in those aged >55 years (P=.019). Analysis stratified by severity of STD showed thatmore than a half of COVID-19 patients presented severe loss of smell. Older age (>55 years) was associated with fever, anorexia, lowerfrequency of headache, and longer persistence of taste dysfunction.Conclusion: STD is a common symptom in COVID-19, even as a unique or preceding symptom. HCPs who reported smell dysfunctionwere younger than those not affected with STD. Taste dysfunction may imply more systemic involvement in COVID-19–positive HCPs. (AU)

Antecedentes: Desde el inicio de la pandemia por el nuevo coronavirus (SARS-CoV-2), la afectación del sentido del olfato y del gusto seha descrito entre el 5% y 88% de la población afecta por COVID-19.Objetivo: Evaluar la alteración del gusto y del olfato en profesionales sanitarios afectos por COVID-19, en relación a parámetros degravedad, características demográficas, síntomas, comorbilidades e ingreso hospitalario.Métodos: Se diseñó un cuestionario de 15 elementos, con las siguientes secciones: demografía, características diagnósticas, patronesde alteración de olfato y del gusto, uso de medicación y efectos adversos asociados y comorbilidades. Dicho cuestionario fue difundidopor las redes sociales de la Sociedad Española de Alergología e Inmunología Clínica, dirigido específicamente a profesionales sanitarios.Resultados: 234 profesionales completaron la encuesta (73,5% mujeres). El 76,5% de los encuestados era ≤55 años. Hubo afectacióndel olfato y/o gusto en el 74,4% de los encuestados. La persistencia media de alteración del gusto fue 21,6± 24,0 días en ≤55 años yde 33,6±26,2 días en >55 años (p=0,019). Ser mayor de 55 años se asociaba estadísticamente con fiebre, anorexia, menos cefalea ymayor persistencia de afectación del gusto.Conclusión: Los profesionales sanitarios que declararon haber padecido SD eran más jóvenes que los que no presentaron STD. La afectacióndel olfato y/o del gusto es un síntoma común entre los profesionales sanitarios con COVID-19 y puede ser patente en fases iniciales ocomo único síntoma en pacientes ≤55 años. La afectación del gusto puede implicar más síntomas sistémicos. (AU)

Adaptation to Spanish and Validation of the Rhinitis Control Assessment Test questionnaire

BACKGROUND: The Rhinitis Control Assessment Test (RCAT) is a patient-based questionnaire that is widely used to evaluate control of rhinitis. OBJECTIVE: To develop and validate a Spanish version of the RCAT (RCATe). METHODS: After translation and cultural adaptation of the original RCAT, this multicenter, observational, prospective study evaluated the properties/attributes of the RCATe by assessing its validity, reliability, responsiveness, effect size, minimal important difference and cut point. RESULTS: The recruited sample comprised 252 allergic rhinitis (AR) patients from 27 allergy and otolaryngology departments in hospitals throughout Spain. Significant and strong correlations were found between the RCATe and the total nasal symptom score and the visual analog scale (-0.79 and -0.77, respectively; P<.0001). The RCATe revealed significant differences between patients grouped in the different categories of severity or duration of AR (P<.001). The internal consistency (Cronbach alpha was good (0.84), and the test-retest reliability was moderate (0.54 evaluated by the physician and 0.49 by the patient). The responsiveness to change was high and significant for RCATe (P<.0001) and correlated linearly with the improvement in AR. The overall effect size was 1.62. The cut-off point to identify patients with adequate control of AR was >20 (area under the receiver operating characteristic curve, 0.746; sensitivity, 58.3%; specificity, 90.9%). CONCLUSION: The psychometric evaluation and validation of the RCATe indicated good reliability, validity, and responsiveness, thus suggesting that it is effective for measuring control of AR symptoms by Spanish-speaking patients

ANTECEDENTES: El cuestionario de control de la rinitis RCAT (Rhinitis Control Assessment Test) es un cuestionario auto administrado para evaluar el control de la rinitis, de uso muy extendido. OBJETIVO: Desarrollar y validar una versión traducida del cuestionario RCAT para pacientes hispanohablantes (RCATe). MÉTODOS: Tras la traducción y adaptación cultural del cuestionario original, se realizó un estudio multicéntrico prospectivo para evaluar los atributos y propiedades del RCATe analizando su validez, fiabilidad, capacidad de respuesta, tamaño del efecto, diferencias mínimas relevantes y puntos de corte. RESULTADOS: Se incluyeron 252 pacientes con rinitis alérgica (AR) de 27 unidades de Alergia y Otorrinolaringología de hospitales de toda España. El RCATe, la puntuación total de síntomas y la escala visual analógica se correlacionaron de forma robusta y significativa (-0,79 and -0,77, respectivamente; p < 0,0001). El RCATe diferenció de forma significativa pacientes clasificados en diferentes categorías de gravedad o duración de la AR (p < 0,001). La consistencia interna (alfa de Cronbach) resultó buena (0,84) y la fiabilidad test-retest moderada (0,54 evaluada por el especialista y 0,49 por el paciente). La sensibilidad al cambio del RCATe fue elevada significativamente (p < 0,0001), y se correlacionó linealmente con la mejoría de la AR. El tamaño del efecto global fue 1,62. El punto de corte para identificar pacientes con un adecuado control de la AR fue >20 (área de la curva ROC= 0,746; sensibilidad= 58,3%; especificidad= 90,9%). CONCLUSIONES: La evaluación psicométrica y la validación del RCATe indicaron una buena fiabilidad, validez y capacidad de respuesta, sugiriendo que puede usarse eficazmente para evaluar el control de los síntomas de AR en pacientes hispanohablantes

Manejo inicialmente conservador de la perforación duodenal de origen diverticular / Conservative initial management of the perforated duodenal diverticulum

OBJETIVO: Exponer la posibilidad de manejo inicialmente conservador de la perforación duodenal de origen diverticular, mediante antibioterapia intravenosa y drenaje percutáneo con intervención quirúrgica diferida. MATERIAL Y MÉTODOS: Descripción de un caso clínico -según las normas CONSORT-, así como las justificaciones al tratamiento conservador y el tipo de cirugía posterior realizados. RESULTADOS: La instauración de antibioterapia (piperacilina-tazobactam) y la realización de un drenaje retroperitoneal ecoguiado permitieron un correcto control inicial del foco infeccioso. Transcurridos 15 días se practicó la intervención quirúrgica definitiva, con la realización de laparotomía, resección de la tercera y cuarta porciones duodenales incluyendo el primer asa yeyu-nal, y reconstrucción mediante duodenoyeyunostomía latero-lateral manual. DISCUSIÓN: En toda perforación duodenal se debe valorar la necesidad de cirugía de entrada. No obstante, el manejo conservador mediante antibioterapia y drenaje percutáneo puede permitir una indicación diferida de la misma. CONCLUSIÓN: Ante pacientes seleccionados -en ausencia de repercusión séptica o hemodinámica- la realización de un drenaje percutáneo inicial con posterior intervención quirúrgica puede comportar una estrategia de tratamiento efectiva en la disminución de la morbimortalidad que esta infrecuente entidad presenta

OBJECTIVE: To show the possibility of initial conservative management of a perforaed duodenal diverticulum with intravenous an-tibiotherapy, percutaneous drainage and deferred surgical intervention. METHODS: Description of a clinical case -following the CONSORT recommendations-, the reasons of the conservative management and the type of surgical intervention. RESULTS: It was initially possible to control the infectious site with the combination of intravenous antibiotherapy (piperacyline-tazobactam) and a retroperitoneal ecoguided drainage. After 15 days the definitive surgical procedure was made. A laparotomy, resection of the third and fourth duodenal segments and manual latero-lateral duodenojejunostomy was performed. DISCUSSION: Event thought surgical intervention should be evaluated in all the duodenal perforations as the first procedure, the conservative management with antibiotherapy and percutaneous drainage can make possible the deferred surgery. CONCLUSION: In selected patients -absence of septic or hemodynamic repercussion- a step strategy, combination of intravenous antibiotherapy and percutaneous drainage, with a deferred surgical procedure can be an effective treatment strategy with low morbimortality of this infrequent entity

Recomendaciones para la normalización gradual en la enfermedad COVID-19 en las unidades de trastornos respiratorios del sueño de Andalucía / No disponible

No disponible

Pollen-induced allergic asthma and rhinoconjunctivitis: differences in outcome between seasonal and nonseasonal exposure to allergens under real-life conditions (The LANDSCAPE Study)

No disponible

Early life origins of asthma: a review of potential effectors

There is growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, chronic obstructive pulmonary disease, and diminished lung function later in life. In fact, from conception to death, a series of continuous, dynamic gene-environment interactions determine 2 fundamental biological processes, namely, lung development and lung aging. Over 130 birth cohorts have been initiated in the last 30 years. Data from these cohorts have improved our understanding of the inception, progression, and persistency of asthma. In this review, we summarize the main data for the early life events proven to determine later development and persistence of asthma, such as maternal atopy and smoking, preterm birth/bronchopulmonary dysplasia, infections, nutrition, obesity, smoking, and other environmental exposures in childhood and adolescence. While some of these factors are obviously impossible to prevent or eliminate, others have been proven to have a protective role, and current research is aimed optimizing them. Available prophylactic measures are also reviewed. In the case of environmental pollution, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas. Future research should focus on better understanding these complex interactions in order to develop and enhance effective preventive therapeutic measures

Existe evidencia de que eventos que ocurren en fases tempranas de la vida, tanto antes como después del nacimiento, se asocian significativamente con el aumento del riesgo futuro de asma, enfermedad pulmonar obstructiva crónica y deterioro de la función pulmonar. En efecto, desde el momento de la concepción hasta la muerte, una serie de interacciones dinámicas y continuas genético-ambientales determinan dos procesos biológicos fundamentales, el desarrollo pulmonar y el envejecimiento pulmonar. En los últimos 30 años se han comenzado más de 130 cohortes de nacimiento. Los datos de estas cohortes han mejorado nuestra comprensión del inicio, la progresión y la persistencia del asma. En esta revisión, resumimos los datos principales de los eventos de la vida temprana probados que determinan el desarrollo y la persistencia posteriores del asma, como atopia materna y tabaquismo, parto prematuro/displasia broncopulmonar, infecciones, nutrición, obesidad, tabaquismo y otras exposiciones ambientales en la infancia y la adolescencia. Si bien algunos de estos factores son obviamente imposibles de prevenir o eliminar, se ha demostrado que otros tienen un papel protector, y la investigación actual apunta a optimizarlos. También se revisan las medidas profilácticas disponibles. En el caso de la contaminación ambiental, las intervenciones políticas a gran escala lograron disminuir los niveles de contaminación, lo que mejoró la función pulmonar y disminuyó la prevalencia de asma en las respectivas áreas geográficas. Las investigaciones futuras deberían centrarse en comprender mejor estas interacciones complejas para desarrollar y mejorar las medidas terapéuticas preventivas eficaces