Clinical outcomes and cost analysis of exacerbations in chronic obstructive pulmonary disease.

BACKGROUND: Exacerbations are a major cause of disability, hospital admissions, and increased healthcare costs in patients with chronic obstructive pulmonary disease (COPD). This study investigated the clinical outcomes of outpatients with moderate to severe exacerbated COPD and their related costs. METHODS: An observational study on the outcomes of ambulatory exacerbations of COPD was conducted. The course of the exacerbation was evaluated at a follow-up visit at 4 weeks. A cost analysis that encompassed the use of healthcare resources for treatment of the exacerbation was performed. RESULTS: A total of 260 patients were included, with a mean age of 68.3 years and a mean FEV1 (% predicted) of 58.9 %. Twenty-two percent of patients had significant cardiovascular comorbidity. The most frequently prescribed antibiotics were moxifloxacin in 137 cases and amoxicillin-clavulanate in 50 cases. The rate of failure at 4 weeks was 12.5 %, with no differences between the two most prescribed antibiotics; however, patients treated with moxifloxacin had symptoms for 1.9 fewer days (P = 0.01). The mean cost of the exacerbation was 344.96 (95 % CI: 48.55-641.78), with 9.6 % of the costs for drugs and 72.9 % for hospital care of patients for whom treatment had failed. CONCLUSIONS: Antibiotic treatment of our population was in compliance with local guidelines. The rate of failure observed in our study was lower than that reported in previous studies; however, the small percentage of patients that required hospital attention generated almost two-thirds of the total costs of the exacerbations.

Differential cortical network engagement during states of un/consciousness in humans.

What happens in the human brain when we are unconscious? Despite substantial work, we are still unsure which brain regions are involved and how they are impacted when consciousness is disrupted. Using intracranial recordings and direct electrical stimulation, we mapped global, network, and regional involvement during wake vs. arousable unconsciousness (sleep) vs. non-arousable unconsciousness (propofol-induced general anesthesia). Information integration and complex processing we`re reduced, while variability increased in any type of unconscious state. These changes were more pronounced during anesthesia than sleep and involved different cortical engagement. During sleep, changes were mostly uniformly distributed across the brain, whereas during anesthesia, the prefrontal cortex was the most disrupted, suggesting that the lack of arousability during anesthesia results not from just altered overall physiology but from a disconnection between the prefrontal and other brain areas. These findings provide direct evidence for different neural dynamics during loss of consciousness compared with loss of arousability.

Predicted heart age profile across 41 countries: A cross-sectional study of nationally representative surveys in six world regions.

Background: Predicted heart age (PHA) can simplify communicating the absolute cardiovascular disease (CVD) risk. Few studies have characterized PHA across multiple populations, and none has described whether people with excess PHA are eligible for preventive treatment for CVD. Methods: Pooled analysis of 41 World Health Organization (WHO) STEPS surveys conducted in 41 countries in six world regions between 2013 and 2019. PHA was calculated as per the non-laboratory Framingham risk score in adults without history of CVD. We described the differences between chronological age and PHA, the distribution of PHA, and the proportion of people with excess PHA that were eligible for antihypertensive and lipid-lowering treatment following the WHO guidelines. Logistic regression models were fitted to assess sociodemographic and health-related variables associated with PHA excess. Findings: 94,655 individuals aged 30-74 years were included. 36% of those aged 30-34 years had a PHA of 30-34 years; 9% of those aged 60-64 years had a PHA of 60-64 years. Countries in Africa had the lowest prevalence of very high PHA (i.e., PHA exceeding chronological age in ≥5 years) and countries in Western Pacific had the highest. ≥50% of the population with PHA excess (i.e., PHA exceeding chronological age in ≥1 year) was not eligible for antihypertensive nor lipid-lowering treatment. Abdominal obesity, high total cholesterol, smoking and having diabetes were associated with higher odds of having PHA excess, whereas higher education and employment were inversely associated with excess PHA. Interpretation: PHA is generally higher than chronological age in LMICs and there are regional disparities. Most people with excess PHA would not be eligible to receive preventive medication. Funding: RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z).

Agreement between the laboratory-based and non-laboratory-based WHO cardiovascular risk charts: a cross-sectional analysis of a national health survey in Peru.

OBJECTIVE: To determine the agreement between the cardiovascular disease (CVD) risk predictions computed with the WHO non-laboratory-based model and laboratory-based model in a nationally representative sample of Peruvian adults. DESIGN: Cross-sectional analysis of a national health survey. METHODS: Absolute CVD risk was computed with the 2019 WHO laboratory-based and non-laboratory-based models. The risk predictions from both models were compared with Bland-Altman plots, Lin's concordance coefficient correlation (LCCC), and kappa statistics, stratified by sex, age, body mass index categories, smoking and diabetes status. RESULTS: 663 people aged 30-59 years were included in the analysis. Overall, there were no substantial differences between the mean CVD risk computed with the laboratory-based model 2.0% (95% CI 1.8% to 2.2%) and the non-laboratory-based model 2.0% (95% CI 1.8% to 2.1%). In the Bland-Altman plots, the limits of agreement were the widest among people with diabetes (-0.21; 4.37) compared with people without diabetes (-1.17; 0.95). The lowest agreement as per the LCCC was also seen in people with diabetes (0.74 (95% CI 0.63 to 0.82)), the same was observed with the kappa statistic (kappa=0.36). In general, agreement between the scores was appropriate in terms of clinical significance. CONCLUSIONS: The absolute cardiovascular predicted risk was similar between the laboratory-based and non-laboratory-based 2019 WHO cardiovascular risk models. Pending validation from longitudinal studies, the non-laboratory-based model (instead of the laboratory-based) could be used when assessing CVD risk in Peruvian population.

A review of the clinical and epidemiological aspects of Guillain-Barré syndrome in patients infected with SARS-CoV-2: An Extended Comprehensive Review / Revisión de los aspectos clínicos y epidemiológicos del Síndrome de Guillain-Barré en pacientes infectados con SARS-CoV-2: Una revisión extensa y comprensiva

ABSRACT Since 2019, cases of patients with COVID-19 who developed Guillain-Barré Syndrome (GBS) have been reported. This review explores mechanisms that explain pathophysiology, clinical features, laboratory findings, and imaging characteristics in these patients. Methodology : A bibliographic search was made of studies on the topic published in NCBI and Scielo, between December 2019 and April 2022. Results : Ninety articles were found, 53 of which were included in this article. No studies were found that explain an association between GBS and COVID19. Specific clinical manifestations found were areflexia (56.95%), hyporeflexia (19.44%), muscle weakness (65.28%), gait disturbance (12.5%), hypoesthesia (26.39%), paresthesia (30.55%), and micturition disturbance (6.94%). The CSF findings included albumin-cytological dissociation (66.67%), and an average protein level of 140.23 mg/dL (SD: 106.71). Some cases reported enhancement of the cervical leptomeningeal, brainstem and cranial nerves on magnetic resonance imaging tests. The predominant variant of GBS was acute inflammatory demyelinating polyneuropathy (56.94%). The findings in the nerve conduction studies were the absence of F waves (61.54%), increased distal motor latency (80%), decreased motor amplitude (93.1%), and decreased motor conduction velocity (75%). In addition, the nerves mainly involved were the tibial (20.21%), peroneal (24.47%), median (20.21%), and ulnar (18.09%). The most frequent alteration of cranial nerves was bilateral (25%) and unilateral (13.89%) facial palsy. Conclusion : The primary GBS variant was Acute Inflammatory Demyelinating Polyneuropathy. Cerebrospinal fluid analysis revealed albumin-cytological dissociation as the most common finding, and MRI tests showed cranial nerves enhancements. An additional differential feature was the lower commitment of the autonomous system.

RESUMEN Desde 2019, se han venido publicando casos de pacientes con COVID-19 que desarrollaron el Síndrome de Guillain-Barré (GBS). Esta revisión explora mecanismos que expliquen fisiopatología, características clínicas, hallazgos de laboratorio y características imagenológicas en estos pacientes. Metodología : Búsqueda bibliográfica de estudios publicados en NCBI y Scielo, entre diciembre de 2019 y abril de 2022. Resultados : Se encontraron noventa artículos, 53 de los cuales se incluyen esta síntesis. No se encontraron estudios que expliquen una asociación entre GBS y COVID-19. Clínicamente, se encontró arreflexia (56.95%), hiporreflexia (19.44%), debilidad muscular (65.28%), alteración de la marcha (12.5%), hipoestesia (26.39%), parestesia (30.55%) y alteración de la micción (6.94%). Los hallazgos en el líquido cefalorraquídeo incluyeron disociación albumino-citológica (66.67%) y un nivel promedio de proteínas de 140.23 mg/dL (DE: 106.71). Algunos casos mostraron realce de las leptomeninges cervicales, tronco encefálico y nervios craneales en tests de resonancia magnética. La variante predominante de GBS fue polineuropatía desmielinizante inflamatoria aguda (56.94%). Los hallazgos en los estudios de conducción nerviosa incluyeron ausencia de ondas F (61.54%), aumento de la latencia motora distal (80%), disminución de la amplitud motora (93.1%) y disminución de la velocidad de conducción motora (75%). Los nervios principalmente involucrados fueron el tibial (20.21%), peroneal (24.47%), mediano (20.21%) y cubital (18.09%). La alteración más frecuente de los nervios craneales fue parálisis facial bilateral (25%) y unilateral (13.89%). Conclusión : La variante primaria del Síndrome de Guillain-Barré (GBS) fue la Polineuropatía Dismielinizante Inflamatoria Aguda. El análisis del líquido cefalorraquídeo reveló una disociación albumino-citológica como el hallazgo más común, y las imágenes en tests de resonancia magnética mostraron incremento de los nervios craneales. Otro hallazgo diferencial fue el menor compromiso del sistema autónomo.

Behavioral characterization of sleep in stumptail macaques (Macaca arctoides) in exterior captivity by means of high-sensitivity videorecording.

There are reasons to consider incomplete the description of sleep in many non-human primate species. Recording animals by highly sensitive videos to obtain detailed descriptions of nighttime behavior and evidence of muscle activity while in a resting posture, seems a promising approach to the non-invasive study of sleep in non-human primates. The present work describes the use of ultrasensitive videocameras to record and analyze spontaneous nighttime behaviors in captive non-human primates. Its main purpose is to emphasize the utility of videorecordings to analyze nighttime behavior. A heterosexual group of nine stumptail macaques (M. arctoides) was studied. It was possible to identify resting postures: immobility or lying on the floor as well as sleep movements and behavioral signs of sleep. This procedure permits recognition of each animal individually and the data suggest that videorecordings, among other techniques available, may be a useful, non-invasive method to study sleep. © 1995 Wiley-Liss, Inc.

Conductas de reposo (letargo) de los macacos cola de muñón (Macaca arctoides) en cautiverio, causadas por un eclipse solar / Resting (lethargic) behaviors of captive stumptail macaca (Macaca arctoides) caused by a colar eclipse

Se estudió la influencia de un eclipse total del sol (México, 11 de julio de 1991) sobre el comportamiento de un grupo de macacos cola de muñón (M. arctoides) que viven en cautiverio exterior. Se empleó un grupo heterosexual de nueve monos de diferentes edades y cada sujeto sirvió como su propio control. Los animales fueron filmados durante aproximadamente una hora continua el día del eclipse (de 1300 a 1405 h), para comparar sus reacciones conductuales con aquellas observadas durante el anochecer y amanecer en días veraniegos ordinarios (de 19:00 h de un día a las 06:00 h del día siguiente). Durante la fase de totalidad del eclipse (13:20 h), los animales formaron un solo grupo y ascendieron lentamente a la plataforma superior dentro del área de vivienda. Este lugar fue el sitio principal para dormir durante los días de control. Mostraron conductas de búsqueda grupal de abrigo, disminuyó la actividad motora y guardaron absoluto silencio. Conforme finalizó el eclipse, la actividad general volvió a la normalidad. Las reacciones conductuales fueron iniciadas por una hembra juvenil, incluyendo una conducta atípica de exploración. Los resultados sugieren que el cambio en el nivel de iluminación fue el factor principal que afectó la conducta de los primates, lo que confirma la dependencia fotoperiódica de sus sistemas circadianos de reposo

Un modelo de estrategia social durante el reposo nocturno en los macacos cola de muñón (Macaca artoides), en cautiverio exterior / A model of social strategy during nocturnal rest in Macaca arctoides in outdoor captivity

Las estrategias sociales son conductas complejas que los individuos elaboraron con el objeto de obtener beneficios dentro del grupo al que pertenecen. Es así que en los grupos de primates no-humanos, dichas estrategias se reflejan en la forma como el individuo se comporta para obtener alimento, su capacidad para establecer "buenas" relaciones con sus compañeros de grupo, el pertenecer a un status social alto y acceder a la cópula, entre otras. Este conjunto de conductas se han estudiado en el periodo de vigilia. Sin embargo, durante la noche parecen sucederse conductas que sugieren un modelo de estrategia social, que se relaciona con calidad del sueño. En la presente investigación se estudiaron las conductas diurnas y nocturnas, así como las pautas conductuales de sueño en relación al parentesco y al género, en todas las categorías de edad de un grupo heterosexual de 10 macacos cola de muñón (M. arctoides). Este grupo se encuentra en cuativerio exteior en el Departamento de Etología de la División de Neurociencias del Instituto Mexicano de Psiquiatría. Mediante la técnica no-invasiva de filmación con una cámara de alta sensibilidad, se hicieron registros nocturnos con una duración total de 60 horas. Los datos se sometieron a un análisis de tablas de contingencia multidimensionales, con el género y el parentesco como factores, de acuerdo con un modelo log-lineal. Después, se calcularon los residuos estandarizados para evaluar las diferencias entre las frecuencias observadas y predichas de cada conducta, con la prueba de chi cuadrada. Se observó una diferencia en la conducta de juego y en la de sacudirse en relación con el parentesco. También se encontraron diferencias significativas en las conductas de sacudirse, de aseo social, de agresión, consolidación y sueño, con respecto al género

Effect of the administration of gabaergic agonists of the GABA A/BDZ receptor on sleep in human subjects

El objetivo de este estudio ha sido evaluar los efectos de la administración aguda de una única dosis de una benzodiacepina de acción prolongada (diacepam, 10 mg), una imidazopiridina (zolpidem, 10 mg), una ciclopirrolona (zopiclona, 7.5 mg), un agonista del complejo molecular GABA A/BDZ (Gabob, 500 mg), y un placebo, sobre el sueño en diez sujetos sanos, utilizando un diseño doble-ciego de cuadrado latino de bloques incompletos. Para ello, se hizo un registro polisomnográfico nocturno (de ocho horas de duración) de cada sujeto durante seis noches consecutivas, en donde se evaluaban variables polisomnográficas relacionadas con la cantidad y la calidad de sueño. Nuestros resultados indicaron que no hubo ningún cambio significativo en las variables polisomnográficas relacionadas con la cantidad de sueño tras la administración de las sustancias. En cambio, los fármacos afectaron tres variables relacionadas con la calidad de sueño; en concreto, al porcentaje de la fase I de sueño, al de sueño; en concreto, al porcentaje de la fase I de sueño, al de sueño MOR (Movimientos Oculares Rápidos) y al de los episodios de la fase II. Por otra parte, nuestros resultados pusieron de manifiesto que la zopiclona fue la sustancia que produjo una mejoría significativa en las variables polisomnográficas relacionadas con la cantidad de sueño, cuando las comparaciones estadísticas se establecieron entre la línea base, la administración del fármaco y el periodo de levado del fármaco. No obstante, el placebo produjo un empeoramiento de las variables polisomnográficas relacionadas con la cantidad de sueño, evidenciándose un claro "efecto placebo" sobre las variables polisomnográficas