Peculiaridades del asma pediátrica

23 páginas.Capítulo incluido en el libro: Hacia un mejor control de nuestros pacientes con asma. Manuel Alcantara Villar (Coordinador). Sevilla: Universidad Internacional de Andalucía, 2019. ISBN 978-84-7993-351-7. Enlace: http://hdl.handle.net/10334/4035

Peculiaridades del tratamiento del asma en la edad pediátrica

págs.: 157-176Capítulo incluido en el libro: Optimizando el abordaje del asma bronquial. Manuel Alcántara Villar (coordinador). Sevilla: Universidad Internacional de Andalucía, 2023. ISBN: 978-84-7993-396-8. Enlace: http://hdl.handle.net/10334/737

Photoluminiscence enhancement in quaternay III-nitrides alloys grown by molecular beam epitaxy with increasing Al content

Room temperature photoluminescence and optical absorption spectra have been measured in wurtzite InxAlyGa1−x−yN (x ∼ 0.06, 0.02<y<0.27) layers grown by molecular beam epitaxy. Photoluminescence spectra show both an enhancement of the integrated intensity and an increasing Stokes shift with the Al content. Both effects arise from an Al-enhanced exciton localization revealed by the S- and W-shaped temperature dependences of the photoluminescence emission energy and bandwidth, respectively. Present results point to these materials as a promising choice for the active region in efficient light emitters. An In-related bowing parameter of 1.6 eV was derived from optical absorption data

Influence of steering effects on strain detection in AlGaInN/GaN heterostructures by ion channellin

Ion steering effects in the interface of heterostructures can strongly influence the shape and position of angular channelling scans leading to considerable error in the determination of strain by ion channelling. As an example, this paper presents channelling measurements on a near-lattice-matched AlGaInN/GaN heterostructure which show no shift between the angular scans from the quaternary layer and the underlying GaN substrate although high resolution x-ray diffraction data confirm the presence of strain in the layer. Such ‘anomalous’ behaviour was studied by means of Monte Carlo simulations for nitride ternary and quaternary films in the whole composition range. The simulations show that the thickness, magnitude of the distortion of the strained lattice and energy of the probing beam are critical parameters controlling the impact of steering. Three composition/strain regions were established for a typical beam of 2MeV alpha particles corresponding to different intensities of the steering potential and in which strain measurements by ion channelling are (a) correct, (b) possible but require corrections and (c) not possible due to steering effects

Effect of the growth temperature and the AlN mole fraction on In incorporation and properties of quaternary III-nitride layers grown by molecular beam epitaxy

Indium incorporation into wurtzite (0001)-oriented InxAlyGa1−x−yN layers grown by plasma-assisted molecular beam epitaxy was studied as a function of the growth temperature (565–635 °C) and the AlN mole fraction (0.01<y<0.27). The layer stoichiometry was determined by Rutherford backscattering spectrometry (RBS). RBS shows that indium incorporation decreased continuously with increasing growth temperature due to thermally enhanced dissociation of In–N bonds and for increasing AlN mole fractions. High resolution x-ray diffraction and transmission electron microscopy (TEM) measurements did not show evidence of phase separation. The mosaicity of the quaternary layers was found to be mainly determined by the growth temperature and independent on alloy composition within the range studied. However, depending on the AlN mole fraction, nanometer-sized composition fluctuations were detected by TEM. Photoluminescence spectra showed a single broad emission at room temperature, with energy and bandwidth S- and W-shaped temperature dependences typical of exciton localization by alloy inhomogeneities. Cathodoluminescence measurements demonstrated that the alloy inhomogeneities, responsible of exciton localization, occur on a lateral length scale below 150 nm, which is corroborated by TE

Management of Patients with Suspected or Confirmed Antibiotic Allergy. Executive Summary of Guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC)

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ss-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients

Single nucleotide polymorphisms in DNA repair genes as risk factors associated to prostate cancer progression

Background Besides serum levels of PSA, there is a lack of prostate cancer specific biomarkers. It is need to develop new biological markers associated with the tumor behavior which would be valuable to better individualize treatment. The aim of this study was to elucidate the relationship between single nucleotide polymorphisms (SNPs) in genes involved in DNA repair and prostate cancer progression.Methods A total of 494 prostate cancer patients from a Spanish multicenter study were genotyped for 10 SNPs in XRCC1, ERCC2, ERCC1, LIG4, ATM and TP53 genes. The SNP genotyping was made in a Biotrove OpenArray® NT Cycler. Clinical tumor stage, diagnostic PSA serum levels, and Gleason score at diagnosis were obtained for all participants. Genotypic and allelic frequencies were determined using the web-based environment SNPator.Results SNPs rs11615 (ERCC1) and rs17503908 (ATM) appeared as risk factors for prostate cancer aggressiveness. Patients wild homozygous for these SNPs (AA and TT, respectively) were at higher risk for developing cT2b – cT4 (OR = 2.21 (confidence interval (CI) 95% 1.47 – 3.31), p < 0.001) and Gleason scores ≥ 7 (OR = 2.22 (CI 95% 1.38 – 3.57), p < 0.001), respectively. Moreover, those patients wild homozygous for both SNPs had the greatest risk of presenting D’Amico high-risk tumors (OR = 2.57 (CI 95% 1.28 – 5.16)).Conclusions Genetic variants at DNA repair genes are associated with prostate cancer progression, and would be taken into account when assessing the malignancy of prostate cancer.This work was subsidized by a grant from the Instituto de Salud Carlos III (Ministerio de Economía y Competitividad from Spain), ID: PI12/01867. Almudena Valenciano has a grant from the Instituto Canario de Investigación del Cáncer (ICIC)

Best practice framework and principles for monitoring the effect of coastal development on marine mammals

As the worlds human population increases along the coastal zone with major alteration of coastal embayments increased on-water activities and a plethora of other intrusions into the coastal zone there is a simultaneous increase in pressures on marine mammals. Growing evidence indicates that many marine mammals are highly susceptible to declines resulting from direct and indirect impacts arising from diverse human activities. Too frequently assessment of the impact from coastal developments on marine mammals has been inadequate or completely lacking. At worst this has led to catastrophic decline in some populations. Without rigorous ecological assessments along with adaptive management frameworks prior to the initiation of developments the number of marine mammal populations likely to be adversely impacted will continue to rise. To address these shortcomings we present a globally applicable best practice framework by; (i) describing guiding principles and; (ii) reviewing appropriate procedures for assessment and monitoring of impacts of coastal developments on marine mammals. The approach outlined is embedded in Environmental Impact Assessment processes as a means by which decision makers and stakeholders can be informed. Recommendations presented are designed to encourage the application of robust scientific evaluation that applies appropriate survey design with sufficient statistical power to detect changes before trigger thresholds are reached. We emphasize that there is an urgent need to ensure assessments are comprehensive effective and integrated with monitoring and adaptive management actions in order to minimize or effectively mitigate the impacts of human activities on marine mammal population

Polymorphisms in DNA-repair genes in a cohort of prostate cancer patients from different areas in Spain: heterogeneity between populations as a confounding factor in association studies

Background: Differences in the distribution of genotypes between individuals of the same ethnicity are an important confounder factor commonly undervalued in typical association studies conducted in radiogenomics. Objective: To evaluate the genotypic distribution of SNPs in a wide set of Spanish prostate cancer patients for determine the homogeneity of the population and to disclose potential bias. Design, Setting, and Participants: A total of 601 prostate cancer patients from Andalusia, Basque Country, Canary and Catalonia were genotyped for 10 SNPs located in 6 different genes associated to DNA repair: XRCC1 (rs25487, rs25489, rs1799782), ERCC2 (rs13181), ERCC1 (rs11615), LIG4 (rs1805388, rs1805386), ATM (rs17503908, rs1800057) and P53 (rs1042522). The SNP genotyping was made in a Biotrove OpenArrayH NT Cycler. Outcome Measurements and Statistical Analysis: Comparisons of genotypic and allelic frequencies among populations, as well as haplotype analyses were determined using the web-based environment SNPator. Principal component analysis was made using the SnpMatrix and XSnpMatrix classes and methods implemented as an R package. Non-supervised hierarchical cluster of SNP was made using MultiExperiment Viewer. Results and Limitations: We observed that genotype distribution of 4 out 10 SNPs was statistically different among the studied populations, showing the greatest differences between Andalusia and Catalonia. These observations were confirmed in cluster analysis, principal component analysis and in the differential distribution of haplotypes among the populations. Because tumor characteristics have not been taken into account, it is possible that some polymorphisms may influence tumor characteristics in the same way that it may pose a risk factor for other disease characteristics. Conclusion: Differences in distribution of genotypes within different populations of the same ethnicity could be an important confounding factor responsible for the lack of validation of SNPs associated with radiation-induced toxicity, especially when extensive meta-analysis with subjects from different countries are carried out

Optimizando el abordaje del asma bronquial

196 páginas.El asma bronquial es una enfermedad crónica que afecta a millones de personas en todo el mundo, siendo la primera enfermedad crónica en la edad pediátrica. Se caracteriza por una inflamación de las vías respiratorias que conduce a la obstrucción del flujo de aire y a la dificultad para respirar. El asma es una enfermedad que afecta a la calidad de vida de las personas que la padece y puede ser una condición potencialmente mortal si no se trata adecuadamente. A pesar de los avances significativos en el tratamiento del asma en las últimas décadas, todavía hay muchas personas que no logran controlar adecuadamente su enfermedad. Muchos pacientes continúan experimentando síntomas a pesar de tomar medicamentos y seguir las recomendaciones médicas. Esto puede deberse a multitud de factores, como una mala adherencia al tratamiento, una falta de comprensión de la enfermedad o una falta de seguimiento por parte de los profesionales sanitarios. Una formación adecuada de los profesionales sanitarios implicados en la atención al paciente asmático (Médicos de Familia, Médicos de urgencias, Pediatras, Neumólogos, Alergólogos, etc) ayudará a establecer una estrategia de tratamiento eficaz y eficiente que pueda traducirse en una mejora del control y por tanto de la calidad de vida de nuestros pacientes. En este libro, se abordan las últimas recomendaciones basadas en la evidencia para el diagnóstico, la evaluación y el tratamiento del asma, con un enfoque multidisciplinar. A lo largo de sus diez capítulos, se describe como llegar a establecer un diagnostico correcto del asma (interpretación de pruebas alérgicas, espirometria y técnicas de imagen), uso adecuado de los distintos dispositivos de inhalación, las peculiaridades del tratamiento en el embarazo y en la edad pediátrica, el importante papel de la inmunoterapia en el tratamiento del asma alérgica, así de como debemos actuar ante una crisis de asma o cuales son los avances actuales y futuros en el asma grave o de difícil control