Study of the clinical and functional conditions of asthmatic patients

Introduction: The main functional alterations in bronchial asthma are the obstruction of the air flow, its reversibility, variability, and bronchial hyper- responsiveness.Objective: To determine the clinical and functional conditions in patients with asthma who go to the outpatient pneumology service for the first time.Material and Methods: A cross-sectional descriptive study was conducted in 110 patients with asthma that were treated for the first time in the outpatient department of the Pneumology Service at the “Benéfico Jurídico” Teaching Hospital in Havana from June 1st,2014 to June 31st,2015. The severity of asthma was confirmed by clinical diagnosis and spirometric tests. The variables consisted of age, sex, family pathological antecedents of asthma or allergy, body mass index, and seriousness or severity of asthma.  Results: The most serious asthma prevailed in patients aged 40 to 59 years, and the patients 40 years old and older presented 4.4 times higher risks. The female sex exhibited 2.1 times higher risks.  75.5% of patients with family pathological antecedents (FPA) of asthma or allergy showed 3.4 times higher risk levels for more serious conditions. More than half of patients presented personal pathological antecedents (PPA) of other diseases and a more serious asthma.  53.6% were overweight or obese who were 4.1 times at higher risks of suffering from more serious conditions. Most patients did not report smoking addiction.Conclusions: Asthmatic patients over 40 years showed a more serious asthma during their first visit to the outpatient pneumology service, and the female sex prevailed. Asthma or allergy, FPA and PPA were the risk factors for suffering from both asthma and more serious conditions. There is a low percentage of smoking asthmatics although this condition provokes more serious symptoms.Keywords: Clinical and functional conditions of asthmatic patients, first appointment, obesity, more serious asthma, risk factor.</p

Las rutas gastronómicas como oportunidad de generar rentas adicionales en el sector agrario: análisis de la ruta del jamón ibérico en la provincia de Córdoba

En la última década se observa un crecimiento en la oferta turista, especialmente la desarrollada en las zonas rurales. Entre las nuevas modalidades de turismo destaca el gastronómico, siendo las rutas gastronómicas itinerarios donde convergen entorno a un producto alimenticio distintos agentes y factores que hacen que se desarrolle una economía adicional capaz de generar rentas complementarias a los habitantes de la zona rural, cuya principal renta es la obtenida por la producción proceso o elaboración de productos agrícolas.En esta investigación se analiza la situación de la actividad turística relacionada con la ruta del jamón Ibérico en denominación de Origen Valle de los Pedroches de la provincia de Córdoba, con el fin de conocer el perfil del consumidor de este producto y la oferta complementaria de la zona, lo que permitirá diseñar herramientas para la promoción y comercialización del turismo del jamón en esta región. Al ser este producto gastronómico típico de la Península Ibérica no es tan conocido ni ha sido tan estudiado como el oleoturismo o enoturismo tanto a nivel nacional e internacional. Por tanto el objetivo de esta investigación es dar a conocer esta ruta gastronómica y analizar su repercusión económica en la zona donde se desarrolla.The last decade shows a growth in tourism, especially in rural areas. A new way to growing trend of tourism highlights: the culinary or gastronomic tourism. The difference with other forms of tourism is the existence of gastronomic routes associated with indigenous foods. This, together with various actors and local factors contribute to the development of a rural economy that generates additional income to the main income, obtained by the production and processing of agricultural products. This study examines the tourism related gastronomic route of the Iberian ham belonging to the designation of origin “Valle de los Pedroches” in the province of Córdoba (Andalusia, Spain), in order to approximate the profile of the consumer of this product and explain the complementary services in the geographical area. We believe that this will help design tools that support the promotion and tourism development of Iberian ham in this region. This gourmet product is typical of the Spain and is not as well known or as studied as the oleotourism or wine tourism, both nationally and internationally. Therefore, the objective of this research is to show the peculiarities of this gastronomic route and analyze their economic impact on the area where it grows

Turismo gastronómico y D.O.P.: Una relación simbiótica en Andalucía

Durante la primera década del siglo XXI los intereses de los turistas han cambiado y se han vuelto más sofisticados. Un nuevo tipo de turismo personalizado ha nacido y se ha consolidado. En esta nueva modalidad de turismo el cliente participa en la organización del mismo. La modalidad emergente de la actividad turística que ofrece mayor diversidad de opciones es el turismo rural (turismo gastronómico, deportivo, cinegético, etc.). Estas opciones, desarrolladas en áreas rurales, permiten a los visitantes entre otras cuestiones estar en contacto con la naturaleza y, al mismo tiempo, disfrutar el patrimonio cultural y conocer las costumbres arraigadas en la vida cotidiana de los habitantes de estas zonas geográficas. Este trabajo presenta un análisis de la relación entre los productos alimenticios asociados a denominaciones de origen e indicaciones geográficas protegidas (D.O.P. e I.G.P.) y la potencialidad del turismo gastronómico. Para ello, se revisan las ventajas e inconvenientes que aporta el desarrollo de este tipo de turismo en Andalucía mediante un análisis DAFO.During the first decade of the century the interests of tourists have changed and become more sophisticated. A new type of personalized tourism was born and has been consolidated. In this new kind of tourism the client is involved in organizing it. The emerging form of tourism that offers greater range of options is rural tourism (gastronomic tourism, sporting, hunting, etc.). These options, developed in rural areas, allowing visitors among other issues get in touch with nature and at the same time enjoy the cultural heritage and know the customs rooted in the everyday life of the inhabitants of these geographic areas. This paper presents an analysis of the relationship between food products associated with designations of origin and protected geographical indications (PDO and PGI) and the potential of culinary tourism. To do this, we review the advantages and disadvantages provided by the development of this type of tourism in Andalusia through a SWOT analysis

Effect of cochlear implant in children suffering genetic hypoacusis caused by Waardenburg Syndrome and 35delG mutation

Introduction: Sensorineural hypoacusia is the most common form of hearing impairment, it is estimated that over 80% of all congenital hearing losses are from genetic origin, being distinguished in syndromic and non-syndromic; 35delG mutation is the most common cause of the first and Waardenburg syndrome (WS) is one of the most frequent in the last one; in both of them cases are usually identified patients with severe to profound hearing losses (HSP). The cochlear implant is considered an effective solution when the HSP do not get enough benefit through hearing aids. Objective: To analyze the results achieved with the use of cochlear implant in patients with HSP due to WS and 35delGmutation. Material and Methods: A descriptive cross-sectional study. Were studied patients with HSP of genetic cause, 27 due to 35delGmutation and 15 by WS. Hearing and logophoniatrics tests were performed. Results: Inner ear lesions happening in the in the studied patients it seems not affect the benefits of cochlear implant if general proper conditions are given. Conclusions: Cochlear Implant is a worthful therapeutic alternative for the hearing impaired due to these two studied illness; however, those with 35delG mutation, achieved best hearing performance categories. Keywords: deafness, hearing loss, genetics, rehabilitation, hearing impairment correction.</p

Chronic venous insufficiency: a review

Chronic venous insufficiency (CVI) comprises a complete spectrum of morphological and functional abnormalities of the venous system1 including any long-term functional and morphological alteration. CVI accounts for several abnormalities of the venous system. It is a highly prevalent disease that causes serious economic consequences, a decrease in the quality of life and can lead to serious complications. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to chronic venous insufficiency. The pathophysiology of chronic venous insufficiency begins with chronic venous hypertension and the dilation of the vessel, this leads to a series of pathological changes in the venous wall and surrounding tissues, in advanced stages of CVI, skin lesions are associated with an increased proliferation of skin capillaries and microcirculatory abnormalities that may be the result of an altered level of factors responsible for the angiogenic response, such as vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2) and angiostatin. In this review, updates on pathophysiology, clinic, diagnosis, classification and treatment of this disease are analyzed, with special emphasis on therapeutic options. Chronic venous insufficiency is a disease that affects the patient at several levels, mainly diminishing his/her quality of life. Currently there are various treatments ranging from habit modifications, pharmacological, to endovenous and surgical treatment.

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true