Indacaterol, A Novel Once Daily Inhaled β2-Adrenoreceptor Agonist

In this article we will review the role of long acting β2-adrenoreceptor agonists and long-acting muscarinic agents in the management of airflow obstruction. We will then focus our attention on indacaterol, one of the new once daily inhaled β2-adrenoreceptor agonists. Pharmacologically this drug is a nearly full β2-agonist without loss of efficacy after prolonged administration. We will also discuss its dosing, safety and tolerability

Propuesta de mejora para la salud ocupacional en guajira Móviles Telecomunicaciones EU, basada en la gestión del conocimiento

Esta investigación evalúa la situación presentada a una filial de movistar Guajira Móviles Telecomunicaciones EU cuya empresa está autorizada para vender sus productos en servicios y planes móviles, sin embargo carece de planes de prevención, promoción y tratamiento a la salud ocupacional de sus empleados que han estado expuestos factores de riesgos asociados a la salud física, mental y social de tal forma se pueda formular estrategias y adoptar un modelo de gestión para que la empresa se comprometa en trabajarle a su inteligencia emocional, a su bienestar y desarrollo social y de esta manera se obtengan menos rotaciones, desvinculación injustificada, ni altos costos en demandas e indemnizaciones.This investigation evaluates the situation presented to a subsidiary of Movistar Guajira Móviles Telecomunicaciones EU whose company is authorized to sell its products in services and mobile plans, however it lacks prevention, promotion and treatment plans for the occupational health of its employees who have been exposed risk factors associated with physical, mental and social health so that strategies can be formulated and a management model adopted so that the company is committed to working on its emotional intelligence, welfare and social development and thus obtain fewer rotations, unjustified disengagement, or high costs in lawsuits and compensation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Análise de associação quanto à produtividade e seus caracteres componentes em linhagens e cultivares de arroz de terras altas

O objetivo deste trabalho foi identificar, por meio da análise de mapeamento associativo, os marcadores moleculares relacionados à produtividade do arroz de terras altas e aos seus caracteres componentes. Foram usadas 113 linhagens e cultivares de arroz de terras altas, da Coleção Nuclear de Arroz da Embrapa, com reduzido vínculo genético entre si. Os seguintes caracteres componentes da produtividade foram avaliados: número de panículas por metro, número de grãos por panícula e peso de 100 grãos. Dos 115 marcadores utilizados, 25 (21,7%) associaram-se significativamente a um ou mais caracteres. Entre os 29 SSR ("simple sequence repeats") colocalizados em QTL ("quantitative trait loci") de produtividade de arroz, 12 foram associados aos caracteres avaliados e considerados como candidatos para uso na seleção assistida por marcadores. Os marcadores NP914540, Q6ZGD1 e Q69JE3, associados ao número de grãos por panícula, ainda não foram anotados no arroz e podem constituir o ponto de partida para estudos de genômica funcional. Entre os marcadores derivados de sequências transcritas, NP914526 e NP914533 destacam-se por pertencer a rotas metabólicas relacionadas ao aumento do potencial produtivo de arroz

Incógnitas en el tratamiento de las bronquiectasias no debidas a fibrosis quística

Las bronquiectasias son dilataciones crónicas anormales e irreversibles de uno o más bronquios. Generalmente son clasificadas en bronquiectasias secundarias a fibrosis quística y no debidas a fibrosis quística. La inflamación crónica bronquial y las infecciones bronquiales de repetición son la base de la progresión de la enfermedad y constituyen un círculo vicioso de daño de las vías respiratorias. La infección crónica por Pseudomonas aeruginosa a nivel bronquial está asociada a síntomas frecuentes, agudizaciones repetidas, peor función pulmonar, empeoramiento de la calidad de vida, días de ausencia laboral y aumento de gastos sanitarios. Por todo ello, es esencial el tratamiento optimizado de la inflamación subyacente y de la infección por Pseudomonas aeruginosa. El tratamiento de las bronquiectasias por fibrosis quística ha sido más estudiado que el de las bronquiectasias no debidas a fibrosis quística, en donde existe escasa o nula evidencia científica en muchas facetas. Esta tesis aporta valiosa información respecto al tratamiento de pacientes con bronquiectasias no debidas a fibrosis quística en cada uno de los dos pilares, inflamación e infección, del círculo vicioso de la patogenia de la enfermedad. Los resultados obtenidos han sido aceptados en dos revistas médicas científicas de considerable factor impacto, “International Journal of Clinical Pharmacy” y “Respiration”. En el primer estudio se evalúa la eficacia i seguridad de la budesonida inhalada como antiinflamatorio. Sus conclusiones son que existe una tendencia a la mejoría en los parámetros clínicos, funcionales e inflamatorios, y que el tratamiento, en los pacientes tratados con budesonida, es seguro. No obstante, la recomendación en espera de más estudios, como también lo hace la literatura médica, es que su utilización debería reservarse para mejorar la sintomatología en aquellos pacientes, en que de manera puntual, se creyera necesario. El segundo estudio analiza la eficacia de la tobramicina nebulizada tras un primer aislamiento de Pseudomonas aeruginosa. Sus resultados muestran que el tratamiento nebulizado con tobramicina durante tres meses después de tratamiento endovenoso durante 14 días puede prevenir la infección de esta bacteria y conlleva un favorable impacto clínico. Este es el primer estudio bien diseñado que evalúa la posibilidad de erradicación de Pseudomonas aeruginosa y, creemos, permite poder recomendar, ya con aval científico, este tipo de tratamiento en pacientes con bronquiectasias no debidas a fibrosis quística.Bronchiectasis are abnormal chronic and irreversible dilatations of one or more bronchi. They are generally classified into cystic fibrosis and non-cystic fibrosis bronchiectasis. Chronic bronchial inflammation and repeated infections underline the progression of the disease and involve a vicious cycle of airway damage. Chronic Pseudomonas aeruginosa infection is associated with frequent symptoms, repeated exacerbations, pulmonary function decline, worsening of quality of life, absence from work, and increased healthcare costs. For these reasons, optimized treatment of the underlying inflammation and Pseudomonas aeruginosa’s infection are essential. Treatment of bronchiectasis due to cystic fibrosis has been more studied than those of non-cystic fibrosis, where there is scarce or no scientific evidence in many aspects. This thesis provides significant information concerning the treatment of patients with non-cystic fibrosis bronchiectasis in each of the two key elements, inflammation and infection, in the vicious circle of disease pathogenesis. The results derived from the study have been reported in two scientific medical journals with significant impact factor: “International Journal of Clinical Pharmacy” and “Respiration”. In the first study, the anti-inflammatory efficacy and safety of inhaled budesonide is evaluated. Final conclusions are that there is a general trend towards improvement as regards clinical, functional and inflammatory parameters, and that treatment with budesonide, is safe. However, the recommendation which still awaiting for future studies, as in the case of medical literature, is that its use should be reserved to improve symptoms in those patients to whom it is believed to be occasionally necessary. The second study examines the efficacy of aerosolized tobramycin after initial isolation of Pseudomonas aeruginosa. Their results show that treatment with nebulized tobramycin followed for three months after intravenous treatment for 14 days may prevent infection from this bacterium and involve a beneficial clinic impact. This is the first well-designed study to evaluate the possibility of eradication of Pseudomonas aeruginosa and, we presume that it allows recommending, based on scientific support, this kind of treatment in patients with non-cystic fibrosis bronchiectasis

Paisaje Collage. La integración de las quintas de recreo del Camino de Aragón en la ciudad del siglo XXI

Este artículo aborda el estudio del paisaje de la periferia nordeste de Madrid, allí donde se vincula al eje histórico del Camino de Aragón, hoy calle de Alcalá, desde su configuración histórica hasta su realidad actual. Para ello, se analiza la transformación de la identidad paisajística de un camino condensador de un tipo arquitectónico característico de Madrid, la quinta de recreo, que, ubicada entre extensos campos de cereales, fue progresivamente absorbida por una ciudad en crecimiento. El objetivo es doble: por una parte, se propone poner en valor la Quinta de los Molinos, menos investigada, como pieza clave de la secuencia urbana. Además, el estudio intenta dilucidar la manera en la que una tipología tradicional se ha adaptado a un nuevo uso, cómo se ha insertado en una trama urbana transformada por nuevas actividades y qué papel pueden jugar todas estas piezas en el futuro de la ciudad.This article investigates the landscape of the north-eastern outskirts of Madrid, in the area where it links to the historical axis of the Camino de Aragón, today calle de Alcalá, from its historical configuration to its present reality. To this end, we analyse the transformation of the landscape identity of a route that condenses a distinct architectural type of Madrid, the country state, which, located between vast cereal fields, was progressively absorbed by a growing city. The purpose of this investigation is twofold: on the one hand, it aims to highlight the underresearched Quinta de los Molinos as a crucial part of the urban sequence. In addition, the study attempts to elucidate how a traditional typology has adapted to a new use, its insertion into a transformed urban fabric and its role in the future of the city

Incógnitas en el tratamiento de las bronquiectasias no debidas a fibrosis quística : tratamiento antiinflamatorio inhalado: papel de la budesonida inhalada : tratamiento antibiótico nebulizado en el aislamiento inicial de Pseudomonas aeruginosa /

Las bronquiectasias son dilataciones crónicas anormales e irreversibles de uno o más bronquios. Generalmente son clasificadas en bronquiectasias secundarias a fibrosis quística y no debidas a fibrosis quística. La inflamación crónica bronquial y las infecciones bronquiales de repetición son la base de la progresión de la enfermedad y constituyen un círculo vicioso de daño de las vías respiratorias. La infección crónica por Pseudomonas aeruginosa a nivel bronquial está asociada a síntomas frecuentes, agudizaciones repetidas, peor función pulmonar, empeoramiento de la calidad de vida, días de ausencia laboral y aumento de gastos sanitarios. Por todo ello, es esencial el tratamiento optimizado de la inflamación subyacente y de la infección por Pseudomonas aeruginosa. El tratamiento de las bronquiectasias por fibrosis quística ha sido más estudiado que el de las bronquiectasias no debidas a fibrosis quística, en donde existe escasa o nula evidencia científica en muchas facetas. Esta tesis aporta valiosa información respecto al tratamiento de pacientes con bronquiectasias no debidas a fibrosis quística en cada uno de los dos pilares, inflamación e infección, del círculo vicioso de la patogenia de la enfermedad. Los resultados obtenidos han sido aceptados en dos revistas médicas científicas de considerable factor impacto, "International Journal of Clinical Pharmacy" y "Respiration". En el primer estudio se evalúa la eficacia i seguridad de la budesonida inhalada como antiinflamatorio. Sus conclusiones son que existe una tendencia a la mejoría en los parámetros clínicos, funcionales e inflamatorios, y que el tratamiento, en los pacientes tratados con budesonida, es seguro. No obstante, la recomendación en espera de más estudios, como también lo hace la literatura médica, es que su utilización debería reservarse para mejorar la sintomatología en aquellos pacientes, en que de manera puntual, se creyera necesario. El segundo estudio analiza la eficacia de la tobramicina nebulizada tras un primer aislamiento de Pseudomonas aeruginosa. Sus resultados muestran que el tratamiento nebulizado con tobramicina durante tres meses después de tratamiento endovenoso durante 14 días puede prevenir la infección de esta bacteria y conlleva un favorable impacto clínico. Este es el primer estudio bien diseñado que evalúa la posibilidad de erradicación de Pseudomonas aeruginosa y, creemos, permite poder recomendar, ya con aval científico, este tipo de tratamiento en pacientes con bronquiectasias no debidas a fibrosis quísticaBronchiectasis are abnormal chronic and irreversible dilatations of one or more bronchi. They are generally classified into cystic fibrosis and non-cystic fibrosis bronchiectasis. Chronic bronchial inflammation and repeated infections underline the progression of the disease and involve a vicious cycle of airway damage. Chronic Pseudomonas aeruginosa infection is associated with frequent symptoms, repeated exacerbations, pulmonary function decline, worsening of quality of life, absence from work, and increased healthcare costs. For these reasons, optimized treatment of the underlying inflammation and Pseudomonas aeruginosa's infection are essential. Treatment of bronchiectasis due to cystic fibrosis has been more studied than those of non-cystic fibrosis, where there is scarce or no scientific evidence in many aspects. This thesis provides significant information concerning the treatment of patients with non-cystic fibrosis bronchiectasis in each of the two key elements, inflammation and infection, in the vicious circle of disease pathogenesis. The results derived from the study have been reported in two scientific medical journals with significant impact factor: "International Journal of Clinical Pharmacy" and "Respiration". In the first study, the anti-inflammatory efficacy and safety of inhaled budesonide is evaluated. Final conclusions are that there is a general trend towards improvement as regards clinical, functional and inflammatory parameters, and that treatment with budesonide, is safe. However, the recommendation which still awaiting for future studies, as in the case of medical literature, is that its use should be reserved to improve symptoms in those patients to whom it is believed to be occasionally necessary. The second study examines the efficacy of aerosolized tobramycin after initial isolation of Pseudomonas aeruginosa. Their results show that treatment with nebulized tobramycin followed for three months after intravenous treatment for 14 days may prevent infection from this bacterium and involve a beneficial clinic impact. This is the first well-designed study to evaluate the possibility of eradication of Pseudomonas aeruginosa and, we presume that it allows recommending, based on scientific support, this kind of treatment in patients with non-cystic fibrosis bronchiectasis

Circulating microRNA profiling is altered in the acute respiratory distress syndrome related to SARS-CoV-2 infection

One of the hallmarks of SARS-CoV-2 infection is an induced immune dysregulation, in some cases resulting in cytokine storm syndrome and acute respiratory distress syndrome (ARDS). Several physiological parameters are altered as a result of infection and cytokine storm. Among them, microRNAs (miRNAs) might reflect this poor condition since they play a significant role in immune cellular performance including inflammatory responses. Circulating miRNAs in patients who underwent ARDS and needed mechanical ventilation (MV+; n = 15) were analyzed by next generation sequencing in comparison with patients who had COVID-19 poor symptoms but without intensive care unit requirement (MV-; n = 13). A comprehensive in silico analysis by integration with public gene expression dataset and pathway enrichment was performed. Whole miRNA sequencing identified 170 differentially expressed miRNAs between patient groups. After the validation step by qPCR in an independent sample set (MV+ = 10 vs. MV- = 10), the miR-369-3p was found significantly decreased in MV+ patients (Fold change - 2.7). After integrating with gene expression results from COVID-19 patients, the most significant GO enriched pathways were acute inflammatory response, regulation of transmembrane receptor protein Ser/Thr, fat cell differentiation, and regulation of biomineralization and ossification. In conclusion, miR-369-3p was altered in patients with mechanical ventilation requirement in comparison with COVID-19 patients without this requirement. This miRNA is involved in inflammatory response which it can be considered as a prognosis factor for ARDS in COVID-19 patients