Editorial

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Editorial

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Epidemiología mundial, latinoamericana y colombiana y mortalidad del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS)

El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es un trastorno frecuente asociado con secuelas cardiovasculares y neuropsicológicas severas que repercuten en altos costos socioeconómicos para la población.Con anterioridad se estimaba una prevalencia aproximada del 3% al 7% en hombres y del 2% al 5% en mujeres (40-60 años para ambos sexos); sin embargo, en las últimas dos décadas aumentó a 10% en hombres de 30 a 49 años, a 17% en hombres de 50 a 70, a 3% en mujeres de 30 a 49 y a 9% en mujeres de 50 a 70.Se calcula que el 20% de adultos de edad media tiene al menos SAHOS leve y el 80% de los casos permanecen sin diagnosticar, de allí la importancia de sospechar el diagnóstico de la enfermedad.En Colombia se realizó un estudio con la metodología ómnibus que mostró que la prevalencia global de alto riesgo de apnea del sueño, según el Cuestionario Berlín, fue del 19% en tres ciudades —Bogotá D.C., Bucaramanga y Santa Marta— (IC95%: 17.3; 20.8%). Con la escala STOP-Bang, la prevalencia global de alto riesgo de SAHOS fue de 26.9% (IC95%: 24.9; 29%).Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a frequent disorder associated with severe cardiovascular and neuropsychological sequelae, which has a high socioeconomic cost to the population.In the past, an average prevalence of 3% to 7% in men and 2% to 5% in women (40-60 years for both sexes) was estimated. However, in the last two decades, it increased to 10% in men aged 30 to 49 years, 17% in men aged 50 to 70, and 3% in women aged 30 to 49 and 9% in women aged 50 to 70.It is estimated that 20% of middle-aged adults have at least mild OSAHS, while 80% of cases remain undiagnosed, hence the importance of suspecting this disease.In Colombia, an omnibus survey was conducted showing that the global prevalence of high-risk sleep apnea, according to the Berlin questionnaire, was 19% in three cities —Bogotá D.C., Bucaramanga and Santa Marta— (CI95%: 17.3, 20.8%). The overall prevalence of high risk of OSAHS was 26.9% (95% CI: 24.9%, 29%) according to the STOP-Bang scale

Detection of air trapping in patients with clinical suspicion of Chronic Obstructive Pulmonary Disease and normal spirometry

OBJETIVOS: determinar cambios tanto en volúmenes pulmonares como en oscilometría en pacientes sintomáticos con historia exposicional y clasificados por espirometría como sanos o con obstrucción leve, con el fin de corroborar si existe correlación entre la clínica, la pletismografía y la oscilometría con la espirometría en el diagnóstico de obstrucción y si es posible realizar diagnóstico temprano de la EPOC mediante pletismografía y oscilometría, en pacientes con sospecha clínica de la enfermedad. MATERIALES Y MÉTODOS: se realizó un estudio de correlación, en el que se recolectaron 214 pacientes con sospecha clínica de EPOC, del Hospital Universitario San Ignacio en Bogotá, Colombia, durante el año 2010. Se hicieron cuestionario de síntomas, espirometría, volúmenes pulmonares y oscilometría de impulso. RESULTADOS: se recolectaron 214 pacientes con sospecha clínica de EPOC, de los cuales el 27% tuvo espirometría compatible con obstrucción. En los volúmenes pulmonares, el 87% mostró volumen residual elevado compatible con atrapamiento de aire y el 69% mostró capacidad funcional residual elevada con relación a hiperinflación. Se midieron resistencias por oscilometría, y el 22% tuvo resistencias elevadas. La correlación mostró ser muy baja entre espirometría y volúmenes pulmonares así como con resistencias. CONCLUSIÓN: los pacientes con diagnóstico clínico de EPOC pueden mostrar, de manera temprana, atrapamiento de aire incluso antes de la aparición de anormalidades en la espirometría.Artículo original19-24OBJECTIVES: to determine changes in lung volumes and oscillometry in symptomatic patients with a history of exposure and classified by spirometry as normal or with slight obstruction, with the aim of establishing whether there is a correlation between clinical findings, plethysmography, and oscillometry with spirometry in diagnosing obstruction, and whether it is possible to achieve early diagnosis of COPD by plethysmography and oscillometry in patients with clinical suspicion of the disease. MATERIALS AND METHODS: a correlation study was carried out, in which 214 patients with clinically suspected COPD from San Ignacio University Hospital (Bogota, Colombia) were collected during the year 2010. A questionnaire of symptoms, spirometry, lung volume measurements, and impulse oscillometry were carried out. RESULTS: 214 patients with clinically suspected COPD were collected, 27% of whom had spirometry consistent with obstruction. With regard to lung volumes, 87% had increased residual capacity consistent with air entrapment, and 69% showed increased residual functional capacity with regard to hyperinflation. Resistances were measured by oscillometry, and 22% had increased resistances. The correlation between spirometry and lung volumes was very low, as was also the case with resistances. CONCLUSION: it is possible to find air entrapment early in patients with clinically diagnosed COPD, even before the appearance of spirometric abnormalities

Tuberculosis, a risk for health workers

La tuberculosis es una enfermedad de gran impacto en nuestro país y en el mundo. Aunque las estrategias de la Organización Mundial de la Salud para controlarla pueden curar casi todos los casos, la resistencia a los medicamentos y el riesgo de transmisión, especialmente en los trabajadores del área de salud, cada día cobran un mayor valor. La tuberculosis representa un riesgo ocupacional significativo, con mayor incidencia en los trabajadores del área de salud sobre la población general, principalmente en los países en desarrollo. El personal de la salud es fundamental en la lucha contra la tuberculosis y, por lo tanto, debe estar protegido. Los factores de riesgo de contagio incluyen la frecuencia de pacientes con tuberculosis atendidos, la función y el lugar de trabajo del trabajador del área de salud, la demora en el diagnóstico, la presencia de pacientes con cepas multirresistentes, los inadecuados sistemas de ventilación, la falta de protección adecuada contra aerosoles y el personal con compromiso de su estado inmunológico o desnutrición.Los aspectos clave para el control y la prevención de la transmisión en hospitales, son la identificación precoz de los casos, las medidas de protección ambiental y los programas efectivos para el control del personal sanitario. Las guías sobre prevención en tuberculosis recomiendan aislamiento en salas ventiladas con presión negativa y el uso de protección respiratoria para todos los trabajadores de la salud en contacto.227-236The impact of tuberculosis in Colombia and in the world is important. Although WHO strategies to control it can cure almost all cases, drug resistance and the risk of transmission, especially to health care workers charge a hefty price. Tuberculosis represents an important occupational risk, with higher incidence amongst health care workers compared with general population, mainly indeveloping countries.The staff is crucial in the fight against tuberculosis and must be protected. Risk factors include the frequency of tuberculosis patients treated, the role and workplace of health workers, delayed diagnosis, presence of patients with multiresistant tuberculosis strains, inadequate ventilation, lack of adequate protection against aerosol and personal with altered immunological status or malnutrition.The key points for control and prevention of tuberculosis transmission in hospitals, are earl cases identification, environmental protection measures and an effective program for control of health personnel. Tuberculosis preventionguidelines recommend patient isolation in ventilated rooms with negative pressure and use of respiratory protection for all health workers in patient contact

Sleep characteristics in an adult with sleep complaints in three cities at different altitudes

Q4Q3Reporte de caso65-68Sleep studies conducted at an altitude that is different from the home altitude can yield misleading results regarding the severity of obstructive sleep apnea (OSA). The objective of the present study was to determine the sleep characteristics of a patient undergoing polysomnography (PSG) in three Colombian cities at different altitudes (Bogotá, at 2,640 m above sea level [ASL]; Bucaramanga, at 959 m ASL; and Santa Marta, at 15 m ASL). The patient was an obese man with diabetes and suspected OSA. All PSG recordings were scored and interpreted in accordance with American Academy of Sleep Medicine criteria. In Bogotá, PSG revealed moderate OSA (an apnea-hypopnea index [AHI] of 21 events/h); in Bucaramanga, PSG revealed increased upper airway resistance (an AHI of 2 events/h); in Santa Marta, PSG revealed mild OSA (an AHI of 7 events/h). The reduction in the AHI was predominantly a reduction in hypopneas and obstructive apneas. The respiratory events were shorter in duration in the city at an intermediate altitude. Given that the AHI varied widely across cities, we can assume that the patient is normal or has moderate OSA depending on the city where he is. Central apneas were found to have no influence on the AHI

Low gain avalanche detectors for high energy physics experiments

Trabajo presentado a la 10th Spanish Conference on Electron Devices, celebrada en Aranjuez (Madrid, España) del 11 al 13 de febrero de 2015.This paper describes a new concept of Silicon radiation detector with internal multiplication of the charge generated by the incident particle, known as Low Gain Avalanche Detector (LGAD), with a gain in the range of 10-20. The LGAD is addressed to tracking applications for high energy physics with enhanced performances compared to the conventional detectors based on the PiN diode structure. The physical behavior, the critical design challenges and the first experimental data on the fabricated LGAD prototypes is described in the paper.Peer Reviewe

Effect of a ropy Exopolysaccharide-producing Bifidobacterium animalis subsp. Lactis strain orally administered on dss-induced colitis mice model

Exopolysaccharide (EPS)-producing bifidobacteria, particularly Bifidobacterium animalis subsp. lactis strains, are used in the functional food industry as promising probiotics with purported beneficial effects. We used three isogenic strains of B. animalis subsp. lactis, with different EPS producing phenotypes (mucoid-ropy and non-ropy), in order to determine their capability to survive the murine gastrointestinal tract transit, as well as to evaluate their role in improving clinical outcomes in a chemically-induced colitis model. The three strains were able to survive in the intestinal tract of C57BL/6J mice during the course of the intervention study. Furthermore, the disease activity index (DAI) of the animal group treated with the ropy strain was significantly lower than of the DAI of the placebo group at the end of the treatment. However, no significant differences were found among the three strains. The analysis of several immune parameters, such as TNFα and IL-10 quantified in blood plasma and lymphocyte populations enumerated in mesenteric nodes, showed some significant variations among the four experimental animal groups. Remarkably, a higher capability of the ropy strain to increase regulatory T-cells in mesenteric lymphoid nodes was demonstrated, suggesting a higher ability of this strain to regulate inflammatory responses at mucosal level. Our data indicate that strains of B. animalis subsp. lactis producing EPS that confer a mucoid-ropy phenotype could represent promising candidates to perform further studies targeting intestinal inflammatory processes.This work was partially financed by FEDER European Union funds through the projects AGL2012-33278 and SAF2011-29648 of the Spanish Ministry of Economy and Competitiveness (MINECO), as well as to the projects AGR-6826 and CTS-164 of the “Junta de Andalucía.” CH acknowledges his FPI fellowship to MINECO and FA acknowledges her fellowship to Junta de Andalucía. The CIBEREHD is funded by the “Instituto de Salud Carlos III.”Peer Reviewe

Prevalence of sleep complaints in Colombia at different altitudes

AbstractStudy objectivesTo determine the prevalence of sleep complaints in adults in Colombia at different altitudes.DesignCross-sectional, population-based and observational study.SettingUrban areas in three cities (Bogotá, Bucaramanga, Santa Marta) located between 15 and 2640 masl. Subjects Over 18 years old.InterventionsEpworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Berlin questionnaire, STOP-Bang questionnaire and diagnostic criteria for restless leg syndrome (IRLSSG).Measurements and resultsThe overall prevalence of sleep complaints was 59.6% (CI 95%: 57.3; 61.8%). According to the Pittsburgh scale, 45.3% (CI 95%: 43.0; 47.5) required medical assistance. The Berlin questionnaire indicated that 19.0% (CI 95%: 17.3; 20.8%) had a high risk of sleep apnea (OSA) compared to 26.9% (CI 95%: 24.9; 29.0%) according to STOP-Bang. Among the subjects, 13.7% (CI 95%: 12.3; 15.3%) had excessive daytime sleepiness and 37.7% (CI 95%: 35.5; 39.8%) had a restless leg syndrome. When comparing cities, significant differences in the overall frequency of subjects requiring care were found between Santa Marta (higher frequency) and the other two cities. Differences in sleep problem frequency (Pittsburgh) were observed between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (higher frequency) and the other two cities. The high risk of OSA (STOP-Bang) was different between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (high frequency) and Bucaramanga.ConclusionsWe observed a high prevalence of sleep complaints with significant differences among the cities, indicating a need to pay a greater attention to these problems

Latin America ClimateSmart Villages AR4D sites: 2016 Inventory

Inventory of CSA practices in Latin America’s ClimateSmart Villages