Characteristics and treatment patterns of patients with asthma on multiple-inhaler triple therapy in Spain

The aim of this observational, retrospective study was to describe characteristics, treatment patterns, and adherence among patients with asthma who initiated multiple-inhaler triple therapy (MITT) in Catalonia, Spain. This study used data of patients initiating MITT in 2016 from the SIDIAP (Information System for Research in Primary Care) database, which covers ~80% of the Catalonian population (5.8 million). Of 1,204 patients initiating MITT, 361 (30.0%) stepped down (discontinued ≥ 1 and continued ≥1 MITT component) and 89 (7.4%) stopped all three components of MITT for a period of 60 days during the following 12 months. In the follow-up period, 196 (16.3%) patients were considered adherent to MITT (>0.8 proportion of days covered [PDC]), with a mean (standard deviation) PDC of 0.52 (0.51) days. Given the low adherence and substantial rates of step down/discontinuation among patients initiating MITT, there is an urgent need to implement strategies to improve treatment adherence/persistence

Efectos de la hipertensión pulmonar en la capacidad de ejercicio en pacientes con enfermedad pulmonar obstructiva crónica

Introduction: The impact of pulmonary hypertension (PH) on exercise tolerance in chronic obstructive pulmonary disease (COPD) has not been fully elucidated. It is necessary to characterize pulmonary hemodynamics in patients with moderate to severe COPD in order to improve their management. The aim of the study was to determine whether in COPD the presence of PH is associated with reduced exercise tolerance in a cohort of stable COPD patients. Methods: Cross-sectional analysis of 174 COPD patients clinically stable: 109 without PH and 65 with PH (COPD-PH). We assessed socio-demographic data, lung function, quality of life, dyspnea, cardiopulmonary exercise testing (CPET), constant workload endurance time (CWET), and six-minute walk test (6MWT). We elaborated a logistic regression model to explore the impact of PH on exercise capacity in COPD patients. Results: COPD-PH patients showed lower exercise capacity both at maximal (CPET) (43(20) versus 68(27) Watts and 50(19)% versus 71(18)% predicted peak oxygen consumption (VO2peak), COPD-PH and COPD, respectively), and at submaximal tests (6MWT) (382(94) versus 486(95) m). In addition, the COPD-PH group had lower endurance time than the non-PH COPD group (265(113) s and 295(164) s, respectively). Conclusions: The presence of PH is an independent factor that impairs exercise capacity in COPD. SPANISH Introducción: El impacto de la hipertensión pulmonar (HTP) en la tolerancia al ejercicio en la enfermedad pulmonar obstructiva crónica (EPOC) no se ha dilucidado en su totalidad. Es necesario caracterizar la hemodinámica pulmonar de los pacientes con EPOC moderada a grave para poder mejorar su manejo. El objetivo de este estudio fue determinar si la presencia de HTP en la EPOC se asociaba con una disminución en la tolerancia al ejercicio en una cohorte de pacientes con EPOC estable. Métodos: Estudio transversal de 174 pacientes con EPOC clínicamente estables: 109 de ellos no mostraban HTP y 65 de ellos sí (EPOC-HTP). Valoramos la información sociodemográfica, la función pulmonar, la calidad de vida, la disnea, realizamos una prueba de ejercicio cardiopulmonar (PECP), medimos el tiempo de tolerancia de ejercicio constante y realizamos de marcha de seis minutos (6MWT, por sus siglas en inglés). Elaboramos un modelo de regresión logística para explorar el impacto de la HTP en la capacidad de ejercicio de los pacientes con EPOC. Resultados: Los pacientes con EPOC-HTP mostraron una menor capacidad de ejercicio, tanto en las pruebas máximas (PECP) (43 (20) W frente a 68 (27) W y 50 (19)% frente a 71 (18)% de consumo de oxígeno máximo predicho (VO2 max), para pacientes con EPOC-HTP y pacientes con EPOC, respectivamente) como en las pruebas submáximas (6MWT) (382 (94) m frente a 486 (95) m). Además, el grupo de EPOC-HTP presentó un menor tiempo de resistencia que el grupo de EPOC sin HTP (265 (113) s y 295 (164) s, respectivamente). Conclusiones: La presencia de HTP es un factor independiente que afecta a la capacidad de ejercicio en la EPOC

Derivation and characterisation of endothelial cells from patients with chronic thromboembolic pulmonary hypertension

Pulmonary endarterectomy (PEA) resected material offers a unique opportunity to develop an in vitro endothelial cell model of chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to comprehensively analyze the endothelial function, molecular signature, and mitochondrial profile of CTEPH-derived endothelial cells to better understand the pathophysiological mechanisms of endothelial dysfunction behind CTEPH, and to identify potential novel targets for the prevention and treatment of the disease. Isolated cells from specimens obtained at PEA (CTEPH-EC), were characterized based on morphology, phenotype, and functional analyses (in vitro and in vivo tubule formation, proliferation, apoptosis, and migration). Mitochondrial content, morphology, and dynamics, as well as high-resolution respirometry and oxidative stress, were also studied. CTEPH-EC displayed a hyperproliferative phenotype with an increase expression of adhesion molecules and a decreased apoptosis, eNOS activity, migration capacity and reduced angiogenic capacity in vitro and in vivo compared to healthy endothelial cells. CTEPH-EC presented altered mitochondrial dynamics, increased mitochondrial respiration and an unbalanced production of reactive oxygen species and antioxidants. Our study is the foremost comprehensive investigation of CTEPH-EC. Modulation of redox, mitochondrial homeostasis and adhesion molecule overexpression arise as novel targets and biomarkers in CTEPH

NKX2-1 expression as a prognostic marker in early-stage non-small-cell lung cancer

BACKGROUND: NKX2-1, a key molecule in lung development, is highly expressed in non-small cell lung cancer (NSCLC), particularly in lung adenocarcinoma (ADK), where it is a diagnostic marker. Studies of the prognostic role of NKX2-1 in NSCLC have reported contradictory findings. Two microRNAs (miRNAs) have been associated with NKX2-1: miR-365, which targets NKX2-1; and miR-33a, which is downstream of NKX2-1. We have examined the effect of NKX2-1, miR-365 and miR-33a on survival in a cohort of early-stage NSCLC patients and in sub-groups of patients classified according to the mutational status of TP53, KRAS, and EGFR. METHODS: mRNA and miRNA expression was determined using TaqMan assays in 110 early-stage NSCLC patients. TP53, KRAS, and EGFR mutations were assessed by Sanger sequencing. RESULTS: NKX2-1 expression was upregulated in never-smokers (P = 0.017), ADK (P < 0.0001) and patients with wild-type TP53 (P = 0.001). A negative correlation between NKX2-1 and miR-365 expression was found (ρ = -0.287; P = 0.003) but there was no correlation between NKX2-1 and miR-33a expression. Overall survival (OS) was longer in patients with high expression of NKX2-1 than in those with low expression (80.8 vs 61.2 months (P = 0.035), while a trend towards longer OS was observed in patients with low miR-365 levels (P = 0.07). The impact of NKX2-1 on OS and DFS was higher in patients with neither TP53 nor KRAS mutations. Higher expression of NKX2-1 was related to higher OS (77.6 vs 54 months; P = 0.017) and DFS (74.6 vs 57.7 months; P = 0.006) compared to low expression. The association between NKX2-1 and OS and DFS was strengthened when the analysis was limited to patients with stage I disease (P = 0.005 and P=0.003 respectively). CONCLUSIONS: NKX2-1 expression impacts prognosis in early-stage NSCLC patients, particularly in those with neither TP53 nor KRAS mutations

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Proyecto plan exportador para la empresa calzado Adriana ubicada en la ciudad de Pereira, con destino a San José de Costa Rica

1 Título ........................................................................................ . 23 2 Problema de investigación ....................................................... 23 3 Objetivos .................................................................................... 25 4 Justificación de la investigación ................................................. 26 5 Marco de referencia ................................................................... 28 6 Variables e indicadores .............................................................. 38 7 Aspectos metodológicos ........................................................... 38 8 Cronograma de actividades........................................................ 40 9 Presupuesto ............................................................................... 40 Desarrollo plan exportador ............................................................ 42 1 Perfil de la expresa .............................................................,....... 42 2 Análisis organizacional................................................................ 46 3 Análisis de producción ................................................................ 49 4 Análisis financiero ....................................................................... 51 5 Producto ...................................................................................... 59 6 Mercadeo .................................................................................... 64 7 Competitividad ............................................................................ 68PregradoAdministrador de Negocio

Turbulencia empresarial en Colombia: sector cines

La Facultad de Administración de Empresas de la Universidad del Rosario,\ud preocupada por suministrar a los directores y gerentes herramientas que les\ud permitan afianzar la perdurabilidad de sus empresas, desarrolla actualmente\ud el proyecto Turbulencia Empresarial en Colombia, perteneciente a la Línea\ud de Investigación en Pensamiento Estratégico. Las investigaciones realizadas\ud permitirán avanzar en la construcción de un modelo de alerta temprana que\ud pueda ser utilizado para identificar discontinuidades en los sectores estratégicos.\ud Con este propósito, se ha comenzado un proceso de análisis de diferentes\ud sectores estratégicos que busca identificar sus niveles de turbulencia;\ud adicionalmente se aplican otras herramientas desarrolladas por la Facultad\ud de Administración durante los últimos cinco años.\ud A este proyecto se han vinculado estudiantes de pregrado y posgrado de\ud los programas de la Facultad de Administración, quienes han contribuido en\ud el levantamiento de información sobre los diversos sectores. Este documento\ud de investigación se ha desarrollado de manera conjunta con estudiantes de\ud pregrado de los programas de Administración de Empresas y de Negocios\ud Internacionales que cursaron la asignatura Estrategia de Empresa II en el\ud segundo semestre del año 2010.\ud Presentamos una exploración del sector de cines en Colombia, el cual\ud ha sido seleccionado teniendo en cuenta que esta industria, desde su creación\ud en el país en 1897, se ha caracterizado por su dinamismo, creatividad y\ud constante innovación.\ud El documento se encuentra estructurado de la siguiente forma: inicialmente\ud se incluye una descripción del sector; luego un análisis de la turbulencia,\ud en el que se hará especial énfasis en tres factores: dinamismo, complejidad\ud e incertidumbre; se continúa con la presentación de las empresas Cine Colombia,\ud Cinemark y Procinal; posteriormente se realiza el análisis del sector\ud teniendo en cuenta las cinco fuerzas del mercado propuestas por Michael\ud Porter, el modelo matricial y las actividades que generan valor. Finalmente,\ud el lector encuentra las conclusiones

Biopsias cerebrales guiadas por marco con estereotaxia: experiencia en un centro en latinoamérica

17 p.Introduction: Stereotactic guided biopsies are chosen for deep-located lesions, as well as for those in eloquent areas, when the risk outweighs the benefit of an open procedure, or when open surgery has no advantage over the suspected histology. Objective: This study aims to describe retrospectively the diagnostic yield and the morbidity and mortality related to a series of stereotactic-guided biopsies in a 6-year period in a single center in Latin America. Materials and methods: 62 medical records of patients who underwent stereotactic-guided brain biopsies were reviewed. The clinical features, the morbidity and mortality associated to the procedures were acquired. Results: The complication rate was 2.7% and the diagnostic yield reached 87%. The most frequent location of the target was frontal and the most frequent diagnosis was glioblastoma. Conclusions: The complication rate and the diagnostic yield in this series were similar to the observed in different series performed with frame-based stereotactic procedures or performed with neuronavigation in the literature