Practice and knowledge about diagnosis and treatment of alpha-1 antitrypsin deficiency in Spain and Portugal

Background: determining physicians' awareness about alpha-1 antitrypsin (AAT) deficiency (AATD) may help to explain the discrepancy between the observed and expected number of patients diagnosed with this disease. This study was designed to assess the opinions on knowledge, practice pattern and attitude regarding AATD among physicians in Spain and Portugal. Methods: as online anonymous survey was performed on pulmonologists (n = 100), internal medicine specialists (IMS) (n = 100) and primary care physicians (PCP) (n = 176). Of the total number of physicians, 221 were from Spain, and 155 were from Portugal. Physicians answered 21 questions related to their personal and professional profile, knowledge regarding AATD and chronic obstructive pulmonary disease (COPD), performance and attitude about AATD, and use of augmentation therapy. Responses were ranked on a 4-point scale indicating the level of agreement. In addition, some of the responses were rated as either "low" or "high" indicating the level of knowledge the respondent felt he/she possessed. Results: only 14 % of physicians reported to "know very well" about AATD (3.3 [SD 0.6] for pulmonologists vs. 2.64 [SD 0.60] for IMS and 2.48 [SD 0.71] for PCP; p < 0.001). Only 45.2 % of physicians correctly answered "<50 mg/dL" as the threshold value of serum AAT to be considered severe AATD (55.0 % of pulmonologists vs. 47.0 % of IMS and 38.6 % of PCP; p = 0.001). Choice of the correct answer did not agree with those physicians self-declaring a high level of AATD knowledge (51.2 %). A total of 43.9 % of physicians correctly identified all diseases or conditions in a list associated or not with AATD. A similar trend was detected when identifying which conditions would be responsive to augmentation therapy (<50 %). Only 15.8 % of specialists performed AATD testing in all patients with COPD (27.0 % pulmonologists, 12.6 % PCP; p = 0.001). Conclusion: the results suggest that a knowledge gap may be contributing to the underdiagnosis of AATD. Physicians in Spain and Portugal showed a marked lack of awareness of their shortcomings in knowledge about AATD, and in general did not follow guidelines and recommendations for AATD testing

Planes de igualdad desde la perspectiva del desarrollo sostenible para la Agenda 2030

La lucha por el empoderamiento de la mujer como motor de cambio es una cuestión que define la época contemporánea, esta lucha está presente a nivel mundial e implica el despertar de un sentimiento colectivo de sororidad que hasta entonces permanecía adormecido y relegado cultural, institucional y políticamente.´Este empoderamiento se ha convertido en un proyecto con miras al futuro por el que abogan organismos de diferentes ámbitos territoriales para reconocer a las mujeres los mismos derechos fundamentales de los que vienen disfrutando la otra mitad de la población mundial, los hombres.El propósito del presente trabajo es contribuir a elevar la igualdad de género a las sendas del desarrollo sostenible, a través de un análisis sobre los planes de igualdad partiendo de las actuaciones realizadas por el Grupo PSA.<br /

La inserción laboral del discapacitado intelectual.

Los discapacitados intelectuales son un colectivo que se encuentra en riesgo de exclusión social, uno de los motivos es el alto desempleo que se da entre ellos. Políticas de responsabilidad social corporativa y un marco legal favorable son vitales para que se produzca una inserción laboral. Esta inserción laboral es un proceso difícil, son muchas las barreras con las que se encuentran las asociaciones de discapacitados que ejercen también de agencias de colocación, una suerte de departamento de recursos humanos, en la que las asociaciones buscan empresas para emplear a las personas con discapacidad y que así, puedan lograr un grado de autonomía suficiente que les permita valerse por sí mismos. La integración en un mercado laboral ordinario es clave para que este colectivo se integre socialmente.<br /

A Data-Driven Approach for Analyzing Healthcare Services Extracted from Clinical Records

Cancer remains one of the major public health challenges worldwide. After cardiovascular diseases, cancer is one of the first causes of death and morbidity in Europe, with more than 4 million new cases and 1.9 million deaths per year. The suboptimal management of cancer patients during treatment and subsequent follows up are major obstacles in achieving better outcomes of the patients and especially regarding cost and quality of life In this paper, we present an initial data-driven approach to analyze the resources and services that are used more frequently by lung-cancer patients with the aim of identifying where the care process can be improved by paying a special attention on services before diagnosis to being able to identify possible lung-cancer patients before they are diagnosed and by reducing the length of stay in the hospital. Our approach has been built by analyzing the clinical notes of those oncological patients to extract this information and their relationships with other variables of the patient. Although the approach shown in this manuscript is very preliminary, it shows that quite interesting outcomes can be derived from further analysis. © 2020 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works

Principales complicaciones asociadas a la administración de quimioterapia intraperitoneal y endovenosa en pacientes con cáncer de ovario

Background: Ovarian cancer displays the highest death rates amongst all gynaecologic cancers. Most cases are diagnosed at an advanced stage of the disease and the treatment of choice is generally the combination therapy of intraperitoneal (IP) and intravenous (IV) chemotherapy. While this approach has been shown to prolong survival, multiple associated toxicities have been reported.Objective: To identify the side effects and complications resulting from IP+IV chemotherapy treatment in stage III and stage IV ovarian cancer patients during the 2007-2015 period. Methods:  A descriptive, longitudinal and retrospective study was performed. A group of 17 women diagnosed with stage III and stage IV ovarian cancer were treated with IP+IV chemotherapy in Hospital Clínic de Barcelona during the period 2007-2015.Results: Of the 17 patients who were treated with IP+IV chemotherapy, only 5 (29,41%) completed the 6 cycles of treatment. Notably, 12 (70,58%) patients discontinued the treatment due to a series of complications, which were frequently associated with IP reservoir and psychological disorders. The most commonly reported side effects were asthenia, neurotoxicity and abdominal pain. Conclusions:  The majority of patients discontinued their prescribed therapy due to complications associated with IP reservoir and psychological disorders. We believe that the nurse plays a key role, not only in managing the technical aspects of the therapy but also in providing patients with emotional support throughout their journey.Antecedentes: El cáncer de ovario causa más muertes que cualquier otro tipo de cáncer ginecológico. La mayoría de casos se diagnostican en una etapa avanzada de la enfermedad y el tratamiento de elección es generalmente la terapia combinada de quimioterapia intraperitoneal (IP) y endovenosa (EV). A pesar de que esta opción farmacológica ha demostrado alargar la supervivencia, se han reportado múltiples efectos adversos asociados a dicho tratamiento.   Objetivo: Identificar los efectos adversos y las complicaciones derivadas del  tratamiento con quimioterapia IP+EV en pacientes con carcinoma de ovario avanzado a partir de estadio IIIC, durante el periodo 2007-2015.Metodología: Se realizó un estudio descriptivo, longitudinal y retrospectivo. Un grupo de 17 mujeres diagnosticadas con cáncer de ovario a partir de estadio III fueron tratadas con quimioterapia IP+EV en el Hospital Clínic de Barcelona durante el periodo 2007-2015.Resultados: De las 17 pacientes que recibieron tratamiento con quimioterapia IP+EV, sólo 5 (29,41%) finalizaron los 6 ciclos de tratamiento. De forma notable, 12 (70,58%) pacientes no completaron el tratamiento debido a una serie de complicaciones, que fueron frecuentemente asociadas al reservorio IP y a trastornos psicológicos. Los principales efectos adversos reportados fueron astenia, neurotoxicidad y dolor abdominal. Conclusiones: La mayoría de pacientes interrumpieron la terapia debido a complicaciones relacionadas con el reservorio IP y trastornos psicológicos. Creemos que la enfermera juega un papel importante, no sólo en el manejo de los aspectos técnicos de la terapia, sino también en el soporte emocional a dichas pacientes durante esta etapa

Usefulness of the CAT, LCOPD, EQ-5D and COPDSS Scales in Understanding the Impact of Lung Disease in Patients with Alpha-1 Antitrypsin Deficiency

Alpha-1-antitrypsin defi ciency (AATD) is an inherited disorder responsible for early onset emphysema associated with a signifi cant impairment of healthrelated quality of life (HRQoL). Our aim was to assess the usefulness of different instruments to evaluate the HRQoL in patients with AATD compared to non-AATD COPD. Observational, cross-sectional study in which all patients fi lled out a series of questionnaires: the COPD severity score (COPDSS), the EuroQoL 5-Dimensions (EQ-5D), the Living with COPD (LCOPD) and the COPD Assessment Test (CAT). A total of 96 patients were included, 35 with AATD (mean age 56.5 yrs, 57.1% male and mean FEV1(%) 48.7% and 61 non-AATD COPD (70.3 yrs, 80.3% men and FEV1(%) 47%. The questionnaire scores were similar, with a tendency towards worse scores in AATD for the EQ-5D (VAS) (64.8 (20.2) vs. 71.6 (17.1); p = 0.08). The correlations between the different scores and FEV1(%) were signifi cant in both groups for COPDSS and LCOPD, but not for CAT and EQ-5D. In general, the correlations of scores with FEV1(%) were stronger for AATD compared with non-AATD COPD patients: COPDSS r = –0.570, p < 0.01 for AATD and r = –0.260, p < 0.05 for COPD; LCOPD r = –0.502, p < 0.001 for AATD and r = –0.304, p < 0.05 for non-AATD COPD. Patients with AATD have a similar degree of HRQoL impairment as older subjects with non-AATD COPD and showed a stronger correlation between HRQoL measurements and lung function impairment compared with non-AATD COPD. This may be related to the characteristics of the disease in these patients who are usually younger, with less co-morbidity and lower smoking consumption

Staphylococcus epidermidis strains isolated from breast milk of women suffering infectious mastitis: potential virulence traits and resistance to antibiotics

<p>Abstract</p> <p>Background</p> <p>Although <it>Staphylococcus aureus </it>is considered the main etiological agent of infectious mastitis, recent studies have suggested that coagulase-negative staphylococci (CNS) may also play an important role in such infections. The aims of this work were to isolate staphylococci from milk of women with lactational mastitis, to select and characterize the CNS isolates, and to compare such properties with those displayed by CNS strains isolated from milk of healthy women.</p> <p>Results</p> <p>The milk of 30 women was collected and bacterial growth was noted in 27 of them, of which <it>Staphylococcus epidermidis </it>was isolated from 26 patients and <it>S. aureus </it>from 8. Among the 270 staphylococcal isolates recovered from milk of women with mastitis, 200 were identified as <it>Staphylococcus epidermidis </it>by phenotypic assays, species-specific PCR and PCR sequencing. They were typified by pulsed field gel electrophoresis (PFGE) genotyping. The PFGE profiles of the <it>S. epidermidis </it>strains were compared with those of 105 isolates from milk of healthy women. A representative of the 76 different PFGE profiles was selected to study the incidence of virulence factors and antibiotic resistance. The number of strains that contained the biofilm-related <it>ica</it>D gene and that showed resistance to oxacillin, erythromycin, clindamycin and mupirocin was significantly higher among the strains isolated from mastitic milk.</p> <p>Conclusion</p> <p><it>S. epidermidis </it>may be a frequent but largely underrated cause of infectious mastitis in lactating women. The resistance to diverse antibiotics and a higher ability to form biofilms found among the strains isolated from milk of women suffering mastitis may explain the chronic and/or recurrent nature of this infectious condition.</p

Association of Right Breast and Kidney Malignant Tumors. A Case Report. 2008

El cáncer renal de células granulares es un tumor que aparece con frecuencia en nuestra área, pero, pero encontrarlo asociado a células  ductales de mama es bastante  extraño. Se hace un reporte de caso de una paciente de 53 años quien fue diagnosticada con ambos tipos de tumores, confirmado histológicamente  en la parte derecha del cuerpo y con un período de ocho años entre ellos. Nada similar se encontrará en la literatura nacional e internacional consultada.Renal granular cells cancer is a frequently tumor encountered in our area, but to find it associated to breast ductal cells cancer is quite rare. We report a case of a 53 year old female patient, who was diagnosed with both kinds of tumors, histologically confirmed; on the rigth side of the body and with a period between them of 8 years. Nothing similar was found in the national and international consulted literature

Beneficial Effects of Proanthocyanidins on Intestinal Permeability and Its Relationship with Inflammation

The intestinal barrier is constantly exposed to potentially harmful environmental factors including food components and bacterial endotoxins. When the intestinal barrier function and immune homeostasis are compromised, inflammatory conditions may be developed and impact overall health. Evidence from experimental animal and cell-culture studies suggests that exposure of intestinal mucosa to proanthocyanidin-rich plant products may contribute to maintain the barrier function and to ameliorate the inflammation present in prevalent pathologies such as diet-induced obesity and inflammatory bowel disease. In this review, we aim to update the current knowledge on the bioactivity of PACs in experimental models of altered intestinal permeability and in humans, emphasizing the beneficial effects of grape-seed proanthocyanidin extracts in intestinal health and giving insights into the subjacent biochemical and molecular mechanism