Applications of telemedicine in the integral management of chronic obstructive pulmonary disease: systematic review

Resumen: Introducción. La enfermedad pulmonar obstructiva crónica es una enfermedad común, prevenible y tratable. Constitu- ye en la actualidad la 4a causa de mortalidad a nivel mundial con tendencia ascendente. Es una entidad muy infradiag- nosticada, que supone un elevado gasto a la Sanidad Pública y una importante pérdida de calidad de vida de las perso- nas que la padecen. En la actualidad no existe un programa de cribado eficaz y el seguimiento de los pacientes es una tarea difícil. Material y métodos. Se ha realizado una búsqueda sistemática de artículos relacionados con el manejo de la EPOC basado en el uso de las tecnologías. Las bases de datos utilizadas han sido: MEDLINE, Web of Science y Cochrane Library, además de las páginas web de organismos como WHO, SEPAR y GOLD. Se han incluido un total de 12 ar- tículos. Resultados. Del total de 12 artículos, 7 encontraron beneficios estadísticamente significativos de la aplicación de estas intervenciones en comparación con la asistencia sanitaria habitual. Entre los beneficios observados se encuentran un aumento de la adherencia a los tratamientos, un aumento de la calidad de vida, un mejor control sintomático y una re- ducción del número de exacerbaciones agudas. Conclusiones. La telemedicina es una herramienta potente que ofrece un amplio abanico de posibilidades para el mane- jo de la EPOC: telemonitorización, coaching electrónico, prevención temprana de las exacerbaciones, screening, tele- rehabilitación... Sin embargo, las evidencias existentes son insuficientes por lo que se requieren estudios potentes para poder extraer conclusiones firmes. Palabras clave: telemedicina; EPOC; telemonitorización; telerehabilitación. Abstract: Introduction. Chronic Obstructive Pulmonary Disease is a common, preventable and treatable disease. It is currently the 4th cause of mortality worldwide with an upward trend. It is a underdiagnosed entity, which implies a high cost to Public Health, and a huge loss of quality of life for the people who suffer it. Currently, there is no effective screening program, and follow-up is a difficult task. Material and methods. A systematic review was made of articles related to the management of COPD based on the use of the technologies. The databases used were: MEDLINE, Web of Science and Cochrane Library in addition to the websites of organizations such as WHO, SEPAR and GOLD. A total of 12 articles have been included. Results. Of the total of 12 articles, 7 found statistically significant benefits of the application of these interventions in comparison with the usual healthcare. Among the benefits there is an increase in treatment adherence, an increase in quality of life, better control of their symptoms and a reduction in the number of accute exacerbations. Conclusions. Telemedicine is a powerful tool that offers a wide range of possibilities for the management of COPD: telemonitoring, electronic coaching, early prevention of exacerbations, screening, telerehabilitation... However, the existing evidence is weak so it is required the development of powerful studies in order to establish firm conclusions. Keywords: telemedicine; COPD; telemonitoring; telerehabilitation

Design of a comprehensive Alzheimer’s disease clinic and research center in Spain to meet critical patient and family needs

AbstractObjectivesAlzheimer's disease (AD) affects people worldwide, and the prevalence is increasing as the population ages. There is an international effort to understand the biology of AD to develop primary and secondary prevention strategies, and to develop effective therapeutic interventions for individuals who are already symptomatic. One of the critically important pieces of all national plans to address AD is the call for the development of service models to deliver quality, effective care based on the best evidence available.MethodsWe describe one type of care model developed by the Fundacio ACE, Institut Catala de Neurociencies Aplicades (Fundacio ACE, Barcelona, Spain) that integrates diagnosis, therapy, follow-up care, daycare, and a day hospital, and does so in the context of an active clinical research and educational program.ResultsThere were 13,048 individuals newly evaluated and diagnosed in Fundacio ACE between 1996 and 2011. Of these, 6132 had AD (47.0%), 3871 had mild cognitive impairment (MCI) (29.7%), and 1958 had no cognitive impairment (15.0%). Follow-up information is available on 4735 (47.3%) AD and MCI patients, and these data indicate that MCI develops into dementia at a rate of 222.6/1000 person-years. Apolipoprotein E (APOE) genotyping was available in 22.4% of the patients. The ε4 allele occurred in 45.7% of the AD patients, in 37.8% of the MCI subjects, and in 31.6% of those without cognitive impairment.ConclusionsFundació ACE can serve as a model system that can be adapted to other settings within their specific cultural, governmental, and legal constraints

Shallow structure beneath the Central Volcanic Complex of Tenerife from new gravity data: implications for its evolution and recent reactivation

We present a new local Bouguer anomaly map of the Central Volcanic Complex (CVC) of Tenerife, Spain, constructed from the amalgamation of 323 new high precision gravity measurements with existing gravity data from 361 observations. The new anomaly map images the high-density core of the CVC and the pronounced gravity low centred in the Las Cañadas caldera in greater detail than previously available. Mathematical construction of a sub-surface model from the local anomaly data, employing a 3D inversion based on 'growing' the sub-surface density distribution via the aggregation of cells, enables mapping of the shallow structure beneath the complex, giving unprecedented insights into the sub-surface architecture. We find the resultant density distribution in agreement with geological and other geophysical data. The modelled sub-surface structure supports a vertical collapse origin of the caldera, and maps the headwall of the ca. 180 ka Icod landslide, which appears to lie buried beneath the Pico Viejo–Pico Teide stratovolcanic complex. The results allow us to put into context the recorded ground deformation and gravity changes at the CVC during its reactivation in spring 2004 in relation to its dominant structural building blocks. For example, the areas undergoing the most significant changes at depth in recent years are underlain by low-density material and are aligned along long-standing structural entities, which have shaped this volcanic ocean island over the past few million years

Genetic risk for schizophrenia and psychosis in Alzheimer disease

Psychotic symptoms, defined as the occurrence of delusions or hallucinations, are frequent in Alzheimer disease (AD), affecting ~40 to 60% of individuals with AD (AD with psychosis (AD+P)). In comparison with AD subjects without psychosis, AD+P subjects have more rapid cognitive decline and poor outcomes. Prior studies have estimated the heritability of psychosis in AD at 61%, but the underlying genetic sources of this risk are not known. We evaluated a Discovery Cohort of 2876 AD subjects with (N=1761) or without psychosis (N=1115). All subjects were genotyped using a custom genotyping array designed to evaluate single-nucleotide polymorphisms (SNPs) with evidence of genetic association with AD+P and include SNPs affecting or putatively affecting risk for schizophrenia and AD. Results were replicated in an independent cohort of 2194 AD subjects with (N=734) or without psychosis (N=1460). We found that AD+P is associated with polygenic risk for a set of novel loci and inversely associated with polygenic risk for schizophrenia. Among the biologic pathways identified by the associations of schizophrenia SNPs with AD+P are endosomal trafficking, autophagy and calcium channel signaling. To the best of our knowledge, these findings provide the first clear demonstration that AD+P is associated with common genetic variation. In addition, they provide an unbiased link between polygenic risk for schizophrenia and a lower risk of psychosis in AD. This provides an opportunity to leverage progress made in identifying the biologic effects of schizophrenia alleles to identify novel mechanisms protecting against more rapid cognitive decline and psychosis risk in AD

Protein analysis of moro blood orange pulp during storage at low temperatures

[EN] A protein analysis in the pulp of Moro blood oranges (Citrus sinensis L. Osbeck) at the onset and after 30 days of storage at either 4 or 9 degrees C was performed. All differential proteins belonged to different functional classes (sugar, amino acid and secondary metabolism, defense, stress response, oxidative process, transport and cellular component biogenesis), displaying a differential accumulation in those Moro oranges kept at 9 versus 4 degrees C, and in those stored at 4 degrees C versus onset. Anthocyanin biosynthesis structural proteins chalcone synthases and flavonone 3-hydroxylase and different glutathione S-transferases related with their vacuolar transport were up-accumulated in fruits kept at 9 versus 4 degrees C and versus the onset. Proteins related with defense and oxidative stress displayed a similar pattern, concomitant with a higher anthocyanin content, denoting a possible role of defense and other stress response pathways in anthocyanin production/accumulation.This work was supported by the São Paulo Research Foundation (FAPESP, Brazil) project (FAPESP 2014/12616-9) and Fundecitrus. LC was funded by a grant from FAPESP (2014/23447-3).Carmona-López, L.; Alquézar-García, B.; Tarraga Herrero, S.; Peña Garcia, L. (2019). Protein analysis of moro blood orange pulp during storage at low temperatures. Food Chemistry. 277:75-83. https://doi.org/10.1016/j.foodchem.2018.10.108S758327

New evidence for the reawakening of Teide volcano

Geophysical signals accompanying the reactivation of a volcano after a period of quiescence must be evaluated as potential precursors to impending eruption. Here we report on the reactivation of the central volcanic complex of Tenerife, Spain, in spring 2004 and present gravity change maps constructed by time-lapse microgravity measurements taken between May 2004 and July 2005. The gravity changes indicate that the recent reactivation after almost a century of inactivity was accompanied by a sub-surface mass addition, yet we did not detect widespread surface deformation. We find that the causative source was evolving in space and time and infer fluid migration at depth as the most likely cause for mass increase. Our results demonstrate that, even in the absence of previous baseline data and ground deformation, microgravity measurements early in developing crises provide crucial insight into the dynamic changes beneath a volcano

Exantema periflexural asimétrico de la infancia: reporte de 2 casos

El exantema periflexural asimétrico de la infancia es una entidad subdiagnosticada, de etiología incierta, que afecta, predominantemente, a niñas alrededor de los dos años de edad. Se caracteriza por ser un exantema que solo afecta a un hemicuerpo y que se resuelve sin tratamiento específico. Se reportan dos casos clínicos acerca de esta entidad. El primero, referente a una niña de 14 meses con exantema papuloeritematoso de inicio en la axila siete días antes y extensión a la extremidad superior y el hemitronco ipsilateral sin otras alteraciones. El segundo, referente a una niña de 24 meses de edad con exantema papuloeritematoso pruriginoso de inicio en la extremidad inferior izquierda y la posterior extensión por el hemicuerpo izquierdo. Dadas las características del exantema y la edad de las pacientes, se diagnosticó exantema periflexural asimétrico y recibió tratamiento sintomático, con resolución del cuadro de forma espontánea

Plasma Aβ42/40 ratio alone or combined with FDG-PET can accurately predict amyloid-PET positivity: a cross-sectional analysis from the AB255 Study

Background: To facilitate population screening and clinical trials of disease-modifying therapies for Alzheimer’s disease, supportive biomarker information is necessary. This study was aimed to investigate the association of plasma amyloid-beta (Aβ) levels with the presence of pathological accumulation of Aβ in the brain measured by amyloid-PET. Both plasma Aβ42/40 ratio alone or combined with an FDG-PET-based biomarker of neurodegeneration were assessed as potential AD biomarkers. Methods: We included 39 cognitively normal subjects and 20 patients with mild cognitive impairment from the AB255 Study who had undergone PiB-PET scans. Total Aβ40 and Aβ42 levels in plasma (TP42/40) were quantified using ABtest kits. Subjects were dichotomized as Aβ-PET positive or negative, and the ability of TP42/40 to detect Aβ-PET positivity was assessed by logistic regression and receiver operating characteristic analyses. Combination of plasma Aβ biomarkers and FDG-PET was further assessed as an improvement for brain amyloidosis detection and diagnosis classification. Results: Eighteen (30.5%) subjects were Aβ-PET positive. TP42/40 ratio alone identified Aβ-PET status with an area under the curve (AUC) of 0.881 (95% confidence interval [CI] = 0.779–0.982). Discriminating performance of TP42/40 to detect Aβ-PET-positive subjects yielded sensitivity and specificity values at Youden’s cutoff of 77.8% and 87.5%, respectively, with a positive predictive value of 0.732 and negative predictive value of 0.900. All these parameters improved after adjusting the model for significant covariates. Applying TP42/40 as the first screening tool in a sequential diagnostic work-up would reduce the number of Aβ-PET scans by 64%. Combination of both FDG-PET scores and plasma Aβ biomarkers was found to be the most accurate Aβ-PET predictor, with an AUC of 0.965 (95% CI = 0.913–0.100). Conclusions: Plasma TP42/40 ratio showed a relevant and significant potential as a screening tool to identify brain Aβ positivity in preclinical and prodromal stages of Alzheimer’s disease