Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic microorganisms. Inhaled antibiotics reach high concentrations in the area of infection, which enhances their effect and enables their long-term administration to defeat the most resistant infections, while minimizing possible adverse effects. New formulations of inhaled dry powder antibiotics have been developed, providing, among other advantages, faster preparation and administration of the drug, as well as avoiding the requirement to clean nebulization equipment. In this review, we analyze the advantages and disadvantages of the different types of devices that allow the inhalation of antibiotics, especially dry powder inhalers. We describe their general characteristics, the different inhalers on the market and the proper way to use them. We analyze the factors that influence the way in which the dry powder drug reaches the lower airways, as well as aspects of microbiological effectiveness and risks of resistance development. We review the scientific evidence on the use of colistin and tobramycin with this type of device, both in patients with CF and with non-CF bronchiectasis. Finally, we discuss the literature on the development of new dry powder antibiotics

Current challenges in chronic bronchial infection in patients with chronic obstructive pulmonary disease

Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients

The role of Epstein-Barr virus in adults with bronchiectasis : A prospective cohort study

Epstein-Barr virus (EBV) is implicated in the progression of chronic obstructive pulmonary disease. We aimed to determine whether EBV correlates with bronchiectasis severity, exacerbations, and progression. We collected induced sputum in healthy controls and spontaneous sputum at 3-6-month intervals and onset of exacerbations in bronchiectasis patients between March 2017 and October 2018. EBV DNA was detected with quantitative polymerase chain reaction. We collected 442 sputum samples from 108 bronchiectasis patients and 50 induced sputum samples from 50 healthy controls. When stable, bronchiectasis patients yielded higher detection rates of EBV DNA (48.1% vs 20.0%; P =.001), but not viral loads (mean log load, 4.45 vs 4.76; P =.266), compared with controls; 64.9% of patients yielded consistent detection status between 2 consecutive stable visits. Neither detection rate (40.8% vs 48.1%; P =.393) nor load (mean log load, 4.34 vs 4.45; P =.580) differed between the onset of exacerbations and stable visits, nor between exacerbations and convalescence. Neither detection status nor viral loads correlated with bronchiectasis severity. EBV loads correlated negatively with sputum interleukin-1β (P =.002), CXC motif chemokine-8 (P =.008), and tumor necrosis factor-α levels (P =.005). Patients initially detected with, or repeatedly detected with, EBV DNA had significantly faster lung function decline and shorter time to next exacerbations (both P .05). The EBV strains detected in bronchiectasis patients were phylogenetically homologous. Patients with detection of EBV DNA have a shorter time to bronchiectasis exacerbations. EBV may contribute to bronchiectasis progression

Sex bias in diagnostic delay in bronchiectasis: An analysis of the Spanish Historical Registry of Bronchiectasis

Diagnostic delay is common in most respiratory diseases, particularly in bronchiectasis. However, sex bias in diagnostic delay has not been studied to date. Objective: Assessment of diagnostic delay in bronchiectasis by sex. Methods: The Spanish Historical Registry of Bronchiectasis recruited adults diagnosed with bronchiectasis from 2002 to 2011 in 36 centres in Spain. From a total of 2113 patients registered we studied 2099, of whom 1125 (53.6%) were women. Results: No differences were found for sex or age (61.0 ± 20.6, p = 0.88) or for localization of bronchiectasis (p = 0.31). Bronchiectasis of unknown aetiology and secondary to asthma, childhood infections and tuberculosis was more common in women (all ps 2 years). Independent factors associated with this sex bias were age at onset of symptoms, smoking history, daily expectoration and reduced lung function

SEPAR Recommendations for COVID-19 Vaccination in Patients With Respiratory Diseases

La Sociedad Espanola de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de reco mendaciones sobre la vacuna para la COVID-19 en las enfermedades respiratorias, con el objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación de estos pacientes. Las recomendaciones han sido elaboradas por un grupo de expertos en la materia, tras la revisión de la literatura recopilada hasta el 7 de marzo del 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha. Podemos concluir que las vacunas para la COVID-19 no solo son seguras y eficaces, sino que, en aquellos pacientes vulnerables con enfermedades respiratorias crónicas, son prioritarias. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas.The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients. The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date. We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage

Bronchial Infection and Temporal Evolution of Bronchiectasis in Patients With Chronic Obstructive Pulmonary Disease

[Background]: Bronchiectasis (BE) impact the clinical course and prognosis of patients with chronic obstructive pulmonary disease (COPD). Yet, the temporal evolution of BE in these patients is unknown. This study seeks to assess the temporal evolution of BE in persons with COPD.[Methods]: 201 moderate-to-severe patients were recruited between 2004 and 2007 and followed up at least every 6 monts (median of 102 months). To investigate the temporal evolution of BE, in 2015 a second high-resolution computed tomography scan (HRCT) was obtained in survivors and compared with the one obtained at recruitment.[Results]: 99 (49.3%) died during follow-up. The second HRCT could be obtained in 77 patients and showed that (1) in 27.3% of patients BE never developed, in 36.4% they remained stable, in 16.9% they increased in size and/or extension, and in 19.5% new BE emerged; and that (2) the presence of chronic purulent sputum (hazard ratio [HR], 2.8 [95% confidence interval {CI}, 1.3–5.8]), number of hospitalizations due to exacerbatons (HR, 1.2 [95% CI, 1.1–1.5]), and number of pathogenic microorganism (PPM) isolations (HR, 1.1 [95% CI, 1.02–1.3]) were independent risk factors for the progression or development of BE.[Conclusions]: The presence of chronic purulent sputum production, number of PPMs isolated in sputum, and number of hospitalizations due to exacerbations of COPD are independent risk factors of BE progression in patients with COPD

Diferentes miradas en la organización

Trabajo colectivo que presentan los académicos del área de investigación, Análisis y gestión de las organizaciones, el cual tiene como objetivo presentar los temas relevantes que ocupan a los investigadores del área. Está integrado por cuatro apartados temáticos: Apartado I. Teoría y estudio de las organizaciones, Apartado II. Problemática organizacional y administrativa, Apartado III. Tecnología, innovación y conocimiento organizacional y Apartado IV. Intervención en las organizaciones y siete capítulos. En el capítulo I “El análisis de las organizaciones y de la gestión: surgimiento, fundamento disciplinar y objeto de estudio de un área de investigación”, se aborda el surgimiento del área Análisis y gestión de las organizaciones. En capítulo II, “Ambiente y su incidencia en los fenómenos organizacionales contemporáneos: un acercamiento desde la contingencia”, el autor señala que los fenómenos organizacionales no son autorreferenciales ni se pueden explicar fuera del entorno en el que se producen. Se continua con el capítulo III “Las ecoaldeas: propuesta de agenda de investigación desde la perspectiva organizacional”, los autores señalan que la importancia del estudio de la ecoaldea radica en que han surgido como una iniciativa de la propia sociedad para buscar soluciones sobre cómo vivir en equilibrio con la naturaleza. En el capítulo IV “Trabajadores del conocimiento y organizaciones informatizadas: los nuevos trabajos de la era en la información”, el autor analiza la emergencia de nuevos empleos derivados del desarrollo del Internet y las tecnologías de la información y la comunicación (TIC) bajo la noción de trabajador del conocimiento, para ello caracteriza algunos de los empleos y las nuevas prácticas laborales que surgen a partir de la incorporación de las TIC en las organizaciones. El capítulo V “Reflexionar y enseñar tecnologías digitales, un primer borrador de una biografía de las cosas”, aquí se señala que las tecnologías digitales son artefactos que tienen una vida social. La línea argumentativa sigue la propuesta de Arjun Appandurai y retoma algunas de las ideas de Igor Kopytoff y John Thompson. El capítulo VI “Escenarios educativos con la integración de TIC. Un análisis organizacional a partir de las interacciones”, habla de que la irrupción de las TIC obliga a las universidades a generar nuevos escenarios en el proceso de formación profesional; las autoras presentan el caso de los simuladores de negocios como medio didáctico y estrategia pedagógica que se despliega en el proceso educativo. el capítulo VII “La intervención en las organizaciones: Apuntes para pensar su importancia” este trabajo es un esfuerzo por conceptualizar lo que es la intervención dentro de las organizaciones, al discutir las diferencias entre la consultoría y la intervención organizacional; además se señala que es importante construir una Teoría general de la intervención organizacional: así como reflexionar en las implicaciones prácticas de la acción interventora en las organizaciones.Elvia Espinosa Infante, coordinador

Krebs von den Lungen-6 glycoprotein circulating levels are not useful as prognostic marker in COVID-19 pneumonia : A large prospective cohort study

Altres ajuts: Departament de Salut, Generalitat de Catalunya (COVID-PoC BioCAT).Coronavirus disease 2019 (COVID-19) has rapidly expanded worldwide. Currently, there are no biomarkers to predict respiratory worsening in patients with mild to moderate COVID-19 pneumonia. Small studies explored the use of Krebs von de Lungen-6 circulating serum levels (sKL-6) as a prognostic biomarker of the worsening of COVID-19 pneumonia. We aimed at a large study to determine the prognostic value of sKL-6 in predicting evolving trends in COVID-19. We prospectively analyzed the characteristics of 836 patients with COVID-19 with mild lung disease on admission. sKL-6 was obtained in all patients at least at baseline and compared among patients with or without respiratory worsening. The receiver operating characteristic curve was used to find the optimal cutoff level. A total of 159 (19%) patients developed respiratory worsening during hospitalization. Baseline sKL-6 levels were not higher in patients who had respiratory worsening (median {IQR} 315.5 {209-469} vs. 306 {214-423} U/ml p = 0.38). The last sKL-6 and the change between baseline and last sKL-6 were higher in the respiratory worsening group (p = 0.02 and p < 0.0001, respectively). The best sKL-6 cutoff point for respiratory worsening was 497 U/ml (area under the curve 0.52; 23% sensitivity and 85% specificity). sKL-6 was not found to be an independent predictor of respiratory worsening. A conditional inference tree (CTREE) was not useful to discriminate patients at risk of worsening. We found that sKL-6 had a low sensibility to predict respiratory worsening in patients with mild-moderate COVID-19 pneumonia and may not be of use to assess the risk of present respiratory worsening in inpatients with COVID-19 pneumonia

SEPAR Recommendations for COVID-19 Vaccination in Patients With Respiratory Diseases

[ES] La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna para la COVID-19 en las enfermedades respiratorias, con el objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación de estos pacientes. Las recomendaciones han sido elaboradas por un grupo de expertos en la materia, tras la revisión de la literatura recopilada hasta el 7 de marzo del 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha. Podemos concluir que las vacunas para la COVID-19 no solo son seguras y eficaces, sino que, en aquellos pacientes vulnerables con enfermedades respiratorias crónicas, son prioritarias. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas.[EN] The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients. The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date. We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage

Thermocatalytic degradation of lignin monomer coniferyl aldehyde by aluminum–boron oxide catalysts

Two aluminum–boron oxide catalysts were produced via a sol–gel method at pH 3 and 4 during the solution mixing step of the synthesis, these materials were employed in thermocatalytic degradation of coniferyl aldehyde (CA), which was used as a probe molecule of the lignin polymeric molecule and is comprised of the repetitive monomers coniferyl, sinapyl, and paracoumaryl. The two synthesized catalysts were mostly amorphous and mesoporous, aiding in permeability and percolation of CA. A commercial catalyst was compared (Pt/alumina at 1 wt%) with both catalysts synthesized in this work by kinetic tests by varying the CA concentration and inlet temperature. Under the same reaction conditions, the commercial catalyst showed higher activity than the aluminum–boron oxide catalysts, but the synthetic catalysts presented a wider variety of organic products than the commercial catalyst. In particular, two high-value products, isomers of eugenol and isoeugenol, were yielded in higher percentages. The experimental reaction rate data was fit to a Langmuir–Hinshelwood model, and kinetic parameters were analyzed, revealing how the adsorbed CA molecules on the catalytic surface had higher mobility with the synthesized catalyst compared with the commercial catalyst, the value of $\Delta S_{\mathrm{ads}}^{0}$ for the synthetic catalysts were $-$5.48 and $-$4.31 J/mol-K and for the commercial catalyst $-$37.17 J/mol-K