Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

"Esos hombres impíos y detestables": la presencia del hereje inglés y su valoración en la Venezuela colonial

Producido en el marco de un esfuerzo mayor por estudiar la valoración de la cultura anglosajona contenida en diversos testimonios de la cultura colonial venezolana, el artículo presentado se centra la revisión y análisis de la valoración del hereje inglés desde Venezuela, desde inicios del siglo XVII y hasta los primeros años de la centuria siguiente, revisión desarrollada a partir del análisis de las diversas causas por Herejía y demás delitos de Fe asociadas a sujetos naturales de Inglaterra y que fueron apresados en Venezuela y remitidos desde distintos puntos de estos territorios a la sede del Tribunal de la Inquisición en Cartagena de Indias

Determination Of Anthocyanins From Acerola (malpighia Emarginata Dc.) And Açai (euterpe Oleracea Mart.) By Hplc-pda-ms/ms

The anthocyanins from acerola and açai, two tropical fruits known for their bioactive compounds, were studied. Two varieties of acerola in natura and one brand of frozen pulp of açai were analyzed by high-performance liquid chromatography connected to photodiode array and mass spectrometry detectors (HPLC-PDA-MS/MS). The açai pulp presented 282-303 mg/100 g of total anthocyanin, with predominance of cyanidin 3-glucoside and cyanidin 3-rutinoside, in average proportions of 13% and 87%, respectively. The composition of the two acerola varieties (Waldy Cati 30 and Olivier) were similar, being cyanidin 3-rhamnoside (76-78%) the major anthocyanin, followed by pelargonidin 3-rhamnoside (12-15%). The acerola Waldy variety showed total anthocyanin content of 6.5-7.6 mg/100 g, while 7.9-8.4 mg/100 g were found in the Olivier variety, for fruits harvested in 2003 and 2004. No statistical differences were found between varieties and harvests for the total anthocyanin content in acerola fruits. © 2008 Elsevier Inc. All rights reserved.214291299Bobbio, F.O., Druzian, J.I., Abrão, P.A., Fadelli, S., Bobbio, P.A., Identificação e quantificação das antocianinas do fruto do açaízeiro (Euterpe oleracea Mart.) (2000) Ciência e Tecnologia de Alimentos, 20, pp. 388-390Cordenunsi, B.R., Nascimento, J.R.O., Genovese, M.I., Lajolo, F.M., Influence of cultivar on quality parameters and chemical composition of strawberry fruits grown in Brazil (2002) Journal of Agricultural and Food Chemistry, 50, pp. 2581-2586Dao, L.T., Takeoka, G.R., Edwards, R.H., Berrios, J.D., Improved method for the stabilization of anthocyanidins (1998) Journal of Agricultural and Food Chemistry, 46, pp. 3564-3569De Ancos, B., Ibañez, E., Reglero, G., Cano, P., Frozen storage effects on anthocyanins and volatile compounds of raspberry fruit (2000) Journal of Agricultural and Food Chemistry, 48, pp. 873-879De Assis, S.A., Lima, D.C., de Faria-Oliveira, O.M.M., Activity of pectinmethyl-esterase, pectin content and vitamin C in acerola fruit at various stages of development (2001) Food Chemistry, 74, pp. 133-137Degenhardt, A., Knapp, H., Winterhalter, P., Separation and purification of anthocyanins by high-speed countercurrent chromatography and screening for antioxidant activity (2000) Journal of Agricultural and Food Chemistry, 48, pp. 338-343Del Pozo-Insfran, D.D., Brenes, C.H., Talcott, S.T., Phytochemical composition and pigment stability of açaí (Euterpe oleracea Mart.) (2004) Journal of Agricultural and Food Chemistry, 52, pp. 1539-1545De Rosso, V.V., Mercadante, A.Z., Carotenoid composition of two Brazilian genotypes of acerola (Malpighia punicifolia L.) from two harvests (2005) Food Research International, 38, pp. 1073-1077De Rosso, V.V., Mercadante, A.Z., HPLC-PDA-MS/MS of anthocyanins and carotenoids from dovyalis and tamarillo fruits (2007) Journal of Agricultural and Food Chemistry, 55, pp. 9135-9141De Rosso, V.V., Mercadante, A.Z., The high ascorbic acid content is the main cause of the low stability of anthocyanin extracts from acerola (2007) Food Chemistry, 103, pp. 935-943Francis, F.J., Analysis of anthocyanins (1982) Anthocyanins as Food Colors, pp. 181-206. , Markakis P. (Ed), Academic Press, LondonFuleki, T., Francis, F.J., Quantitative methods form anthocyanins. 1. Extraction and determination of total anthocyanins in cranberries (1968) Journal of Food Science, 33, pp. 72-77Gallori, S., Bilia, A.R., Bergonzi, M.C., Barbosa, W.L.R., Vincieri, F.F., Polyphenolic constituents of fruit pulp of Euterpe oleracea Mart. (açai palm) (2004) Chromatographia, 59, pp. 739-743Gusti, M.M., Rodriguez-Saona, L.E., Griffin, D., Wrolstad, R.E., Spectroscopy as tools for anthocyanin characterization (1999) Journal of Agricultural and Food Chemistry, 47, pp. 4657-4664Hanamura, T., Hagiwara, T., Kawagishi, H., Structural and functional characterization of polyphenols isolated from acerola (Malpighia emarginata DC.) fruit (2005) Bioscience Biotechnology and Biochemistry, 69, pp. 280-286Hong, V., Wrolstad, R., Characterization of anthocyanin-containing colorants and fruit juices by HPLC/photodiode array detection (1990) Journal of Agricultural and Food Chemistry, 38, pp. 698-708Hong, V., Wrolstad, R., Use of HPLC/photodiode array detection for characterization of anthocyanins (1990) Journal of Agricultural and Food Chemistry, 38, pp. 708-715Iacobucci, G.A., Sweeny, J.G., The chemistry of anthocyanins, anthocyanidins and related flavylium salts (1983) Tetrahedron, 39, pp. 3005-3038Kong, J., Chia, L., Goh, N., Chia, T., Brouillard, R., Analysis and biological activities of anthocyanins (2003) Phytochemistry, 64, pp. 923-933Lichtenthäler, R., Rodrigues, R.B., Maia, J.G.S., Papagiannopoulos, M., Fabricius, H., Marx, F., Total oxidant scavenging capacities of Euterpe oleracea Mart. (Açaí) fruits (2005) International Journal of Food Sciences and Nutrition, 56, pp. 53-64Longo, L., Vasapollo, G., Extraction and identification of anthocyanins from Smilax aspera L. berries (2006) Food Chemistry, 94, pp. 226-231Macz-Pop, G.A., Rivas-Gonzalo, J.C., Pérez-Alonso, J.J., González-Paramás, A.M., Natural occurrence of free anthocyanin aglycones in beans (Phaseolus vulgaris L.) (2006) Food Chemistry, 94, pp. 448-456Mercadante, A.Z., Bobbio, F.O., Anthocyanins in foods: occurrence and physicochemical properties (2007) Food Colorants: Chemical and Functional Properties, pp. 241-276. , Socaciu C. (Ed), CRC Press LLC, Boca Raton, FLMerken, H.M., Merken, C.D., Beecher, G.R., Kinetics for the quantification of anthocyanidins, flavonols, and flavones in foods (2001) Journal of Agricultural and Food Chemistry, 49, pp. 2727-2732Revilla, I., Pérez-Magariño, S., González-Sanjosé, M.L., Beltrán, S., Identification of anthocyanin derivatives in grape skin extracts and red wines by liquid chromatography with diode array and mass spectrometric detection (1999) Journal of Chromatography A, 847, pp. 83-90Rodríguez-Saona, L.E., Giusti, M.M., Wrolstad, R.E., Color and pigment stability of red radish anthocyanins and red-fleshed potato anthocyanins in juice model systems (1999) Journal of Food Science, 64, pp. 451-456Rogez, H., 2000. Açaí: preparo, composição, e melhoramento da conservação, Belém, Pará, EDUUFPARubinskiene, M., Viskelis, P., Jasutiene, I., Viskeliene, R., Bobinas, C., Impact of various factors on the composition and stability of black currant anthocyanins (2005) Food Research International, 38, pp. 867-871Santini, R., Huyke, A.J., 1993. Identification of the anthocyanin present in the acerola which produces color changes in the juice on pasteurization and canning. In: Mazza, G., Miniati, E. (Eds.), Anthocyanins in Fruits, Vegetables and Grains. CRC Press Inc., Boca Raton, p. 131. Reprinted from: Journal of Agriculture of University of Puerto Rico, 40, 171-176 (1956)São José, A.B., Alves, R.E., 1995. Acerola no Brasil: produção e mercado. Vitória da Conquista, Bahia: Il. Graf. TabSchauss, G.A., Wu, X., Prior, R., Ou, B., Huang, D., Owens, J., Agarwal, A., Shanbrom, E., Antioxidant capacity and other bioactivities of the freeze-dried Amazonian palm berry, Euterpe oleraceae Mart. (Acai) (2006) Journal of Agricultural and Food Chemistry, 54, pp. 8604-8610Schauss, A.G., Wu, X., Prior, R.L., Ou, B., Patel, D., Huang, D., Kababick, J.P., Phytochemical and nutrient composition of the freeze-dried Amazonian palm berry, Euterpe oleraceae Mart. (açai) (2006) Journal Agricultural and Food Chemistry, 54, pp. 8598-8603Schwarz, M., Hillebrand, S., Habben, S., Degenhardt, A., Winterhalter, P., Application of high-speed countercurrent chromatography to the large-scale isolation of anthocyanins (2003) Biochemical Engineering Journal, 14, pp. 179-189Seeram, N.P., Nair, M., Inhibition of lipid peroxidation and structure-activity related studies of the dietary constituents anthocyanins, anthocyanidins, and catechins (2002) Journal of Agricultural and Food Chemistry, 50, pp. 5308-5312Seeram, N.P., Lee, R., Scheuller, S., Heber, D., Identification of phenolic compounds in strawberries by liquid chromatography electrospray ionization mass spectroscopy (2006) Food Chemistry, 97, pp. 1-11Vendramini, A.L., Trugo, L.C., Chemical composition of acerola fruit (Malpighia punicifolia L.) at three stages of maturity (2000) Food Chemistry, 71, pp. 195-198Vendramini, A.L., Trugo, L.C., Phenolic compounds in acerola fruit (Malpighia punicifolia L.) (2004) Journal of the Brazilian Chemical Society, 15, pp. 664-668Wang, H., Cao, G.H., Prior, R.L., Oxygen radical absorbing capacity of anthocyanins (1997) Journal of Agricultural and Food Chemistry, 45, pp. 304-309Wu, X., Prior, R., Systematic identification and characterization of anthocyanins by HPLC-ESI-MS/MS in common foods in the United States: fruits and berries (2005) Journal of Agricultural and Food Chemistry, 53, pp. 2589-2599Zanatta, C.F., Cuevas, E., Bobbio, F.O., Winterhalter, P., Mercadante, A.Z., Determination of anthocyanins from camu-camu (Myrciaria dubia) by HPLC-PDA, HPLC-MS and NMR (2005) Journal of Agricultural and Food Chemistry, 53, pp. 9531-953