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Obstructive sleep apnea (OSA) is an important risk factor for poor asthma control. The objective of this study is to analyze the symptomatic control in asthmatic patients with OSA after using continuous positive airway pressure (CPAP).Patients were collected in a monographic asthma consult and a polygraphy was performed due to clinical suspicion or poor disease control. Asthma associated pathologies, as well as clinical and patient-perceived asthma control parameters were evaluated before and after the initiation of CPAP.A hundred patients were included, 59% were women and 41% men. From them, 54% had severe OSA, 33% moderate OSA and 13% mild OSA, and 10% could not tolerate CPAP. Eighty four percent had a moderate or severe degree of asthma with fractional exhaled nitric oxide (FENO) 32 ± 24.6 ppm and an asthma control test (ACT) before CPAP of 19 ± 4. Asthma control before CPAP was good in 41% of patients, partial in 29%, and bad in 30%. After three or more months of CPAP, clinical asthma control was good in 70% (p 0.001), perceived control by ACT after CPAP was 21 ± 4 (p 0.001). When asked for their opinion, 51.5% referred clinical improvement after CPAP, no change in 46.5%.The use of CPAP in asthmatic patients with OSA improves both clinical and perceived asthma control in a statistically significant way. Most patients had good adaptation to CPAP (90%) and 51.5% had clinical improvement.

En el presente trabajo se muestra el desarrollo de la industria del vestido en dos localidades rurales del estado de Jalisco. El objetivo es señalar la informalidad de este tipo de trabajo en esos lugares, donde los hogares funcionan como maquiladoras y los trabajadores de estos talleres laboran en condiciones precarias, sin salario base y con una total inexistencia de seguridad social, donde asumen ellos mismos algunos costos de producción como la compra de la maquinaria para poder trabajar y el pago de la electricidad para las máquinas. Además, prestan el espacio donde trabajan, guardan sus herramientas, y también sirve de almacén para guardar la mercancía que producen mientras pasan a recogerla los empresarios para quienes trabajan. Todas estas desventajas ayudan a subsidiar los costos de producción. Finalmente, contrario a lo que se puede pensar, estos empleos siguen siendo vigentes en el campo mexicano.

Continuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients' levels of adherence with CPAP treatment.A questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated.5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r=.986; p.001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173]=8.097, p.001); CPAP treatment information (t[173]=15.170, p.001); and CPAP use (t[173]=14.642, p.001). The final 12-item version was reliable (CRI=.793) and its internal structure was adequate (χThe interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.

An innovative approach for the primary and definitive treatment of obstructive sleep apnea (OSA) in adult patients is presented: Bilateral Internal Ramus Distraction of the mandible (BIRD), which is a slow, progressive and more stable procedure to advance the mandibular bone. This study investigated whether this surgical approach is useful to cure OSA.Study design was of an interventional (surgical) one-arm trial of OSA patients assessed before and 12 months after BIRD. All patients were evaluated by pre- and post-operative polysomnography and three-dimensional scans. The amount of skeletal advancement, percentage of upper airway volume increase and postoperative value of mandibular occlusal plane were the predictor variables. Changes in the apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), and percentage of time with saturation under 90% (TC90) were the main outcome variables.Thirty-two subjects with a mean ± SD age of 41.9 ± 13.3 years and 87.5% male were included, and they were followed-up 32 ± 14.2 months. AHI was 47.9 ± 23.1 per hour before surgery and the Epworth Sleepiness Scale (ESS) was 13.4 ± 4.4. Postoperative AHI was 4.8 ± 5.6 per hour 12 months after surgery (P0.001), with 81.2% of the patients considered cured (AHI5) and 18.8% suffering from a mild-to-moderate residual OSA. ESS decreased to 1.9 ± 1.8 at the end of the surgical treatment (P0.001). 3D changes revealed an upper airway volume increase of 188.4% ± 73.5% (P0.001).Lengthening the mandibular ramus by distraction osteogenesis to cure OSA appears to be more effective and safer when compared to other surgical protocols, especially in very severe cases with initial AHI50/h. Titration of the mandibular advancement weekly using respiratory polygraphy allows better healing control and customization of the skeletal advancement, enhancing the aesthetic result.

Introduction: Down syndrome(DS), due to the anatomy of their upper airways, have a high prevalence of obstructive sleep apnea-hypopnea(OSA), this relation has been little studied. We aimed to determine the prevalence, clinical and polygraphic features ofOSA, and their changes after the start of treatment. Material and methods: Observational study design, consecutive DSpatients with suspectedOSA were included, being referred because of excessive daytime sleepiness and cognitive impairment. A complete sleep history assesment and either polygraphy(PG) or polysomnography(PSG) were conducted. Results: 47 patients were studied,60% male, age of35±10 years, BMI30±6 kg/m2, neck circumference41±4 cm. The Epworth score was13±5. PG was performed in92%, andPSG in the other8%, resulting 7% normal, 7% mild,41% moderate and45% severe OSA, with an AHI of38±31h-1, dominated by events in supine position(56±33), ODI33.6±28h-1, minimum oxygen saturation79±10%, shorter than90% of saturation22±24%. Treatment was started withCPAP in 25(53.2%), with a pressure of7±2 cmH2O, 72% of them had good adaptation and compliance, resulting with improvement in52% after6 months. Conclusions: OSA was diagnosed in93%;42% of them had severe OSA, with a high prevalence of respiratory events in supine position. CPAP treatment was started in more than half, with an objective improvement in52% of patients.

Este trabajo tiene como finalidad realizar un estudio comparativo sobre la difusión de los Géneros Periodísticos, por lo que se planteó el objetivo: Identificar los Géneros Periodísticos que utilizan los diarios El Universo y Expreso en sus publicaciones. A través de la investigación bibliográfica se indagó los contenidos científicos y con la Investigación Documental se revisaron los diarios: El Universo y el Expreso. Por otra parte, con el Método Analítico se identificó los tipos de los textos. También se aplicó el Método Estadístico para tabular los datos. Se utilizó el método comparativo para confrontar los textos que difunden los dos medios de comunicación impresos. Debido a los resultados obtenidos, se concluyó que el Género Informativo la noticia es el más utilizado para la divulgación de la información igualmente la publicidad del Género Instrumental.&nbsp

Este trabajo tiene como finalidad realizar un estudio comparativo sobre la difusion de los Generos Periodisticos, por lo que se planteo el objetivo : Identificar los Generos Periodisticos que utilizan los diarios de Universo y Experso en sus publicaciones . A traves de las investigaciones bibliografica se indago los contenidos cientificos y con la investigacion Documental se revisaron los diarios : El universo y el Experso . Por otra parte , con el Metodo Analitico se identifico los tipos de los textos . Tambien se aplico el Metodo Estadistico para tabular los datos . se utilizo el metodo comparativo para confortar los textos que difunden los dos medios de comunicacion impresos . Debido a los resultados obtenidos , se concluyo que el genero Informativo la noticia es el mas utilizado para la divulgacion de la informacion igualmente la publicidad del Genero Instrumental .

Ante el incremento acelerado de aplicaciones móviles en plataformas digitales se observan herramientas tecnológicas que pretenden ser útiles al usuario en la solución inmediata en situaciones laborables, académicas o sociales; al momento de descargar o adquirir las aplicaciones móviles para realizar una tarea o una actividad determinada, se piensa en obtener los resultados sobre la información que se requiere o se solicita; el objetivo de esta investigación es mostrar el nivel de calidad que tiene la App como herramienta para generar información financiera sobre el manejo y control del efectivo; en el desarrollo de la aplicación se sustentó en la norma ISO 13407, esta norma establece el diseño centrado en las necesidades del usuario y los procedimientos para el procesamiento de datos con base en la normatividad de auditoría en donde se sustenta el control interno del rubro sobre el efectivo; para realizar las pruebas sobre el uso de la aplicación se utilizaron datos reales de pymes dedicados a la actividad comercial, industrial y prestación de servicios; en la validación de contendió y resultados participaron 80 contadores públicos certificados, quienes dieron su opinión por escrito sobre el nivel de uso conforme a la norma ISO 25010; los resultados revelan que la herramienta presenta niveles de calidad excelentes debido a que cumple con todas y cada una de las variables de funcionalidad, eficiencia, compatibilidad, usabilidad, confiabilidad, seguridad, mantenibilidad y portabilidad, por tanto es generador de información financiera oportuna, confiable, comprensible y relevante, útil al usuario para una efectiva toma de decisiones en el manejo y control del efectivo.

Introduction: The first-line treatment for obstructive sleep apnoea is (OSA) continuous positive airway pressure (CPAP) therapy, which achieves a high level of efficacy with continuous use. However, daily application of this therapy requires a motivated patient profile, as lack of adherence is the main problem with this therapy. The aim of this study was to determine whether an educational and training program based on motivational interviewing and proper feedback, improved adherence. Methods: A randomized, controlled, single-center trial design was performed. The interventions were standard of care vs MEntA Program based on motivational interview for adherence. The main outcome was the adherence with the CPAP therapy after 90 days of treatment. Secondary outcomes were the motivation, perceived competence, quality of life, sleepiness, emotional state, activities and social relations. Results: For adherence, statistically significant results were obtained in favor of the interventional arm with the MEntA (p

Background COVID-19 patients can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation (IMV). Since interleukin-6 (IL-6) is a relevant cytokine in ARDS, the blockade of its receptor with Tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective To determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods Retrospective observational study performed in hospitalized patients diagnosed of COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with pre- and post-administration of TCZ. Multivariable logistic and linear regressions, and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio (PaO2/FiO2) or mortality. Results One hundred and forty-six patients were studied, predominantly male (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels>30 pg/ml was the best predictor for IMV (OR:7.1; p30 pg/ml predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administration., Baseline IL-6 serum levels>30 pg/ml identify severe COVID-19 patients and should be used to guide the intervention with IL-6R inhibitors, aiming to improve their use in an uncertain and evolving therapeutic scenario.

Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection. Sin financiación No data 2020 UEM

Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P

Backgrounds: Smoking is the leading cause of high levels of carboxyhemogloblin(COHb). We aimed to describe clinical and demographic features in these patients Methods: This is a retrospective observational study with 375 patients with arterial blood gas from Nursery Respiratory Clinic at La Princesa Hospital. We selected patients with high levels of COHb(>2%) and classified them in 3 groups:active smoker(A), never smokers(B) and ex-smokers(C). Socio-demographic and clinical features were correlated with levels of COHb. Results: 73% of the cohort presented high levels of COHb. Average age was 69±19 years. 52% were males. 20% were group A, 32% group B and 48 group C. Comorbidities and clinical features shown in Table1. Almost 30% of our cohort use oxygen theraphy and many of them had high levels of COHb (2.7%: >5% and 49%:2.4-4.9%, p=0.03) of which 23% were group B and whose main indication of oxygen was cardiovascular disease. 16% of patients in groups B and C had passive smoking history. CoHb levels >2.5% were observed in 47% of the patients belonging to groups B and C, while 41% of group A presented COHb levels >5. In Chronic Obstructive Pulmonary Disease (COPD) patients, 11% had COHb>5%, and 56% of COPD patients from group B and C had COHb>2.5%. Negative correlation was described between the time without smoking and levels of COHb(r:-0.22 p Conclusions: The longer the non-smoking period, the lower the levels of COHb and the better the polyglobulia levels. Almost half of non-smoking and ex-smokers in our sample presented high COHb, due to non-smoke-free environment

Background: CPAP during night rest is the first line treatment for OSAHS. However, several factors interfere in its adequate compliance and therefore, affect directly its effectiveness. Our study aim was to analyze most relevant causes of therapeutic noncompliance, as well as possible proposals to mitigate this problem. Methods: we have selected 175 individuals from a tertiary hospital pulmonology clinics whose compliance was lower than 60 minutes daily. We’ve analyzed the follow-up place, subjective treatment compliance, daily treatment hours, possible non-compliance reasons and what proposals improve adherence. We tried to contact these 175 patients by phone to complete a standardized questionnaire. Results: 133 patients were contacted. 9,77% do not develop any follow up. 62.4% admitted inadequate compliance, while the remaining (37.31%) denied it. 47 patients do not use CPAP, 39 use it between 1 and 5 hours, 43 between 6 and 8 hours and 4 more than 8 hours. Most common reasons for non-compliance were: interphase intolerance in 22.5% of patients and absence of clinical improvement in 9%. As a possible proposals, 51 patients suggested to make technical and interface improvements and 16 requested to receive more information about the disease and its treatment. 14 patients preferred to withdraw the CPAP therapy. Conclusion: subjective perception of patients own compliance is not always related to actual compliance. Most relevant measures to reduce inadequate compliance are: technical simplification and ergonomic interface improvements to increase the CPAP tolerance and offer all necessary information related to the disease and its treatment.

Resumen: Presentamos un nuevo abordaje mínimamente invasivo mediante distracción intraoral de rama mandibular bilateral (bilateral internal ramus distraction) para el tratamiento del síndrome de apnea obstructiva del sueño en el paciente adulto. Tras la planificación virtual 3 D, el paciente es intervenido bajo anestesia general y asistencia endoscópica, dentro de un protocolo de cirugía mayor ambulatoria, y es dado de alta el mismo día de la cirugía. Tras un periodo de 5 días, la rama mandibular se alarga verticalmente durante un periodo que oscila entre 10 y 50 días, a un ritmo de 0,5 a 1 mm diario, hasta que el índice de apnea hipopnea alcanza una cifra inferior a 5 pausas por hora (nivel de curación) o el resalte negativo dentario (overjet) se sitúa en valores que ya superan los 10 mm.La titulación del procedimiento mediante parámetros clínicos, poligráficos o polisomnográficos permite al cirujano personalizar el avance mandibular en cada caso. Tras un alargamiento que suele oscilar entre 10 y 25 mm, los distractores se mantienen durante 6 meses hasta que concluye el periodo de consolidación. La indicación de cirugía maxilar tras el avance mandibular se realizará en dependencia del índice de apnea hipopnea residual, de la oclusión y del análisis facial.La distracción intraoral de rama mandibular bilateral es una técnica altamente efectiva para la curación del síndrome de apnea obstructiva del sueño en pacientes adultos con o sin retrognatia, y podría estar indicada incluso en pacientes con morbilidades asociadas, como enfermedades cardiovasculares graves u obesidad mórbida, en los que un procedimiento quirúrgico de mayor envergadura, como el avance maxilomandibular clásico, se descarta como alternativa quirúrgica. Abstract: An innovative and minimally invasive approach for adult obstructive sleep apnoea by using bilateral internal ramus distraction osteogenesis of the mandible is presented. After a careful virtual 3 D planning, mandibular distraction surgery is performed under general anaesthesia and endoscopic assistance, using a major ambulatory surgery protocol, with the patient being discharged home the same day. After an initial latency of 5 days, the ascending ramus is gradually lengthened vertically during a period varying between 10 and 50 days, at a rate of 0.5 mm to 1 mm daily, until an apnoea-hypopnoea index below 5/h is achieved (cure level), and/or a negative overjet > 10 mm is reached.Titration of the procedure according to clinical criteria with the assistance of polygraphy and/or polysomnography allows the clinician to customise the mandibular advancement to each particular case. After a mandibular ramus lengthening ranging between 10 and 25 mm, the distraction devices are kept in place for 6 months after completion of the consolidation period.Bilateral internal ramus distraction is a highly effective surgical technique in curing obstructive sleep apnoea in adults with or without retrognathia, and could be indicated even in patients with comorbidities, such as cardiovascular disease or morbid obesity, in which a major surgical procedure, i.e. conventional maxillomandibular advancement, should be discouraged. Palabras clave: Apnea obstructiva del sueño, Alteraciones respiratorias del sueño, Cirugía ortognática, Obstrucción respiratoria, Distracción osteogénica mandibular, Cirugía mínimamente invasiva, Avance maxilomandibular, Keywords: Obstructive sleep apnoea, Sleep-disordered breathing, Orthognathic surgery, Respiratory obstruction, Mandibular distraction osteogenesis, Minimally invasive surgery, Maxillomandibular advancement

Background: Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. Methods: We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH >= 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure. (Continued on next page) Results: We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 +/- 7.2 and 19 +/- 5.8 for the ACPE patients (p < 0.05), 20 +/- 5.7 and 19 +/- 5.1 for the COPD patients (p < 0.01) and 18 +/- 5.9 and 17 +/- 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 +/- 22 and 70 +/- 15 in the ACPE patients (p < 0.001), 87 +/- 21 and 76 +/- 14 in the COPD patients, and 83 +/- 17 and 74 +/- 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 +/- 3.1 vs. 3.6 +/- 2.5, NS; COPD, 5.1 +/- 3 vs. 3.6 +/- 2.1, p < 0.001; and OHS, 4.3 +/- 2.6 vs. 3.7 +/- 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. Conclusions: ACPE, COPD and OHS patients with AHRF and severe acidosis (pH, Spanish Respiratory Foundation, 2011 (FEPAR)

Respiratory frequency increases during exacerbations of COPD (ECOPD). We hypothesized that this increase can be detected at home before ECOPD hospitalization.To test this hypothesis, respiratory frequency was monitored at home daily for 3 months in 89 patients with COPD (FEV₁, 42.3% ± 14.0%; reference) who were receiving domiciliary oxygen therapy (9.6 ± 4.0 h/d).During follow-up, 30 patients (33.7%) required hospitalization because of ECOPD. In 21 of them (70%), mean respiratory frequency increased (vs baseline) during the 5 days that preceded it (from 15.2 ± 4.3/min to 19.1 ± 5.9/min, P.05). This was not the case in patients without ECOPD (16.1 ± 4.8/min vs 15.9 ± 4.9/min). Receiver operating characteristic analysis showed that 24 h before hospitalization, a mean increase of 4.4/min (30% from baseline) provided the best combination of sensitivity (66%) and specificity (93%) (area under the curve [AUC] = 0.79, P.05). Two days before hospitalization, a mean increase of 2.3/min (15% change from baseline) was associated with a sensitivity of 72% and a specificity of 77% (AUC = 0.76, P.05).Respiratory frequency can be monitored daily at home in patients with COPD receiving domiciliary oxygen therapy. In these patients, breathing rate increases significantly days before they require hospitalization because of ECOPD. This may offer a window of opportunity for early intervention.

Objetivo Determinar la utilidad de la ventilacion mecanica no invasiva (VMNI) en pacientes ancianos (?75 anos) que ingresan en una unidad de monitorizacion respiratoria (UMR) durante el ingreso y al ano del alta. Comparamos los resultados con el grupo de pacientes de menor edad (

Resumen La neumonitis por hipersensibilidad o alveolitis alergica extrinseca (AAE) se origina por una reaccion de hipersensibilidad a antigenos inhalados sobre un pulmon con una susceptibilidad individual. En el caso del pulmon del cuidador de aves, son particulas que suelen encontrarse en el epitelio, el polvo que cubre las plumas o las heces de las aves. En la exploracion fisica destacan los crepitantes inspiratorios a la auscultacion pulmonar y los hallazgos en la radiografia de torax pueden ser muy variables. La TC nos muestra diferentes patrones en funcion de la fase de la enfermedad en que nos encontremos. Respecto a las pruebas de funcion respiratoria, la mayoria de los pacientes presenta un patron restrictivo. Un diagnostico precoz sera crucial en la evolucion de la enfermedad, ya que la progresion puede conducir a una fibrosis pulmonar o una enfermedad pulmonar obstructiva cronica. Lo principal es eliminar la exposicion a los antigenos, con ello muchos pacientes se recuperan.

Introduccion El objetivo de este estudio ha sido analizar la prevalencia, las actitudes y las caracteristicas del tabaquismo en la poblacion de pacientes sometidos a oxigenoterapia cronica domiciliaria (OCD) en la Comunidad de Madrid. Pacientes y metodos De un total de 11.174 sujetos que cumplian los criterios de inclusion, se obtuvo una muestra representativa de 845 sujetos. De ellos 461 (54,6%) eran hombres. La edad media fue de 78,25 anos [IC95%:77,55�78,95; Dt=10,36]. Se realizo un estudio descriptivo transversal basado en cuestionarios y acompanado de cooximetria. Resultados 48 sujetos (5,7%; IC95%: 4,3�7,5%) eran fumadores y 438 (51,8%; IC95%: 48,5�55,2%) exfumadores. La tasa de fumadores activos fue mas alta en el grupo de sujetos con 60 o menos anos (?2; p

The objective of this study is to analyse the prevalence, attitudes and characteristics of smoking in the population of patients subjected to Long Term Domiciliary Oxygen Therapy (LTDOT) in the Community of Madrid.A representative sample of 845 subjects (of which 461 (46%) were male) was obtained from a total of 11,174 who fulfilled the inclusion criteria. The mean age was 78.25 years (95% Confidence Interval (CI): 77.55-78.95; SD=10.36). A descriptive cross-sectional study was conducted based on questionnaires as well as cooximetry.Forty-eight subjects (5.7%; 95%CI: 4.3%-7.5%) were smokers and 438 (51.8%; 95%CI: 48.5%-55.2%) were ex-smokers. The percentage of active smokers was higher in the 60 years or less subject group (χ(2); P0.001). The large majority (75%) of smokers were men, their proportion being significantly higher than that of current non-smokers (χ(2); P0.003). The mean score in the Fagerström Test was 3.6. More than 65% of smokers had their first cigarette up to 30 min from getting up in the morning, and 45% of these were in a preparation phase. Seventeen percent of these subjects said that they had not received advice on quitting smoking.There is a high rate of smoking in patients on LTDOT, with a higher probability of males and younger subjects continuing to smoke. There is a high level of physical dependency for nicotine.

Cystic fibrosis (CF) is a fatal inherited disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene whose mortality is conditioned by a progressive decline in lung function. Bacterial infections play a key role in this decline. Chronic bacterial infection in CF patients varies over time and the presence of Pseudomonas aeruginosa in sputum is a marker of poor prognosis. P. aeruginosa is eradicated from the airways using inhaled antibiotics administered in various formulations and devices. Antipseudomonal antibiotics have extended the survival of CF patients to 40 years. Tobramycin is a bactericidal aminoglycoside antibiotic with demonstrated activity against gram-negative microorganisms. Initially, the drug was administered as an inhaled parenteral solution. Subsequently, a specific tobramycin inhalation solution was developed. PulmoSphere™ technology enables dry tobramycin powder to be formulated for inhalation (tobramycin inhalation powder) using a small and portable capsule-based breath-activated device (T-326). Chronic colonization by P. aeruginosa is the main indication for aerosol antibiotic therapy. The American Cystic Fibrosis Foundation, European guidelines, and Spanish consensus guidelines provide different recommendations for eradication.

La enfermedad de Wegener es una vasculitis granulomatosa sistemica de etiologia desconocida, que afecta sobre todo al tracto respiratorio superior e inferior y al rinon, aunque se distingue una forma limitada al pulmon. Es una entidad poco frecuente, con una incidencia estimada de 8,5 por 1.000.000 de habitantes/ano. Los principales sintomas de comienzo suelen ser los derivados de la afectacion de las vias aereas superior e inferior. El sistema nervioso central se implica en alrededor de un 22% de los casos, pero es infrecuente que la clinica neurologica forme parte de la sintomatologia inicial. Los anticuerpos anticitoplasma del neutrofilo especificos contra la proteinasa 3 constituyen marcadores serologicos de gran utilidad para el establecimiento del diag- nostico, aunque este debe confirmarse por la biopsia tisular del organo afectado.

Resumen Las alteraciones anatomicas de la via aerea son un factor de riesgo para desarrollar un sindrome de apnea-hipopnea del sueno (SAHS). Presentamos un caso clinico de un paciente con estenosis traqueal y masa en lengua que desarrolla un SAHS que evoluciono favorablemente con ventilacion mecanica no invasora.

To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and 1 year later in comparison with the results from the younger age group (75).Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH7.35 and PaCO(2)45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 h), complications and evolution at the 1-year follow-up.Mean age of the sample was 80.6. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the 1-year follow-up was 63.21%.NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.

Introduction and objective There is a significant lack of scientific evidence on the role of SAHS in the elderly despite the increasing ageing of the population. The objective of the present study is to analyse the current healthcare situation in Spain on the diagnosis and treatment of sleep apnoea in the elderly population (≥65 years) and its progress over the last few years. Material and method Cross-sectional study. Healthcare information was collected on the diagnosis and treatment of patients of both sexes, ≥65 years old suspected of having SAHS and referred to sleep units (SU) between 2002 and 2008. Results There were 51,229 sleep studies performed in 16 SU. Of these, 24.3% were performed on subjects ≥65 years old (64.9% men), of which 71.5% had an apnoea-hypopnoea index (AHI) > 10 (68.6% treated with CPAP). There were no differences over time as regards mean age, mean AHI or percentage of studies done. A significant decrease was observed in the number of CPAP prescribed to men ≥65 years from 2002 to 2005 ( P =.01) which subsequently increased up to 2008 ( P =.01). This phenomenon was not observed in women ≥65 years. Conclusion Despite the lack of evidence on the subject, healthcare activity due to suspected SAHS in the elderly population is intense; therefore it should be a priority to start clinical studies that may be able to answer key questions on the diagnosis and treatment of SAHS in this age group

Wegener's granulomatosis is a systemic vasculitis of unknown etiology, primarily affecting the upper and lower respiratory tract and the kidneys, although there is a form restricted to the lungs. Wegener's granulomatosis occurs infrequently, with an estimated annual incidence of 8.5 cases per million. The principal symptoms at onset usually involve the upper and lower airway. The central nervous system is involved in approximately 22% of cases, but neurological signs occur infrequently among the initial clinical manifestations. Proteinase 3-specific antineutrophil cytoplasmic antibodies are useful serological markers for establishing a diagnosis, which should, however, be confirmed by a tissue biopsy of the affected organ.

Following institutional ethics board approval and parental consent, we describe a paediatric case in which a unique mouthopening rescue manoeuvre was used to prevent catastrophic airway obstruction following laryngeal mask airway (LMATM) breathing tube fracture. Upon emergence from anaesthesia, a 4-year-old patient, having undergone an uneventful circumcision, began clenching his teeth and bit the LMA breathing tube into two pieces. Gentle traction on the LMATM inflation line caused it to separate from the LMATM cuff. The attending anaesthesiologist opened the child’s mouth by applying pressure on both cheeks with the thumb and index finger between the upper and lower molars and successfully extracted the remaining half of the LMATM. Following this manoeuvre, the child recovered uneventfully.

This paper addresses the process used from the award of the project to the successful completion of the conversion of a parallel taxiway to a temporary runway and the overlay of the main runway at the Oakland Airport. It describes the tremendous planning, communication and work effort required from all stakeholders of the project. It also describes the infrastructure improvements required to support the project and some of the problems that were encountered prior to the start and during construction of the project.

La hematopoyesis extramedular es un fenomeno compensador que se desarrolla en distintas enfermedades en las que existe una produccion insuficiente o una destruccion excesiva de celulas hematicas. Una de sus posibles localizaciones, si bien rara, es en las regiones toracicas paravertebrales. La existencia de una opacidad radiologica a este nivel en un paciente con historia de anemia cronica y/o esplenomegalia o antecedentes de esplenectomia, debe hacer sospechar el diagnostico de hematopoyesis extramedular intratoracica (HEMIT). Presentamos el caso de un varon de 57 anos en el que se descubrio casualmente en una radiografia de torax una masa mediastinica posterior. Fue diagnosticado de HEMIT tras toracotomia. El hecho de carecer de enfermedad hematologica subyacente objetivable en el momento del diagnostico lo convertiria en el primer caso de HEMIT aparentemente idiopatica diagnosticada in vivo .