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Purpose Chronic cough (cough that persists for [greater than or equal to] 8 weeks) can cause a range of physical symptoms and psychosocial effects that significantly impair patients' quality of life. Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are challenging to diagnose and manage, with substantial economic implications for healthcare systems. Methods This retrospective multicenter non-interventional study aimed to characterize the profile and health resource consumption of patients with RCC or UCC who attended outpatient clinics at Spanish hospitals. Data were collected from medical records of patients with RCC or UCC for up to 3 years before study inclusion. Results The patient cohort (n = 196) was representative of the chronic cough population (77.6% female, mean age 58.5 years). Two-thirds of patients (n = 126) had RCC. The most frequently visited doctors were pulmonologists (93.4% of patients) and primary care physicians (78.6%), with a mean of 5 visits per patient over three years' observation. The most common diagnostic tests were chest x-ray (83.7%) and spirometry with bronchodilation (77.0%). The most commonly prescribed treatments were proton pump inhibitors (79.6%) and respiratory medications (87.8%). Antibiotics were prescribed empirically to 56 (28.6%) patients. Differences between RCC or UCC groups related mainly to approaches used to manage cough-associated conditions (gastroesophageal reflux disease, asthma) in patients with RCC. Conclusion RCC and UCC are responsible for high health resource utilization in Spanish hospitals. Specific treatments targeting the pathological processes driving chronic cough may provide opportunities to reduce the associated burden for patients and healthcare systems., Author(s): Ignacio Dávila [sup.1], Luis Puente [sup.2], Santiago Quirce [sup.3], Ebymar Arismendi [sup.4], Miguel Díaz-Palacios [sup.5], Antonio Pereira-Vega [sup.6], Alfredo de Diego [sup.7], Juan Luis Rodriguez-Hermosa [sup.8], Luis Cea-Calvo [sup.9], [...]

Objective: To investigate markers of premature menopause (

BackgroundThe prevalence of obstructive sleep apnea is higher in women after menopause. This is suggested to be a result of an altered sex hormone balance but has so far not been confirmed in a population-based study.ObjectiveTo investigate whether serum concentration of estrogens and progesterone are associated with the prevalence of sleep apnea symptoms in middle-aged women of the general population.MethodsWe analyzed data from 774 women (40-67 years) from 15 study centers in seven countries participating in the second follow-up of the European Community Respiratory Health Survey (2010-2012). Multiple logistic regression models were fitted with self-reported symptoms of sleep apnea as outcomes and serum concentrations of various estrogens and progesterone as predictors. All analyses were adjusted for relevant covariates including age, BMI, education, study center, smoking habits, and reproductive age.ResultsAmong all included women, a doubling of serum concentrations of estrone and progesterone was associated with 19% respectively 9% decreased odds of snoring. Among snorers, a doubling of the concentrations of 17β-estradiol, estrone and estrone 3-sulfate was associated with 18%, 23% and 17% decreased odds of breathing irregularly, and a doubling of the progesterone concentration was further associated with 12% decreased odds of waking up suddenly with a chocking sensation. Other evaluated associations were not statistically significant.ConclusionsMiddle-aged women with low serum estrogen and progesterone levels are more likely to snore and report symptoms of obstructive sleep apnea.

Abstract Background Early life exposure to tobacco smoke has been extensively studied but the role of second-hand smoke (SHS) for new-onset respiratory symptoms and lung function decline in adulthood has not been widely investigated in longitudinal studies. Our aim is to investigate the associations of exposure to SHS in adults with respiratory symptoms, respiratory conditions and lung function over 20 years. Methods We used information from 3011 adults from 26 centres in 12 countries who participated in the European Community Respiratory Health Surveys I-III and were never or former smokers at all three surveys. Associations of SHS exposure with respiratory health (asthma symptom score, asthma, chronic bronchitis, COPD) were analysed using generalised linear mixed-effects models adjusted for confounding factors (including sex, age, smoking status, socioeconomic status and allergic sensitisation). Linear mixed-effects models with additional adjustment for height were used to assess the relationships between SHS exposure and lung function levels and decline. Results Reported exposure to SHS decreased in all 26 study centres over time. The prevalence of SHS exposure was 38.7% at baseline (1990–1994) and 7.1% after the 20-year follow-up (2008–2011). On average 2.4% of the study participants were not exposed at the first, but were exposed at the third examination. An increase in SHS exposure over time was associated with doctor-diagnosed asthma (odds ratio (OR): 2.7; 95% confidence interval (95%-CI): 1.2–5.9), chronic bronchitis (OR: 4.8; 95%-CI: 1.6–15.0), asthma symptom score (count ratio (CR): 1.9; 95%-CI: 1.2–2.9) and dyspnoea (OR: 2.7; 95%-CI: 1.1–6.7) compared to never exposed to SHS. Associations between increase in SHS exposure and incidence of COPD (OR: 2.0; 95%-CI: 0.6–6.0) or lung function (β: − 49 ml; 95%-CI: -132, 35 for FEV1 and β: − 62 ml; 95%-CI: -165, 40 for FVC) were not apparent. Conclusion Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes.

Background: Fractional exhaled nitric oxide (FeNO) is a marker of type-2 inflammation used both to support diagnosis of asthma and follow up asthma patients. The associations of FeNO with lung function decline and bronchodilator (BD) response have been studied only scarcely in large populations. Objectives: To study the association between FeNO and a) retrospective lung function decline over 20 years, and b) lung function response to BD among asthmatic subjects compared with non-asthmatic subjects and with regards to current smoking and sex. Methods: Longitudinal analyses of previous lung function decline and FeNO level at follow-up and cross-sectional analyses of BD response and FeNO levels in 4257 participants (651 asthmatics) from the European Community Respiratory Health Survey. Results: Among asthmatic subjects, higher percentage declines of FEV1 and FEV1/FVC were associated with higher FeNO levels (p = 0.001 for both) at follow-up. These correlations were found mainly among non-smoking individuals (p = 0.001) and females (p = 0.001) in stratified analyses.Percentage increase in FEV1 after BD was positively associated with FeNO levels in non-asthmatic subjects. Further, after stratified for sex and smoking separately, a positive association was seen between FEV1 and FeNO levels in non-smokers and women, regardless of asthma status. Conclusions: We found a relationship between elevated FeNO and larger FEV1 decline over 20 years among subjects with asthma who were non-smokers or women. The association between elevated FeNO levels and larger BD response was found in both non-asthmatic and asthmatic subjects, mainly in women and non-smoking subjects.

El continuo incremento del gasto en medicamentos a nivel mundial, íntimamente asociado al crecimiento poblacional y al aumento de la esperanza de vida de las personas, ha llevado en las últimas décadas a los gobiernos a buscar alternativas que contribuyan a reducir el impacto de este rubro en los presupuestos. Una alternativa es el uso de medicamentos genéricos, que son más baratos que los innovadores. Sin embargo, antes de ser registrado, el producto genérico debe demostrar su equivalencia terapéutica mediante ensayos in vitro y/o in vivo contra un medicamento de referencia, con el propósito de garantizar su calidad, seguridad y eficacia y, como consecuencia de ello, su intercambiabilidad. Mediante una encuesta online realizada en Costa Rica durante los meses de marzo y abril de 2013, se determinó que existía una demanda de 85 medicamentos fabricados en el país, que para ser registrados a nivel nacional requerían de la misma cantidad de estudios de equivalencia terapéutica, de los cuales 47 correspondían a ensayos in vitro y 38 a ensayos in vivo. Esta demanda provenía principalmente de cuatro laboratorios que fabrican medicamentos en Costa Rica, y aumenta si se consideran los medicamentos exportados. En cuanto a la oferta nacional de estos servicios (ensayos in vitro e in vivo) por parte de laboratorios ajenos a la casa fabricante, se sabe que es muy limitada, ya que solo había dos que los ofertaban y su labor se circunscribe, por ahora, a los ensayos in vitro.

The history of the green fluorescent protein (GFP) starts with Osamu Shimomura at the beginning of the 1960s, with his discovery from the extracts of the Aequorea victoria jellyfish. However, it is not until the beginning of the 1990s, that the neurobiologist Martin Chalfie, applying genetic engineering tech- niques, achieved for the first time the heterology expression of the GFP in prokaryotes (E. coli) and eukaryotes (Caernohabditis elegans), from a clone of the jellyfish’s gen that codifies the GFP prepared by Douglas Prasher. Besides fluorescing in green, the results from this work also demonstrated that it does not require any other cofactor or enzyme of the jellyfish for its expression or for the own forming of a fluorophore. At the same time, Chalfie proposed that the GFP could be used for the marking of cells on living ani- mals or the tag of proteins. Based upon these results, many scientists started working on research related to the GFP; actually this protein is used on different fields such as biotechnol- ogy, development biology, environmental chemistry and medicine. In the case of the latter, it has helped to elucidate the cellular mechanisms from which diseases are made of. Science owes Roger Tsien, amongst other contributions, the creation of differ- ent mutations of the GFP.La historia de la proteína verde fluorescente (GFP) se inicia con Osamu Shimomura a principios de la década de 1960, con su descubrimiento de esta proteína a partir de extractos de la medusa Aequorea victoria. Sin embargo, es a principios de la década de 1990 que el neurobiólogo Martin Chalfie, aplicando técnicas de ingeniería genética, logra por primera vez la expresión heteróloga de la GFP en procariotas (Escherichia coli) y eucariotas (Caernohabditis elegans), a partir de un clon del gen de la medusa que codifica a la GFP, preparado por Douglas Prasher. Además de fluorescer en verde, los resultados de este trabajo también demostraron que no se requiere ningún cofactor o enzima de la medusa para su expresión o para la formación misma del fluoróforo. Asimismo, Chalfie propuso que la GFP podría utilizarse para el marcaje de células en anima- les vivos o para el etiquetado de proteínas. Los resultados de Chalfie dispararon las investiga- ciones sobre esta proteína y en la actualidad se usa en diversos campos, tales como la biotecnología, la biología del desarrollo, la química ambiental y la medicina. En la medicina está ayudando a dilucidar los mecanismos celulares por los que se producen muchas enfermedades. A Roger Tsien se le debe, entre otros aportes, la creación de diversas mutan- tes de la GFP.

AIM: To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. METHODS: The Committee on Maternal Mortality of São Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2% and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3%) cases. RESULTS: Ninety-five (66.9%) of the deaths occurred during the puerperal period and 34 (23.9%) occurred during pregnancy. The time of death was not reported in 13 (9.2%) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4%), acute pulmonary edema (24.6%), and coagulopathies (14.1%). Cesarean section was performed in 85 (59.9%) cases and vaginal delivery in 15 (16.0%). CONCLUSION: Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in São Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.OBJETIVO: Descrever o perfil dos casos de morte materna decorrente de complicações da hipertensão arterial e propor medidas para sua redução. MÉTODOS: De 1995 a 1999 o Comitê de Mortalidade Materna da Cidade de São Paulo identificou 609 casos de morte materna obstétrica, com uma subnotificação de 52,2% e um CMM=56,7/100.000 Nascidos Vivos. A hipertensão arterial foi a principal causa de óbito materno, correspondendo a 142 (23,3%) casos. RESULTADOS: Ocorreram 95 (66,9%) de óbitos no puerpério e 34 (23,9%) durante a gestação. Em 13 (9,2%) casos não se teve referência ao momento do óbito. Houve relato de crises convulsivas em 41 casos com a utilização de sulfato de magnésio em quatro deles. As principais causas determinantes do óbito foram: o acidente vascular cerebral (44,4%), o edema agudo de pulmão (24,6%) e as coagulopatias (14,1%). A cesárea foi realizada em 85 (59,9%) casos e o parto vaginal em 15 (16,0%). Em 28 (19,7%) casos não foi realizada nenhuma conduta para interromper a gravidez e em 14 (9,8%) não se obteve relato do procedimento. CONCLUSÃO: As complicações da hipertensão arterial no ciclo gravídico-puerperal determinam altos índices de mortalidade materna na cidade de São Paulo. A realização de um pré-natal de qualidade e o atendimento apropriado da gestante hipertensa no parto e no pós-parto são medidas de fundamental importância para um melhor controle desse evento, sendo primordial para a redução dessas ocorrências.

El presente artículo sintetiza la investigación realizada por un equipo interdisciplinario sobre la experiencia de las carreras de Trabajo Social, Farmacia, Orientación y Educación Especial de la Universidad de Costa Rica relacionada con la obtención de información sobre la permanencia de la población estudiantil, esto para atender las compromisos de autoevaluación y la toma de decisiones. También se consideró oportuno indagar sobre el rol de las instancias universitarias que brindan la información requerida. La investigación se realizó en el año 2013, desde una aproximación cualitativa, descriptiva y reflexiva sobre el acceso a la información relacionada con la permanencia del estudiantado. Como resultados se obtienen los requerimientos de información y las principales fuentes, las experiencias positivas y negativas desde la perspectiva de las carreras y de las instancias universitarias, así como un análisis de las implicaciones que tiene para la gestión de las Carreras y la Universidad las limitaciones en el acceso a la información entre las que se destacan los tiempos de respuesta, inconsistencias cuantitativas entre la información aportada por las diversas dependencias los limitados recursos humanos y la carencia de aplicaciones informáticas para dar respuesta a los requerimientos de las carreras. Concluye el artículo insistiendo en que para lograr la calidad de la educación se requiere de un sistema de información que permita dar cuenta de los logros y los retos de las carreras y evidenciar que la población estudiantil ejerce el pleno derecho a la Educación Superior cumpliendo con los compromisos asumidos ante la sociedad costarricense. This article synthesizes the research performed by an interdisciplinary team about the experience of the Social Work, Pharmacy, Counseling, and Special Education careers in the University of Costa Rica, related to the compilation of information about the continuity of the student population. This is done to attend the demands of the self-evaluation and the decision-making process. It was also considered convenient to inquire about the experience of the university offices that provide the required information. The research was carried out in the year 2013, from a qualitative, descriptive and reflexive approach regarding the access to information connected to the continuity of the students. The results are: the need for information and main sources, positive and negative experiences from the perspective of the careers and the university offices, as well as an analysis of the implications the limitations to information access have for the management of the Careers and the University, among which the following stand out: response times, quantitative inconsistencies between the information provided by the dependence, limited human resources, and the lack of technological applications to support the needs of the careers. The article concludes with a reminder that to accomplish the desired quality of education an information system is required, which accounts for the accomplishments and the challenges of the careers, and demonstrates that the student body exercises its rights to Superior Education by accepting their responsibility towards Costa Rican society.

A razão de mortalidade materna (MM) é indicador da qualidade de saúde, influenciada diretamente pelo grau de desenvolvimento econômico-cultural-tecnológico de um país. Os dados oficiais de MM no Brasil, ainda que subestimados, sinalizam a falta de qualidade dos serviços de assistência à gestação, parto e puerpério. Esta característica é comum entre os países em desenvolvimento, onde estão as gestantes mais necessitadas e com maior dificuldade de acesso a assistência de qualidade. A assistência pré-natal não pode prevenir as principais complicações do parto, causas importantes de MM, mas algumas intervenções no pré-natal poderão favorecer o prognóstico materno e prevenir a MM. Neste contexto, o artigo faz uma atualização, embasada em evidências científicas, sobre intervenções efetivas no pré-natal para prevenção da mortalidade materna. As estratégias mais importantes constituem um tripé, com intervenções específicas relacionadas a promoção da saúde materna, prevenção dos riscos e garantia de suporte nutricional durante a gestação, além de critérios para investigação do risco gestacional e inclusão da gestante no componente básico do modelo de assistência pré-natal. Finaliza com a definição de prioridades na prevenção de MM relacionada à eclâmpsia/pré-eclâmpsia e reforça a importância da normatização dos sistemas de referência para os casos de emergência obstétrica.Maternal mortality rate (MM) is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are important causes of MM; however, some interventions during the prenatal period can favor maternal prognosis and prevent MM. In this setting, this study brings a scientifically based update concerning effective interventions for maternal mortality prevention during the prenatal period. The most important strategies consist of a tripod with specific interventions related to maternal health promotion, risk prevention and assurance of nutritional support during gestation, in addition to criteria to investigate gestational risk and inclusion of the pregnant woman in the basic component of the prenatal care model. It ends with the definition of priorities in the prevention of MM related to eclampsia/preeclampsia and reinforces the importance of normalization of reference systems for obstetric emergency cases.