[The role of civil society in improving childhood cancer care in Latin AmericaO papel da sociedade civil na melhoria da atenção ao câncer infantil na América Latina]. / El papel de la sociedad civil en la mejora de los cuidados del cáncer infantil en América Latina.

In Latin America, childhood cancer includes a number of resource-intensive diseases, with inequalities in access to timely and appropriate diagnosis and treatment. In this context, civil society plays a fundamental role in improving childhood cancer care. The Region's organizations in this sector have become stronger and they now play a leading role in the delivery of services and in the promotion of awareness and advocacy for children's health. The Global Initiative for Childhood Cancer, promoted by the World Health Organization and other relevant actors, is an opportunity for governments and civil society to work together to implement best practices in the control of childhood cancer. This article addresses the role of civil society in the care of pediatric cancer in Latin America, highlighting the importance of its commitment to the fight against cancer, participation in awareness-raising, and defense of public policies that favor access to quality health services. It also focuses on the problems and opportunities for civil society in the Region in relation to the implementation of strategies to improve the survival and quality of life of children and adolescents living with cancer.

Na América Latina, o câncer infantil inclui várias doenças que demandam muitos recursos e trazem desigualdades no acesso a diagnóstico e tratamento oportunos e adequados. Nesse contexto, a sociedade civil tem um papel fundamental na melhoria da atenção ao câncer infantil. As organizações desse setor foram fortalecidas na região para desempenhar um papel de liderança na prestação de serviços, na conscientização e na defesa da saúde infantil. A Iniciativa Global para o Câncer Infantil, impulsionada pela Organização Mundial da Saúde e outros atores relevantes, é uma oportunidade para que os governos e a sociedade civil trabalhem juntos para implementar melhores práticas no controle do câncer infantil. Nesse contexto, este artigo aborda o papel da sociedade civil na atenção ao câncer na população pediátrica da América Latina. Destaca-se a importância do compromisso da sociedade na luta contra essa doença, da participação na conscientização e da defesa de políticas públicas que favoreçam o acesso a serviços de saúde de qualidade. Além disso, destacam-se problemas e oportunidades da sociedade civil da Região no que diz respeito à implementação de estratégias para melhorar a sobrevida e a qualidade de vida de crianças e adolescentes que sofrem dessa doença.

El papel de la sociedad civil en la mejora de los cuidados del cáncer infantil en América Latina / The role of civil society in improving childhood cancer care in Latin America / O papel da sociedade civil na melhoria da atenção ao câncer infantil na América Latina

[RESUMEN]. En América Latina, el cáncer infantil incluye una serie de enfermedades que exigen muchos recursos y presentan desigualdades en el acceso a diagnóstico y tratamiento oportunos y adecuados. En este contexto, la sociedad civil juega un papel fundamental en la mejora de los cuidados del cáncer infantil. Las organizaciones de este sector se han fortalecido en la Región para cumplir un papel protagónico en la entrega de servicios y en la promoción de conciencia y defensa en pro de la salud infantil. La Iniciativa Global para el Cáncer Infantil, impulsada por la Organización Mundial de la Salud y otros actores relevantes, es una oportunidad para que los gobiernos y la sociedad civil trabajen juntos en la implementación de mejores prácticas en el control del cáncer infantil. En este sentido, en este artículo se aborda el papel de la sociedad civil en el cuidado del cáncer en la edad pediátrica en América Latina. Se destaca la importancia de su compromiso en la lucha contra esta enfermedad, participación en la concienciación y la defensa de políticas públicas que favorezcan el acceso a servicios de salud de calidad. Además, se destacan los problemas y las oportunidades que tiene la sociedad civil en la Región con relación a la implementación de estrategias para mejorar la sobrevida y la calidad de vida de los niños, niñas y adolescentes que padecen esta enfermedad.

[ABSTRACT]. In Latin America, childhood cancer includes a number of resource-intensive diseases, with inequalities in access to timely and appropriate diagnosis and treatment. In this context, civil society plays a fundamental role in improving childhood cancer care. The Region's organizations in this sector have become stronger and they now play a leading role in the delivery of services and in the promotion of awareness and advocacy for children's health. The Global Initiative for Childhood Cancer, promoted by the World Health Organization and other relevant actors, is an opportunity for governments and civil society to work together to implement best practices in the control of childhood cancer. This article addresses the role of civil society in the care of pediatric cancer in Latin America, highlighting the importance of its commitment to the fight against cancer, participation in awareness-raising, and defense of public policies that favor access to quality health services. It also focuses on the problems and opportunities for civil society in the Region in relation to the implementation of strategies to improve the survival and quality of life of children and adolescents living with cancer.

[RESUMO]. Na América Latina, o câncer infantil inclui várias doenças que demandam muitos recursos e trazem desigualdades no acesso a diagnóstico e tratamento oportunos e adequados. Nesse contexto, a sociedade civil tem um papel fundamental na melhoria da atenção ao câncer infantil. As organizações desse setor foram fortalecidas na região para desempenhar um papel de liderança na prestação de serviços, na conscientização e na defesa da saúde infantil. A Iniciativa Global para o Câncer Infantil, impulsionada pela Organização Mundial da Saúde e outros atores relevantes, é uma oportunidade para que os governos e a sociedade civil trabalhem juntos para implementar melhores práticas no controle do câncer infantil. Nesse contexto, este artigo aborda o papel da sociedade civil na atenção ao câncer na população pediátrica da América Latina. Destaca-se a importância do compromisso da sociedade na luta contra essa doença, da participação na conscientização e da defesa de políticas públicas que favoreçam o acesso a serviços de saúde de qualidade. Além disso, destacam-se problemas e oportunidades da sociedade civil da Região no que diz respeito à implementação de estratégias para melhorar a sobrevida e a qualidade de vida de crianças e adolescentes que sofrem dessa doença.

Expresión de los factores de transcripción sensibles a la hipoxia, de la respuesta inflamatoria y del estrés oxidativo a nivel muscular en tres modelos clínicos de hipoxemia / Expression of transcription factors sensitive to hypoxia, of the inflammatory response and oxidative stress to muscle level in three clinical models of hypoxemia

OBJETIVO: Comparar la expresión de marcadores de respuesta a hipoxia, inflamatorios y de estrés oxidativo en biopsia muscular de grupos de pacientes con hipoxia crónica continua, crónica intermitente y ambas combinadas. Evaluar el estado de la musculatura periférica y compararla entre grupos. METODOLOGÍA: Incluimos varones mayores de 18 años, diagnosticados de EPOC, Apnea Obstructiva del Sueño (AOS) o AOS-EPOC, a los que se realizó biopsia muscular del cuádriceps. Los biomarcadores seleccionados para su estudio en músculo fueron factores de transcripción asociados a la hipoxia, como el factor inducible por hipoxia HIF-1, HIF-2 y el factor nuclear. También biomarcadores inflamatorios como factor de necrosis tumoral-α, interkeukina 6 y 8, factor de crecimiento endotelial vascular y proteína de adhesión celular vascular 1 (VCAM-1), así como biomarcadores de estrés oxidativo, como superóxidodismutasa (SOD) y actividad catalasa. Además se realizó evaluación de la función muscular en los tres grupos. RESULTADOS: Reclutamos 29 sujetos: 4 con EPOC, 12 con AOS y 13 EPOC-AOS. En el músculo, encontramos diferencias entre los grupos de estudio en VCAM-1 (casos de EPOC que expresan 2,1 veces más que AOS y 1,16 veces más que EPOC-AOS) y SOD (EPOC-AOS que expresan 3,48 veces más que EPOC, y AOS 3,02 veces más que EPOC). CONCLUSIONES: La expresión de biomarcadores estudiados es de intensidad similar en los tres grupos de pacientes referidos, con pocas excepciones.La fuerza muscular periférica y el porcentaje de masa libre de grasa es significativamente menor en los pacientes con EPOC que en los pacientes con AOS. (AU)

OBJECTIVE: Compare the expression of markers of response to hypoxia, inflammation and oxidative stress in biopsy muscle of groups of patients with continuous chronic hypoxia, intermittent chronic and both combined. Evaluate the state of the peripheral musculature and compare it between groups. METHODOLOGY: We included males older than 18 years, diagnosed of COPD, Obstructive Sleep Apnea (OSA) or OSA-COPD, to quadriceps muscle biopsy was performed. biomarkers selected for study in muscle were factors of transcription associated with hypoxia, such as the factor inducible by hypoxia HIF-1, HIF-2 and nuclear factor. Also biomarkers Inflammatory agents such as tumor necrosis factor-α, interkeukin 6, and 8, vascular endothelial growth factor and adhesion protein vascular cell 1 (VCAM-1), as well as stress biomarkers oxidative, such as superoxide dismutase (SOD) and catalase activity. In addition, evaluation of muscle function was performed in the three groups. RESULTS: We recruited 29 subjects: 4 with COPD, 12 with OSA and 13 COPD-OSA. In muscle, we found differences between the study groups in VCAM-1 (COPD cases expressing 2.1-fold more than OSA and 1.16 times more than COPD-OSA) and SOD (COPD-OSA than express 3.48 times more than COPD, and OSA 3.02 times more than COPD). CONCLUSIONS: The expression of studied biomarkers is of similar intensity in the three groups of referred patients, with few exceptions. Peripheral muscle strength and percentage of fat-free mass is significantly lower in patients with COPD than in patients with OSA. (AU)

El papel de la sociedad civil en la mejora de los cuidados del cáncer infantil en América Latina / The role of civil society in improving childhood cancer care in Latin America / O papel da sociedade civil na melhoria da atenção ao câncer infantil na América Latina

RESUMEN En América Latina, el cáncer infantil incluye una serie de enfermedades que exigen muchos recursos y presentan desigualdades en el acceso a diagnóstico y tratamiento oportunos y adecuados. En este contexto, la sociedad civil juega un papel fundamental en la mejora de los cuidados del cáncer infantil. Las organizaciones de este sector se han fortalecido en la Región para cumplir un papel protagónico en la entrega de servicios y en la promoción de conciencia y defensa en pro de la salud infantil. La Iniciativa Global para el Cáncer Infantil, impulsada por la Organización Mundial de la Salud y otros actores relevantes, es una oportunidad para que los gobiernos y la sociedad civil trabajen juntos en la implementación de mejores prácticas en el control del cáncer infantil. En este sentido, en este artículo se aborda el papel de la sociedad civil en el cuidado del cáncer en la edad pediátrica en América Latina. Se destaca la importancia de su compromiso en la lucha contra esta enfermedad, participación en la concienciación y la defensa de políticas públicas que favorezcan el acceso a servicios de salud de calidad. Además, se destacan los problemas y las oportunidades que tiene la sociedad civil en la Región con relación a la implementación de estrategias para mejorar la sobrevida y la calidad de vida de los niños, niñas y adolescentes que padecen esta enfermedad.

ABSTRACT In Latin America, childhood cancer includes a number of resource-intensive diseases, with inequalities in access to timely and appropriate diagnosis and treatment. In this context, civil society plays a fundamental role in improving childhood cancer care. The Region's organizations in this sector have become stronger and they now play a leading role in the delivery of services and in the promotion of awareness and advocacy for children's health. The Global Initiative for Childhood Cancer, promoted by the World Health Organization and other relevant actors, is an opportunity for governments and civil society to work together to implement best practices in the control of childhood cancer. This article addresses the role of civil society in the care of pediatric cancer in Latin America, highlighting the importance of its commitment to the fight against cancer, participation in awareness-raising, and defense of public policies that favor access to quality health services. It also focuses on the problems and opportunities for civil society in the Region in relation to the implementation of strategies to improve the survival and quality of life of children and adolescents living with cancer.

RESUMO Na América Latina, o câncer infantil inclui várias doenças que demandam muitos recursos e trazem desigualdades no acesso a diagnóstico e tratamento oportunos e adequados. Nesse contexto, a sociedade civil tem um papel fundamental na melhoria da atenção ao câncer infantil. As organizações desse setor foram fortalecidas na região para desempenhar um papel de liderança na prestação de serviços, na conscientização e na defesa da saúde infantil. A Iniciativa Global para o Câncer Infantil, impulsionada pela Organização Mundial da Saúde e outros atores relevantes, é uma oportunidade para que os governos e a sociedade civil trabalhem juntos para implementar melhores práticas no controle do câncer infantil. Nesse contexto, este artigo aborda o papel da sociedade civil na atenção ao câncer na população pediátrica da América Latina. Destaca-se a importância do compromisso da sociedade na luta contra essa doença, da participação na conscientização e da defesa de políticas públicas que favoreçam o acesso a serviços de saúde de qualidade. Além disso, destacam-se problemas e oportunidades da sociedade civil da Região no que diz respeito à implementação de estratégias para melhorar a sobrevida e a qualidade de vida de crianças e adolescentes que sofrem dessa doença.

Cellular mechanisms involved in the pathogenesis of airway remodeling in chronic lung disease.

Background: Airway epithelial cells and lung fibroblasts play an important role in the development of chronic lung disease, but the exact mechanisms responsible have not been clarified. Our objective was to investigate the involvement of these cells in the inflammatory response associated to chronic lung disease. Methods: Human lung fibroblasts and airway epithelial cells were challenged with Interleukin-1ß and hypoxia, and with inhibitory (simvastatin) stimuli of the inflammatory response. Expression of markers of local inflammation ((IL-8, monocyte chemoattractant protein-1 (MCP-1), factor-κB1 (NF-κB1)), systemic inflammation ((C-reactive protein (CRP) and serum amyloid A (SAA)) and proteases matrix metalloproteinase (MMP) 9 and 12 were assessed by PCR and ELISA. Apoptosis/necrosis was analyzed by flow cytometry. Results: Our results showed that the lung fibroblasts had a higher expression of local and systemic inflammation and protease activity markers when they were treated with IL-1ß compared to airway epithelial cells. Under hypoxic conditions, we observed a decrease in systemic inflammation in lung fibroblasts, which was further attenuated by simvastatin. Conclusion: The lung fibroblasts seem to be the main initially stimulated cells that could potentially trigger the inflammatory response, and be responsible for the eventual onset of chronic lung disease. The involvement of IL-1ß stimulation in systemic inflammatory and proteinase imbalance biomarkers is higher in lung fibroblasts. Apoptosis is not a predominant mechanism in these cells.

Hyptis mociniana: phytochemical fingerprint and photochemoprotective effect against UV-B radiation-induced erythema and skin carcinogenesis.

Skin cancer is a public health problem due to its high incidence. Ultraviolet radiation (UVR) is the main etiological agent of this disease. Photochemoprotection involves the use of substances to avoid damage caused by UV exposure. The aim of this work was to determine the phytochemical fingerprint and photochemoprotective effect against UVB radiation-induced skin damage such as erythema and carcinogenesis of H. mociniana methanolic extract (MEHm). The chemical composition of the MEHm was analysed by LC/ESI-MS/MS. Three quercetin derivatives, two pectinolides, and two caffeic acid derivatives were identified in the methanolic extract. MEHm has antioxidant effect and it is not cytotoxic in HaCaT cells. Phytochemicals from H. mociniana have a photochemopreventive effect because they absorb UV light and protect HaCaT cells from UVR-induced cell death. Also, in SKH-1 mice -acute exposure-, it decreased erythema formation, modulating the inflammatory response, reduced the skin damage according to histological analysis and diminished p53 expression. Finally, MEHm protects from photocarcinogenesis by reducing the incidence and multiplicity of skin carcinomas in SKH-1 mice exposed chronically to UVB radiation.

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP). / Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP).

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Pediatric mastocytosis: report of 23 cases in 5 years / Mastocitosis cutánea en niños: reporte de 23 casos en 5 años

RESUMEN Introducción: Las mastocitosis son un conjunto de trastornos clínicos, producidos todos ellos por una proliferación de mastocitos y su acumulación en varios órganos, entre los cuales el más común es la piel. Objetivo: Presentar la experiencia de pacientes con mastocitosis oriundos de Neuquén atendidos en el consultorio de Dermatología pediátrica en un período de 5 años. Detallar formas clínicas, presentación, topografía de las lesiones y evolución. Diseño: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en el período comprendido entre abril de 2013 y marzo de 2018. Materiales y Método: Se revisaron las Historias clínicas digitales de pacientes con diagnóstico de mastocitosis cutánea que concurrieron al consultorio de dermatología infantil en la ciudad de Neuquén. Resultados: Se reunieron 23 casos de mastocitosis cutánea; de ellos el 60,87% corresponden a mastocitosis maculopapular y el 39,13%, a mastocitomas. No hubo diferencias significativas en cuanto al sexo. La mayoría de ellos presentó lesiones localizadas en tronco y miembros. El 95% tuvo signo de Darier positivo. Conclusiones: En nuestra muestra la presentación clínica más frecuente fue la mastocitosis maculopapular y la edad de inicio fue antes del año de vida en la totalidad de los pacientes. Las lesiones se distribuyeron en tronco y miembros en la mayoría de los casos. Los pacientes con mastocitomas solitarios permanecieron estables; en los casos de mastocitosis maculopapular se utilizaron antihistamínicos, con buena evolución.

ABSTRACT Introduction: Mastocytosis is a heterogeneous group of disorders, characterized by a proliferation of mast cells and its accumulation in several organs, being the skin the most frequently affected one. Design: A descriptive, retrospective cross-sectional study, was conducted in the period from April 2013 to March 2018 in Neuquen city. Materials and Method: Electronic medical records of patients diagnosed with cutaneous mastocytosis who attended to the pediatric dermatology clinic in Neuquen city were reviewed. Results: We present 23 cases of cutaneous mastocytosis, of which 60,87% were maculopapular and 39,13% mastocytomas. There were no significant differences in terms of sexes. Most of them presented localized lesions in trunk and limbs. 95% had positive Darier´s sign. Conclusions: In our sample, the most frequent clinical presentation was maculopapular mastocytosis, and the age of onset was during the first year of life in all patients. The majority of lesions were distributed over the trunk and limbs. Patients with mastocytoma remained stable; maculopapular patients recieved antihistamines, with good evolution.

Picaduras por aracnomorfos en la ciudad de Sucre (Chuquisaca, Bolivia) / Arachnomorph´s pitting in the city of Sucre (Chuquisaca, Bolivia)

Se realizó un estudio de picaduras de aracnomrofos en la ciudad de Sucre (Chuquisaca). El método comprendió el uso de encuestas semiestructuradas, donde se consultó sobre la percepción que tienen, sintomatologías y conocimiento local sobre métodos de curación. Los resultados obtenidos evidencian que la mayoría tiene fobia hacia los arácnidos. El conocimiento local, permite conocer los diferentes tipos de arañas y escorpiones que residen en los domicilios. Se describe los síntomas que causan debido al efecto de las picadas, además de los métodos convencionales y naturales de curación.

We study of pitting Arachnomorph´s was held in the city of Sucre (Chuquisaca). The method realized using semistructured interviews, which were consulted on the perception, symptom and local knowledge of healing methods. The results show that most have phobia of arachnids. Local knowledge, allows to know the different types of spiders and scorpions that live in the homes. They are causing symptoms due to the effect of bites and of natural and using the conventional and natural healing methods.

La arteria pulmonar es el principal productor de reactantes de fase aguda en pacientes con enfermedad pulmonar obstructiva crónica / The pulmonary artery is the main producer of acute phase reactants in patients with chronic obstructive pulmonary disease

INTRODUCCIÓN: El origen de la inflamación sistémica en la EPOC sigue estando poco aclarada. Hemos tratado de comparar la expresión de los niveles de reactantes de fase aguda en pacientes con EPOC y los fumadores sanos (controles), tanto en las arterias pulmonares locales como en leucocitos de sangre periférica y plasma. MÉTODO: Los pacientes se clasificaron como EPOC o fumadores sanos según los resultados de la espirometría. Las arterias pulmonares, leucocitos de sangre periférica y las muestras de plasma se obtuvieron de todos los sujetos incluidos. La expresión génica de la proteína C-reactiva (PCR) y el amiloide sérico A (AAS1, AAS2, y AAS4) se evaluó en muestras de tejidos y leucocitos de sangre periférica mediante RT-PCR. Los niveles de PCR y AAS se midieron mediante ensayos inmunoenzimáticos. RESULTADOS: Se incluyeron un total de 40 pacientes con EPOC y 62 fumadores sanos, reclutados desde comienzos del año 2011 hasta finales del 2012. Tanto PCR y AAS se sobreexpresa en la arteria pulmonar en comparación con los leucocitos de sangre periférica. En los pacientes con EPOC, en la arteria pulmonar, los niveles de expresión génica de la PCR, el AAS1, y el AAS2 fueron 8-, 56-, y 2,3 veces mayor que en los leucocitos de sangre periférica, respectivamente. No se observó correlación entre los niveles plasmáticos de marcadores inflamatorios y su expresión en la arteria pulmonar y leucocitos de sangre periférica. CONCLUSIONES: La sobreexpresión de AAS en las arterias pulmonares en comparación con los leucocitos de sangre periférica sugiere que el pulmón puede ser la principal fuente de AAS en pacientes con EPOC. Otras fuentes potenciales de inflamación sistémica en la EPOC (por ejemplo, el hígado) necesitan un examen más detallado

INTRODUCTION: The origin of systemic inflammation in COPD is still not completely clear. We have attempted to compare the expression levels of acute phase reactants in patients with COPD and healthy smokers (controls), both in the local pulmonary artery and in peripheral blood leukocytes and plasma. METHOD: Patients were classified as having COPD or being healthy smokers according to spirometry results. The pulmonary artery, peripheral blood leukocyte and plasma samples were obtained from all included subjects. Genetic expression of the C-reactive protein (CRP) and serum amyloid A (SAA1, SAA2 and SAA4) was evaluated in tissue samples and peripheral blood leukocytes using RT-CRP. CRP and SAA levels were measured using immunoenzymatic assays. RESULTS: A total of 40 patients with COPD and 62 healthy smokers were included, recruited between early 2011 and late 2012. Both CRP and SAA was overexpressed in the pulmonary artery in comparison with peripheral blood leukocytes. In patients with COPD, genetic expression levels of CRP, SAA1 and SAA2 in the pulmonary artery were 8, 56, and 2.3 times higher than in peripheral blood leukocytes, respectively. No correlation was observed between inflammatory marker plasma levels and their expression in the pulmonary artery and peripheral blood leukocytes. CONCLUSIONS: The overexpression of SAA in pulmonary arteries in comparison with peripheral blood leukocytes suggests that the lung may be the main source of SAA in patients with COPD. Other potential sources of systemic inflammation in COPD (for example, the liver) require more detailed examination

Variabilidad de la práctica clínica para la enfermedad pulmonar obstructiva crónica en consultas externas / Variability in clinical practice for chronic obstructive pulmonary disease in outpatient clinics

OBJETIVOS: hasta el momento no existen trabajos de auditorías clínicas que evalúen la práctica clínica en la enfermedad pulmonar obstructiva crónica (EPOC) en el ámbito de consultas externas. El presente trabajo es un primer proyecto piloto que tiene por objetivo evaluar la variabilidad de la práctica clínica para la EPOC en este ámbito asistencial. MÉTODO: proyecto piloto de auditoría de historias clínicas llevada a cabo en consultas externas de Neumología en 9 hospitales públicos de Andalucía entre octubre 2013 y septiembre 2014. El objetivo era auditar 80 casos por centro, repartidos durante los 4 trimestres del año. La información se recogió mediante cuestionario estandarizado con 182 variables. Los datos se describen con medias y rangos interhospitalarios para evaluar la variabilidad. RESULTADOS: durante el año de estudio se analizaron 621 historias. Los pacientes eran mayoritariamente hombres, en la séptima década de la vida, con un porcentaje de fumadores activos del 26,2%, un considerable número de comorbilidades y mayoritariamente del ámbito urbano. Los datos indican que la atención sanitaria es en general correcta como promedio, pero indicando áreas de mejora en algunos puntos y una considerable variabilidad entre centros con diferencias significativas (p <0,001) para los cambios intercentro de la mayoría de las variables. CONCLUSIONES: la atención sanitaria al paciente con EPOC en consultas externas de Neumología en Andalucía muestra una considerable variabilidad que probablemente no pueda ser explicada sólo por la condición clínica del paciente. Estudios futuros deberán dilucidar qué factores inciden en esta variabilidad

OBJECTIVES: To date, there have been no clinical audits that evaluate clinical practice for chronic obstructive pulmonary disease (COPD) in outpatient clinics. This study is the first pilot project that aims to evaluate the variability in clinical practice for COPD in this healthcare setting. METHOD: A medical history audit pilot project carried out in outpatient pulmonology clinics in 9 public hospitals in Andalusia from October 2013 to September 2014. The objective was to audit 80 cases per center, distributed across the 4 quarters of the year. Information was collected using a standardized questionnaire with 182 variables. Data is described as averages and inter-hospital ranges to evaluate variability. RESULTS: 621 histories were analyzed during the year of the study. Patients were primarily male, in the seventh decade of life, 26.2% were active smokers, there were a considerable number of comorbidities and subjects lived in mainly urban areas. Data indicates that healthcare is generally appropriate on average, but there are areas of improvement in some points and there is a considerable variability between centers with significant differences (p <0.001) for inter-center changes for the majority of variables. CONCLUSIONS: Healthcare for patients with COPD in outpatient pulmonology clinics in Andalusia shows considerable variability that likely cannot be explained solely by the patient's clinical condition. Future studies must clarify what factors come into play in this variability

Psychometric properties of the parent́s perception uncertainty in illness scale, spanish version. / Escala de incertidumbre en la enfermedad­forma padres/hijos: validación de la adaptación al español.

OBJECTIVE: To analyze the psychometric properties of the Parents' Perception of Uncertainty in Illness Scale, parents/children, adapted to Spanish. METHOD: A descriptive methodological study involving the translation into Spanish of the Parents' Perception of Uncertainty in Illness Scale, parents/children, and analysis of their face validity, content validity, construct validity and internal consistency. RESULTS: The original version of the scale in English was translated into Spanish, and approved by its author. Six face validity items with comprehension difficulty were reported; which were reviewed and adapted, keeping its structure. The global content validity index with expert appraisal was 0.94. In the exploratory analysis of factors, 3 dimensions were identified: ambiguity and lack of information, unpredictability and lack of clarity, with a KMO=0.846, which accumulated 91.5% of the explained variance. The internal consistency of the scale yielded a Cronbach alpha of 0.86 demonstrating a good level of correlation between items. CONCLUSION: The Spanish version of "Parent's Perception of Uncertainty in Illness Scale" is a valid and reliable tool that can be used to determine the level of uncertainty of parents facing the illness of their children.

Lippia graveolens photochemopreventive effect against UVB radiation-induced skin carcinogenesis.

Lippia graveolens HBK (Mexican oregano) is a species that is regularly used as a condiment in Mexican cuisine. In traditional medicine, it is used for the treatment of respiratory and digestive illnesses, headaches, rheumatism and inflammation-related disorders. The main chemical components reported in this species include the following: terpenoids, iridoids and flavonoids. The aim of this study was to determine the potential photochemopreventive effect of the methanolic extract of Lippia graveolens (MELG) against ultraviolet B (UVB)-induced skin cancer in SKH-1 mice. The phenolic content, radical scavenger activity, penetration and genotoxicity of the MELG were also evaluated. The MELG exhibited scavenging activity against 1,1-diphenyl-2-picrylhydrazyl, superoxide and hydroxyl radicals, and it did not exhibit genotoxic activity in the micronucleus test. In addition, the MELG absorbed UVB (280nm) electromagnetic radiation. The main components detected in the plant extract were naringenin and galangin, and pinocembrin was also isolated and identified through spectroscopic analysis. The MELG demonstrated a photoprotective effect against UVB-induced cell death in Escherichia coli. In chronic challenge experiments, the MELG protected against UVB-induced skin cancer in SKH-1 mice. The MELG penetrated the skin of mice. Topical administration of the MELG protected against chronic UVB-induced damage in mouse SKH-1 skin. Our results suggest that the MELG has photochemopreventive activity and may potentially prevent photo-tumorigenesis.

Metodología geométrica para la evaluación de la saturación arterial de oxígeno en pacientes de la Unidad de Cuidados Intensivos / Geometric methodology for the saturation evaluation arterial oxygen in patients of the Care Unit Intensive

Introducción: En cardiología, la aplicación de teorías, como la de los sistemas dinámicos y la geometría fractal, han generado nuevos diagnósticos matemáticos que diferencian, de manera geométrica y cuantitativa, el comportamiento normal del enfermo a partir de la ocupación del atractor caótico cardíaco. El objetivo de este estudio fue desarrollar, en el contexto de la teoría de los sistemas dinámicos, una metodología de evaluación de la saturación arterial de oxígeno para pacientes en la Unidad de Cuidados Intensivos. Materiales y Métodos: Se seleccionaron 10 pacientes con diferentes enfermedades, provenientes de la Unidad de Cuidados Intensivos, a los cuales se les registró la saturación arterial de oxígeno durante su estancia en la Unidad, y se construyeron atractores caóticos en el mapa de retardo. Posteriormente, se establecieron cuantificaciones de los valores mínimos y máximos del atractor. Resultados: Los valores máximos y mínimos de los atractores de la saturación de oxígeno variaron entre el 100% y el 70%, para los pacientes que fallecieron, mientras que para aquellos que vivieron, se mantuvo entre el 99% y el 85%. Conclusiones: Se observó un comportamiento caótico asociado a la saturación arterial de oxígeno, cuantificable a partir de los valores máximos y mínimos hallados de la totalidad del atractor, estableciendo una nueva medida matemática y física del paciente crítico en la Unidad de Cuidados Intensivo (AU)

Introduction: In cardiology, the application of theories, such as dynamical systems and fractal geometry, has generated new mathematical diagnoses that differentiate geometrically and quantitatively the normal from the diseased behavior through the occupation of the cardiac chaotic attractor. The objective of this study was to develop, in the context of the dynamical systems theory, a methodology for the evaluation of arterial oxygen saturation in patients of the Intensive Care Unit. Materials and Methods: Ten patients with different pathologies from the Intensive Care Unit were selected. The arterial oxygen saturation was recorded during their stay in the Intensive Care Unit and chaotic attractors were built in the delay map. Subsequently, quantifications of the minimum and maximum values of the attractor were established. Results: The maximum and minimum values of the oxygen saturation attractors varied between 100% and 70% for patients who died, whereas for those who lived, saturation values between 99% and 85% were maintained. Conclusions: A chaotic behavior associated with arterial oxygen saturation, quantifiable through the maximum and minimum values found in the entire attractor, was observed, establishing a new mathematical and physical measurement of the critical patient in the Intensive Care Unit.(AU)

Valoración de la posible transmisión intrafamiliar de bacterias que colonizan a los pacientes con fibrosis quística / Assessment of possible intra-family transmission of bacteria that colonize patients with cystic fibrosis

INTRODUCCIÓN: En la Fibrosis Quística (FQ), la patología broncopulmonar es la más representativa y grave en todo el espectro de la enfermedad, causada principalmente por la colonización persistente de la vía aérea por bacterias con capacidad patogénica. Su control es fundamental para mejorar el pronóstico de estos pacientes. Conocer las fuentes de infección en estos casos permitiría diseñar mejores estrategias para su prevención. OBJETIVOS: Evaluar, en el entorno familiar de pacientes con FQ, la posible transmisión de bacterias que frecuentemente colonizan las vías respiratorias, como Pseudomonas aeruginosa y Streptococcus pneumoniae. MATERIAL Y MÉTODO: Se incluyeron un total de 10 pacientes con FQ y 15 familiares convivientes, de los que se tomaron muestras de esputo y frotis orofaríngeo respectivamente. En ellos se trataron de identificar bacterias mediante técnicas de metagenómica (PCR- DGGE del gen 16S-rRNA para bacterias) y de ampliación de ácidos nucleicos. RESULTADOS: Los resultados del estudio de metagenómica mostraron la presencia de diferentes bacterias en todos los pacientes evaluados, siendo las más frecuentes Pseudomonas spp. (n=9), Streptococcus spp. (n=4), Staphylococcus spp. (n=2) y Haemophilus influenzae (n=2). En los familiares se identificó por PCR Pseudomona aeruginosa en el 46,5% de los casos y S. pneumoniae en el 66,7%. La concordancia entre familiares y pacientes fue del 40% para P. aeruginosa, con coincidencia de genotipos del 100% y una concordancia del 20% para S. pneumoniae. CONCLUSIONES: La presencia de bacterias que frecuentemente colonizan el tracto respiratorio de los pacientes con fibrosis quística es frecuente entre los familiares que cohabitan con ellos, lo que podría facilitar la transmisión de unos sujetos a otros y la persistencia de éstas en el entorno familiar

INTRODUCTION: In Cystic Fibrosis (CF), bronchial-pulmonary pathology is the most representative and serious within the scope of this disease, and generally caused by the persistent colonization of the airways by pathogenic bacteria. Control is essential to improve the prognosis of these patients. In these cases, understanding the source of infection would facilitate the design of improved prevention strategies. OBJECTIVES: Assess, within the family environment of patients with CF, the possible transmission of bacteria that frequently colonize airways, such as Pseudomonas aeruginosa and Streptococcus pneumoniae. MATERIAL AND METHODS: Ten patients with CF were included in this study, as well as 15 cohabiting relatives, from whom sputum samples and oropharyngeal smears were taken respectively. Using metagenomics, the bacteria were identified (PCR- DGGE of the gene16S-rRNAfor bacteria) and the expanding of nucleic acids. RESULTS: The results of the metagenomic study proved the presence of various bacteria in all patients assessed, with the most frequent being Pseudomonas spp. (n=9), Streptococcus spp. (n=4), Staphylococcus spp. (n=2) and Haemophilus influenzae (n=2). Using PCR in the relatives, P. aeruginosa was identified in 46.5% of the cases, and S. pneumoniae in 66.7%. Consistency between relative and patient was 40% for P. aeruginosa, with a 100% genotype coincidence and a 20% consistency for S. pneumoniae. CONCLUSIONS: The presence of bacteria that frequently colonize the respiratory tract in patients with cystic fibrosis is recurrent among relatives cohabiting with them, which could facilitate the transmission of bacteria from one person to another and the persistence of said bacteria within the family environment

Efficient fluorescence quenching in electrochemically exfoliated graphene decorated with gold nanoparticles.

High surface area graphene sheets were obtained by electrochemical exfoliation of graphite in an acid medium under constant potential conditions. Filtration and centrifugation processes played an important role in order to obtain stable dispersions in water. Scanning electron microscopy and transmission electron microscopy imaging revealed highly exfoliated crystalline samples of ∼5 µm. Raman, Fourier transform infrared and x-ray photoelectron spectroscopy further confirmed the high quality of the exfoliated material. The electrochemically exfoliated graphene (EEG) was decorated with gold nanoparticles (AuNPs) using sodium cholate as a buffer layer. This approach allowed for a non-covalent functionalization without altering the desirable electronic properties of the EEG. The AuNP-EEG samples were characterized with various techniques including absorbance and fluorescence spectroscopy. These samples displayed a fluorescence signal using an excitation wavelength of 290 nm. The calculated quantum yield (Φ) for these samples was 40.04%, a high efficiency compared to previous studies using solution processable graphene.

Evaluación de la exposición a factores de riesgo alternativos al tabaco en la EPOC en Neumosur. Resultados del estudio On-Sint / Assessment of exposition to alternative risk factors, other than smoking, in COPD at Neumosur: On-Sint study results

OBJETIVO: El estudio On-Sint es una cohorte retrospectiva que tiene por objetivo la evaluación de la presentación clínica y funcional de la enfermedad pulmonar obstructiva crónica (EPOC) al diagnóstico, así como su evolución en el tiempo, tanto en atención primaria como en atención especializada. MÉTODO: estudio observacional, de no intervención, para la generación de una cohorte retrospectiva, en el que 329 médicos de Atención Primaria o Neumología de todo el ámbito nacional (69 en el ámbito de Neumosur) incluyeron 1.214 sujetos fumadores o exfumadores con el diagnóstico de EPOC (269 en Neumosur). Se recogió información en el momento del diagnóstico y en el actual. RESULTADOS: la cohorte On-Sint estaba compuesta por 1.214 pacientes con EPOC, de los que 257 (21,16%) eran del ámbito de Neumosur. Todos los enfermos eran fumadores o exfumadores. El porcentaje de pacientes fumadores descendió durante el seguimiento del 56,4% al diagnóstico al 34,2% (p < 0,001) en el momento actual. Adicionalmente, 45 casos (17,8%) referían exposición a otras sustancias distintas al tabaco. La exposición a estos factores de riesgo resultó más frecuente (p = 0,001) en Atención Primaria (22,7%) que en Especializada (6,5%). No encontramos relación en la distribución de grados funcionales GOLD y la exposición a estos compuestos, ni en el momento del diagnóstico ni en el actual. CONCLUSIONES: además del tabaco, un número considerable de pacientes con EPOC también están expuestos a otras sustancias inhaladas potencialmente tóxicas. De ellas, las químicas profesionales son más frecuentes que la biomasa. No parece que esta exposición tenga un impacto relevante en la evolución de la enfermedad

OBJECTIVE: the On-Sint study is a retrospective cohort that assesses the clinical and functional diagnostic presentation of chronic obstructive pulmonary disease (COPD), and its development over time from the perspective of primary and specialized care. METHOD: this was an observational, non-interventional study to generate a retrospective cohort, in which 329 primary care doctors or pneumologists were included from all over Spain (69 from within the scope of Neumosur); the cohort included 1214 smokers or former smokers, who were diagnosed with COPD (269 at Neumosur). Information was collected both at the initial diagnosis and at the time of closing the study. RESULTS: the On-Sint cohort included 1214 patients with COPD, of which 257 (21.16%) were from within the scope of Neumosur. All patients were smokers or ex-smokers. The percentage of smokers decreased throughout follow-up, from 56.4% at the time of the diagnosis to 34.2% (p < 0.001) at the current moment. Likewise, 45 cases (17.8%) referred to the exposition of substances, other than smoking. Exposition to these risk factors was more frequent (p = 0.001) in Primary Care (22.7%) than in specialized care (6.5%). We found no relationship in the GOLD classification distribution and the exposition to these compounds, neither when diagnosed nor currently. CONCLUSIONS: n addition to smoking, a considerable number of COPD patients are exposed to inhaling other potentially toxic substances. Among these, professionals from the chemical sector are more frequent than those from the biomass sector. This exposition does not seem to have a relevant impact on the development of the disease

Repercusión de las auditorías de historias clínicas en la calidad asistencial recibida por los pacientes que ingresan por una agudización de EPOC / Repercussions from the clinical history audit regarding the quality of the healthcare received by patients in hospital due to worsened COPD

OBJETIVO: el objetivo de este trabajo es la valoración comparativa de dos auditorías clínicas, realizadas en centros públicos de Andalucía y Extremadura, en cuanto a variables relacionadas con la calidad asistencial recibida por el paciente que ingresa con una agudización de su EPOC. Se pretende valorar el posible impacto de una auditoría sobre la práctica clínica asistencial y la calidad de la asistencia sanitaria prestada a estos pacientes. MÉTODO: se recopilaron datos clínicos y demográficos de la auditoría realizada en estos centros en 2008 (dentro del programa AUDIPOC España) y de la del 2011 (dentro de COPD ERS Audit) y, además, se han comparado los resultados de cumplimentación de las normativas GOLD en lo que respecta a las medidas diagnósticas y terapéuticas recibidas por los pacientes ingresados por una EPOC agudizada. RESULTADOS: quince hospitales (12 de Andalucía y 3 de Extremadura) participaron en ambas auditorías clínicas. Se analizaron un total de 1.016 ingresos en ambas auditorías (397 en la auditoría 1 y 619 en la auditoría 2). Los pacientes eran, mayoritariamente, varones en la 8ª década de la vida, con un porcentaje considerable de fumadores activos. La adherencia a la guía GOLD es cercana al 90% en numerosos parámetros terapéuticos medidos, siendo más baja en los parámetros diagnósticos. Algunos parámetros evaluados mejoraron en la segunda auditoría, fundamentalmente parámetros terapéuticos, como son reducción del uso inadecuado de metilxantinas (de un 10,6% a un 3,1% ) y aumento del uso de broncodilatadores de acción corta (del 69,3% al 72,5%). CONCLUSIONES: tras los resultados obtenidos, puede concluirse que la adherencia a la guía GOLD es bastante aceptable y que a pesar de haberse evidenciado algunos cambios de pequeña magnitud, son necesarias estrategias de implementación de la mejora asistencial tras haber realizado una auditoría para obtener un futuro impacto clínico relevante en nuestros pacientes

OBJECTIVE: the objective of this work is to perform a comparative assessment of two clinical audits. These audits were carried out at public healthcare centers in the regions of Andalusia and Extremadura (Spain). This comparison included variables regarding the quality of the healthcare received by the patient upon admission to hospital due to the worsening of his/her COPD. The objective was to assess the possible impact of an audit regarding clinical healthcare and the quality of the healthcare provided. METHOD: clinical and demographic data was collected for the audit, carried out in 2008 (with the program AUDIPOC España) and again in 2011 (within the scope of COPD ERS Audit). Also, the compliance results based on GOLD COPD Guidelines regarding the diagnostic and therapeutic measures received by the patients admitted to hospital due to acute COPD were also compared. RESULTS: if teen hospitals (12 in Andalusia and 3 in Extremadura) participated in both clinical audits. A total of 1016 patients admitted to hospital were included in both audits (397 in audit 1 and 619 in audit 2). For the most part, the patients were males, in their 80s, with a considerable percentage being active smokers. Adherence to the GOLD guidelines was almost 90% for the many therapeutic parameters measured, with the diagnostic parameters being the lowest. Some parameters improved by the second audit; essentially therapeutic parameters, such as the reduced use of methylxanthines (down from 10.6% to 3.1%) and an increase in the use of short-acting bronchodilators (up from 69.3% to 72.5%). CONCLUSIONS: based on the results obtained, it may be concluded that adherence to the GOLD COPD guidelines is quite acceptable. Despite some slight changes, strategies need to be implemented to improve healthcare after having performed an audit to obtain a future clinical impact that is relevant in our patients

Auditoría del manejo diagnóstico en pacientes con sospecha de tromboembolismo pulmonar en un Hospital Universitario / Auditing diagnostic management in patients suspected of having pulmonary thromboembolism at a University Hospital

OBJETIVO: conocer la adherencia de los facultativos a las guías de práctica clínica para el diagnóstico del tromboembolismo pulmonar (TEP). Pacientes y método: hemos realizado un análisis retrospectivo de los pacientes sometidos a estudios de imagen pulmonar por sospecha de TEP, gammagrafía de perfusión pulmonar y angiotomografía axial computerizada de tórax multidetector (angio-TAC multidetector), durante el año 2009. Se analizaron la estrategia y los criterios diagnósticos empleados. Una estrategia diagnóstica adecuada y un criterio diagnóstico correcto fueron aquellos que siguieron las guías de práctica clínica (GPC) internacionalmente aceptadas. RESULTADOS: Se han incluido 343 pacientes sometidos a pruebas de imagen pulmonar por sospecha de TEP. En 161 pacientes (46,9%) se realizó gammagrafía de perfusión pulmonar, en 134 (39,1%) angio-TAC torácica multidetector y 48 (14%) se sometieron a ambas pruebas. De los 343 pacientes estudiados, el TEP se confirmó en 95 (27,7%). En 228 (66,5%) no se siguió una estrategia diagnóstica adecuada. Cuando se descarta el TEP, el criterio diagnóstico se consideró incorrecto en un 46% de los pacientes. Cuando se confirma el TEP, el criterio diagnóstico es correcto en el 98,9% de los casos. CONCLUSIONES: El manejo diagnóstico del TEP en la práctica habitual difiere de las recomendaciones que marcan las GPC y sería susceptible de ser mejorado en cuanto a los criterios diagnósticos para descartar la enfermedad y en cuanto a la utilización de recursos y estrategias utilizadas

OBJECTIVE: to determine physicians adherence to clinical practice guidelines for the diagnosis of pulmonary embolism (PE). PATIENTS AND METHODS: we carried out a retrospective analysis of patients undergoing image studies, pulmonary perfusion scintigraphy or computed tomographic pulmonary angiography (CTPA), due to suspicion of PE in 2009. The strategy and the diagnostic criteria used were analyzed. An appropriate diagnostic strategy and proper diagnostic criteria were those wich followed the clinical practice guidelines (CPG) accepted internationally. RESULTS: we included 343 patients undergoing studies of lung image with suspicion of PE. A lung perfusion scintigraphy was performed in 161 patients (46,9%) and a CPTA in 134 (39,1%), 48 patients (14%) underwent both test. PE was confirmed in 95 cases (27,7%) out of the 343 patients under study. In 228 (66,5%) an appropriate diagnostic strategy was not followed. Once the PE is ruled out, the diagnostic criteria was incorrect in 46% of the patients. When PE is confirmed, the diagnosis is correct in 98,9% of the cases. CONCLUSIONS: the management of PE diagnosis in routine practice differs from the recommendations that make CPGs and is able to be improved in terms of the diagnostic criteria for the disease and rule regarding the use of resources and strategies used

Actitudes de los médicos hacia los cuestionarios e índices para la EPOC en Neumosur. Resultados del estudio On-Sint / Physician attitudes toward questionnaires and indices for COPD in Neumosur. Results of On-Sint study

INTRODUCCIÓN: el estudio On-Sint es una cohorte retrospectiva que tiene por objetivo la evaluación de la presentación clínica y funcional de la enfermedad pulmonar obstructiva crónica (EPOC) al diagnóstico, así como su evolución en el tiempo, tanto en Atención Primaria, como en Especializada. El presente trabajo, muestra la actitud de los médicos participantes ante el uso de la espirometría, cuestionarios de calidad de vida y los índices multidimensionales en el ámbito de Neumosur. MÉTODO: estudio observacional de no intervención para la generación de una cohorte retrospectiva, en el que 329 médicos de Atención Primaria o Neumología de todo el ámbito nacional (69 en el ámbito de Neumosur) incluyeron 1.214 sujetos fumadores o exfumadores con el diagnóstico de EPOC (269 en Neumosur). En la cohorte se recogió información sobre los médicos que intervinieron, registrando si realizaban cuestionarios de calidad de vida o empleaban índices multidimensionales, así como de la frecuencia de las espirometrías o la periodicidad de las visitas mé- dicas. RESULTADOS: de los 69 médicos del ámbito de Neumosur que participaron en el estudio, 49 (71%) completaron la encuesta del investigador (34 de Atención Primaria y 15 de Atención Especializada). La mayoría (95,9%) refirieron tener 10 ó más años de experiencia, el 77,6% pertenecientes al ámbito urbano, 95,9% viendo 30 ó más pacientes a la semana, con un promedio de 18,5 ± 11,9 pacientes con EPOC semanales. En Atención Especializada realizaban principalmente espirometrías en cada visita en el 53,3%, mientras que en Atención Primaria, la mayoría (29,4%) las hacía anualmente (p = 0,016). El 28,6% declaró usar cuestionarios de calidad de vida en su práctica habitual, principalmente el CAT (18,4%). Encontramos diferencias entre Atención Especializada y Atención Primaria en el uso de índices multidimensionales (80,0% vs 41,2%; p < 0,039). De todos los participantes, el 30,6% referían que usaban la escala MRC y el 26,5% el BODE en su práctica habitual.CONCLUSIONES: los resultados de la presente encuesta muestran un uso limitado de los cuestionarios de calidad de vida e índices multidimensionales en el ámbito de Neumosur. Es necesario con-trastar los resultados de esta encuesta con el uso de estos cuestio-narios en la práctica clínica

INTRODUCTION: on-Sint is a retrospective cohort study that aims to evaluate the clinical and functional presentation of chronic obstructive pulmonary disease (COPD) at the moment of diagnosis and its progression in time, both in primary (PC) and Specialized (SC) care. The present work shows the attitude of participating physicians to the use of spirometry, quality of life questionnaires and multidimensional indexes. METHOD: observational non-intervention study to generate a retrospective cohort in which 329 primary care physicians or pulmonologists from Spain included 1214 smokers or former smokers diagnosed with COPD. In the present study we asked the investigator on the use of quality of life questionnaires, multidimensional indexes, spirometry and the frequency of medical visits. RESULTS: of the 69 doctors in the field of Neumosur who participated in the study, 49 (71%) completed the survey researcher (34 SC and 15 PC),of which 95.9% reported having ≥10 years of experience, 77.6 % in urban areas, 95.9 % seeing ≥ 30 (18,5 ± 11,9) patients/week. Medical consultation on demand was inversely proportional to the severity of COPD. In SC, spirometry was performed at each visit in 53.3%, while in PC the majority (29.4%) made them annually (p < 0,001). 28.6 % reported using quality of life questionnaires in their usual practice, mainly the CAT (18.4%). We found differences between SP and PC in the use of multidimensional indexes (80,0% vs 41,2%; p < 0,039).). 30.6 % reported to use the MRC scale and 26.5% the BODE in their usual practice. CONCLUSIONS: the results of this survey show a limited use of quality of life questionnaires and multidimensional indexes in the field of Neumosur. It is necessary to compare the results of this survey with the use of these questionnaires in the clinical setting