Waveforms Analysis in Patients With Amyotrophic Lateral Sclerosis for Enhanced Efficacy of Mechanically Assisted Coughing.

BACKGROUND: Effectiveness of mechanical assisted coughing with insufflation-exsufflation (MI-E) in amyotrophic lateral sclerosis (ALS) depends largely on severity of bulbar dysfunction, which can generate different upper-airway responses. The aim of the study was to evaluate the use of graphs generated by MI-E in ALS to detect airway obstruction and set parameters to achieve an effective mechanically assisted coughing. METHODS: This was a prospective study enrolling patients with ALS. Several sessions with MI-E were applied, administering different insufflation-exsufflation (± 20, ± 30, ± 40, ± 50 cm H2O) levels in each session. The graphs produced were recorded and analyzed, and the results were used to select the parameters resulting in more effective MI-E. RESULTS: Sixty-nine subjects with ALS were included, yielding a total of 351 analyzed records. A pattern of obstruction during insufflation was detected in 34 subjects (50.7%) and of upper-airway collapse during exsufflation in 18 subjects (26%). The variable associated with obstruction during insufflation was bulbar upper motor neuron dysfunction (odds ratio 7.19 [95% CI 2.32-22.29], P = .001), whereas bulbar lower motor neuron dysfunction was related to upper-airway collapse during exsufflation (odds ratio 0.32 [95% CI 0.11-0.98], P = .046). After parameters were adjusted, in 68 subjects (98.55%) an effective MI-E was achieved. The only variable that predicted absence of alterations in the graphs was Norris bulbar score (odds ratio 0.87 [95% CI 0.78-0.96], P = .007). CONCLUSIONS: Analysis of graphics generated by applying MI-E in ALS was an effective method to detect upper-airway responses and select optimal set parameters. Obstruction during insufflation is related to bulbar upper motor neuron dysfunction and collapse during exsufflation to bulbar lower motor neuron dysfunction.

Interés de los germinados y su Seguridad Alimentaria / Interest of sprouts and their Food Security

INTRODUCCIÓN: Los germinados son alimentos listos para el consumo cuyo uso está bastante extendido y de los que es necesario garantizar su inocuidad. OBJETIVOS: Nuestros objetivos fueron conocer la Nor - mativa Europea que regula la Seguridad Alimentaria de los mismos y evaluar la calidad microbiológica de algunos tipos de germinados. METODOLOGÍA: La Normativa Europea estudiada recoge la evolución relativa a la Seguridad Alimentaria de hortalizas, incluyendo las semillas germinadas. En 2005 se establece únicamente la investigación de Salmonella y a partir de 2013 plantea criterios de calidad microbiológica para los germinados; dicha Normativa esta transpuesta a la Reglamentación Española. Para el estudio microbiológico se utilizaron 5 tipos diferentes de germinados adquiridos en el comercio, que se analizaron directamente (control), después de su lavado con agua destilada y tras su tratamiento con un desinfectante. Se realizaron recuentos de bacterias aerobias mesófilas totales, Escherichia coli y Listeria monocytogenes y se investigó la presencia de Salmonella spp. RESULTADOS: Los recuentos de bacterias aerobias mesófilas totales en los controles estuvieron comprendidos entre 1,0 X 108 a 2,0 X 109 ufc/g; en los lavados, fueron de 6,0 X 107 a 1,1 X 109 ufc/g y en los tratados de 1,0 X 107 a 6,8 X 108 ufc/g. La reducción de la carga bacteriana por el lavado fue de 24 % (ajo) a 50 % (brócoli) y en el caso del tratamiento con el desinfectante de 59 % (ajo) a 90 % (alfalfa). Los recuentos de Escherichia coli y Listeria monocytogenes fueron inferiores a 10 ufc/g en todas las muestras y en el caso de Salmonella spp. hubo ausencia en 25 g en todas las muestras analizadas. CONCLUSIONES: Los recuentos de Escherichia coli y Listeria monocytogenes son inferiores a lo indicado en la normativa y no se encontró presencia de Salmonella spp. En conclusión los germinados analizados se consideran alimentos seguros

INTRODUCTION: Sprouts are ready-to-eat foods, and their use is quite widespread, consequently it is necessary to guarantee their safety. OBJECTIVE: The aims of this study were to know the European Regulations about Food Safety of sprouts and to evaluate the microbiological quality of some types of sprouts. METHODS: The European Regulation reflects the evolution related to Food Safety of vegetables, including sprouted seeds. In 2005, only Salmonella was established to be investigated in sprouts, and in 2013, the European Union proposed microbiological quality criteria for sprouts and that Regulation was transposed to the Spanish Regulations. For the microbiological study, five different types of commercial sprouts were chosen; they were directly analyzed (control), after distilled water washing and after treatment with a disinfectant. Total mesophilic aerobic bacteria, Escherichia coli and Listeria monocytogenes were counted and presence of Salmonella spp. was determined. RESULTS: Counts of total mesophilic aerobic bacteria were between 1.0 X 108 to 2.0 X 109 cfu/g in control samples; in the washed ones, from 6.0 X 107 to 1.1 X 109 cfu/g, and, in the treated ones, from 1.0 X 107 to 6.8 X 108 cfu/g. The reduction of bacterial load by washing was from 24 % (garlic) to 50 % (broccoli) and in the case of treatment with the disinfectant from 59 % (garlic) to 90 % (alfalfa). Escherichia coli and Listeria monocytogenes counts were lower than 10 cfu/g in all samples, and there was absence of Salmonella spp. in 25 g of all the samples analyzed. CONCLUSIONS: Escherichia coli and Listeria monocytogenes counts were lower than those indicated in the Regulations, and no presence of Salmonella spp was found. In conclusion, the analyzed sprouts are considered safe and innocuous foods

Hygienization and control of Diplodia seriata fungus in vine pruning waste composting and its seasonal variability in open and closed systems.

After the ban on sodium arsenite, waste management alternatives to the prevalent burning method, such as the hygienization and biodegradation in solid phase by composting, are required for the pruned material from grapevines affected by various fungi. In this work the dynamics of a fungus associated with vine decay (Diplodia seriata) during the composting process of a mixture of laying hen manure and vine pruning waste (2:1w/w) have been investigated in an open pile and a discontinuous closed biodigester. Through the optimization of the various physical-chemical parameters, hygienization of the infected waste materials was attained, yielding class-A organo-mineral fertilizers. Nevertheless, important differences in the efficiency of each system were observed: whereas in the open pile it took 10days to control D. seriata and 35 additional composting days to achieve full inactivation, in the discontinuous biodigester the fungus was entirely inactivated within the first 3-7days. Finally, the impact of seasonal variability was assessed and summer temperatures shown to have greater significance in the open pile.

Tuberculosis e inmigración / Tuberculosis and immigration

La incidencia de tuberculosis va descendiendo a nivel mundial. Sin embargo, en los países occidentales este descenso es más lento debido al impacto de la inmigración. La tuberculosis en la población inmigrante se relaciona con el estatus de salud en el país de origen y con las condiciones de hacinamiento y pobreza en el país de acogida. Los inmigrantes con tuberculosis son más jóvenes, tienen mayor prevalencia de formas extrapulmonares, mayor proporción de casos de resistencia y tasas de abandono de tratamiento superiores a los autóctonos. Las nuevas técnicas moleculares, además de reducir el tiempo de demora diagnóstica, permiten la identificación rápida de resistencias y mejoran el conocimiento de los patrones de transmisión. Es necesario implementar medidas que mejoren la cumplimentación del tratamiento de este grupo de población como el uso de pautas fijas de tratamiento, el empleo de mediadores y agentes comunitarios de salud, facilitar el acceso a la tarjeta sanitaria y la gratuidad de los fármacos

The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs

[Tuberculosis and immigration]. / Tuberculosis e inmigración.

The incidence of tuberculosis worldwide is declining. However, in Western countries this decline is slower due to the impact of immigration. Tuberculosis in the immigrant population is related to health status in the country of origin and with overcrowding and poverty conditions in the host country. Immigrants with tuberculosis are younger, have a higher prevalence of extrapulmonary forms, greater proportion of drug resistance and higher treatment default rates than those of natives. New molecular techniques not only reduce diagnostic delay time but also allow the rapid identification of resistances and improve knowledge of transmission patterns. It is necessary to implement measures to improve treatment compliance in this population group like facilitating access to health card, the use of fixed-dose combination drugs, the participation of cultural mediators and community health workers and gratuity of drugs.

Síndrome de Hermansky-Pudlak: descripción de un caso / Hermansky-Pudlak syndrome: A case report

No disponible

Documento de consenso sobre el fenotipo mixto EPOC-asma en la EPOC / Consensus Document on the Overlap Phenotype COPD-Asthma in COPD

Introducción: Aunque asma y EPOC son enfermedades distintas, muchos pacientes comparten características de ambas entidades. Estos casos pueden tener una evolución y una respuesta al tratamiento diferente. Sin embargo, la evidencia disponible es escasa, y es necesario valorar si representan un fenotipo diferencial y aportar recomendaciones sobre su diagnóstico y tratamiento, además de identificar posibles lagunas de conocimiento. Método: Consenso nacional de expertos en EPOC en dos etapas: 1) Se establecieron los bloques temáticos a tratar y se elaboró una primera propuesta de aseveraciones, mediante una reunión presencial con metodología de «tormenta de ideas» estructurada. 2) Se realizaron dos rondas de consenso vía correo electrónico, utilizando una escala tipo Likert. Resultados: Se consensua la existencia de un fenotipo clínico diferencial denominado «fenotipo mixto EPOC-asma», cuyo diagnóstico se realizará si se cumplen 2 criterios mayores o uno mayor y 2 menores (criterios mayores: prueba broncodilatadora muy positiva [aumento del FEV1≥15% y≥400ml], eosinofilia en esputo y antecedentes personales de asma; criterios menores: IgE total elevada, antecedentes personales de atopia y prueba broncodilatadora positiva [aumento del FEV1≥12% y≥200ml] en dos o más ocasiones). Se recomienda el uso precoz de corticoides inhalados (CI) ajustados individualmente, ser cautos con la retirada brusca de CI y, en casos graves, valorar el uso de la triple terapia. Finalmente, queda patente la falta de estudios específicos sobre la historia natural y el tratamiento de estos pacientes. Conclusiones: Es preciso profundizar en el conocimiento de este fenotipo para establecer pautas y recomendaciones adecuadas para su diagnóstico y tratamiento(AU)

Introduction: Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. Methods: A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured «brainstorming» method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. Results: Consensus was reached about the existence of a differential clinical phenotype known as «Overlap Phenotype COPD-Asthma», whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV1 ≥15% and ≥400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥12% and ≥200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. Conclusions: It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment(AU)

Consensus document on the overlap phenotype COPD-asthma in COPD.

INTRODUCTION: Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. METHODS: A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. RESULTS: Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. CONCLUSIONS: It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.