Determination of global chemical patterns in exhaled breath for the discrimination of lung damage in postCOVID patients using olfactory technology.

The objective of this work was to evaluate the use of an electronic nose and chemometric analysis to discriminate global patterns of volatile organic compounds (VOCs) in breath of postCOVID syndrome patients with pulmonary sequelae. A cross-sectional study was performed in two groups, the group 1 were subjects recovered from COVID-19 without lung damage and the group 2 were subjects recovered from COVID-19 with impaired lung function. The VOCs analysis was executed using a Cyranose 320 electronic nose with 32 sensors, applying principal component analysis (PCA), Partial Least Square-Discriminant Analysis, random forest, canonical discriminant analysis (CAP) and the diagnostic power of the test was evaluated using the ROC (Receiver Operating Characteristic) curve. A total of 228 participants were obtained, for the postCOVID group there are 157 and 71 for the control group, the chemometric analysis results indicate in the PCA an 84% explanation of the variability between the groups, the PLS-DA indicates an observable separation between the groups and 10 sensors related to this separation, by random forest, a classification error was obtained for the control group of 0.090 and for the postCOVID group of 0.088 correct classification. The CAP model showed 83.8% of correct classification and the external validation of the model showed 80.1% of correct classification. Sensitivity and specificity reached 88.9% (73.9%-96.9%) and 96.9% (83.7%-99.9%) respectively. It is considered that this technology can be used to establish the starting point in the evaluation of lung damage in postCOVID patients with pulmonary sequelae.

Cold bed: A challenge for an academic medical center in San Luis Potosi, Mexico.

OBJECTIVE: The objective of this study was to identify the time period during which a hospital bed could be virtually available according to the informatics and administrative hospital system while still being physically occupied by a patient in a hospital in Mexico. MATERIALS AND METHODS: A cross-sectional study was conducted in a 250-bed Academic Medical Center located in Central Northern Mexico during February 2015. Both administrative and real patient discharges were registered in a hospital format. Central tendency measures were used to present collected data and bed/day costs were obtained from official national published costs. RESULTS: Nine hundred and forty-three patients were followed up during their hospital discharge process. Overall, 2.4% of hospital beds were occupied by discharged patients. The annual cost only for cold beds was $959,220.00 US$ ($14,348,304.00 MNX), without bringing about any benefits for patients. Cold beds represented 1.31% of the 2015 annual hospital budget. CONCLUSIONS: Quality improvement initiatives must be implemented to allocate beds to patients more efficiently. The discharge process must be standardized to reduce bed/day direct hospital costs and strengthen the supervision of medical residents during this process.

OBJETIVO: Identificar el periodo de tiempo durante el cual una cama hospitalaria está virtualmente disponible en el sistema informático, mientras está ocupada por un paciente, en un hospital de México. MÉTODO: Se realizó un estudio transversal en un centro médico académico de 250 camas, localizado en el centro-norte de México, en febrero de 2015. El alta administrativa y real del paciente fueron registradas en un formato institucional. Se utilizaron medidas de tendencia central para presentar los datos. El costo del día/cama se obtuvo de lo oficial publicado para la nación. RESULTADOS: 943 pacientes fueron seguidos durante el proceso de egreso. El 2.4% del total de las camas estuvo ocupada por pacientes egresados. El costo anual por las camas frías/muertas fue de $959,220.00 US$ ($14,348,304.00 MNX), sin beneficio para los pacientes. Las camas frías/muertas representaron el 1.31% del presupuesto hospitalario anual en el año 2015. CONCLUSIONES: Es necesario implementar iniciativas de mejora para asignar eficientemente las camas a los pacientes. El proceso de egreso debe estandarizarse para reducir el costo directo hospitalario por día/cama. Hay que fortalecer la supervisión de médicos residentes que participan en este proceso.

DPP-4 Levels Are Increased in Subjects with Poor Sleep Quality.

Background: Up to 30% of the population has sleep disturbances, generating a negative health impact, a situation that is often not known and no medical attention is sought. It has been observed that after a total deprivation of sleep, the levels of dipeptidyl peptidase 4 (DPP-4) tend to increase. The aim of this study was to compare serum levels of DPP-4 in healthy subjects, with adequate and poor-quality sleep needing medical/pharmacological treatment. Materials and Methods: Cross-sectional study of subjects scheduled for elective surgery with low cardiometabolic risk. Subjects between 18-70 years of age were included, without previous diagnosed pathology (diabetes mellitus type 2; neoplasm; nephropathy; and liver disease) and major amputations, and who signed informed consent. The study protocol was aproved in the Local Committee for Ethics and Research, number 45-16. Anthropometry was performed (% body fat; waist and neck circumferences), and sleep quality assessment (Pittsburgh Sleep Quality Index [PSQI]) to classify them as worthy or not worthy of medical/pharmacological care. Serum DPP-4 was determined by Enzime Linked Immunosorbent Assay (ELISA). The statistical analysis was done in RStudio Software. Results: Fifty seven subjects (2017-2018) were included, with a combined frequency of overweight/obesity of 66.6% and with abdominal circumference values of 93.2 ± 13.6, higher than that proposed by the International Diabetes Federation. The PSQI was 8.3 ± 4.1, and 56.1% were classified as worthy of medical/pharmacological attention. When comparing the levels of DPP-4, these were higher in this group 2385.0 ± 2082.0 versus not worthy 1716.7 ± 1261.7 pg/mL, being statistically significant (P = 0.035). Conclusions: The elevated levels of DPP-4 in person with poor quality sleep worthy of medical/pharmacological treatment could be an early indicator of metabolic disorders, which need to be evaluated in depth.

Pediatric asthma treatment: What to do when international guideline recommendations do not agree.

BACKGROUND: There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs. OBJECTIVE: To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part. RESULTS: Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma. CONCLUSION: For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.

[Mexican Asthma Guidelines: GUIMA 2017]. / Guía Mexicana del Asma: GUIMA 2017.

BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

[Video-assisted thoracic surgery diagnosis of mucinous (colloid) lung adenocarcinoma: Case report]. / Diagnóstico de adenocarcinoma mucinoso (coloide) pulmonar por cirugía torácica asistida por video. Reporte de caso.

BACKGROUND: Mucinous colloid lung adenocarcinoma is an uncommon variant of lung carcinomas with similar features to tumours seen in the gastrointestinal tract. To distinguish between these tumours and other mucinous lung tumours, such as mucinous bronchioloalveolar cell carcinomas and metastatic mucinous lesions could be difficult with small biopsy specimens from fine needle aspiration. CLINICAL CASE: The case is described of a 49-year-old female with history of dyspnoea and cough with bloody sputum and weight lose. Thorax axial computed tomography demonstrated a right lower lobe spiculated mass with calcifications. Transthoracic computed tomography- guided fine needle biopsy reported negative results, and the biopsy obtained with video-assisted thoracic surgery was useful for an adequate cytology report of a colloid variant of mucinous lung adenocarcinoma. CONCLUSION: Video-assisted thoracic surgery is an appropriate option for obtaining a larger specimen in those cases where small biopsies are inconclusive for the diagnosis of thoracic pathologies such as malignant tumours.

[Diagnosis and treatment of acute asthma in adults]. / Diagnóstico y tratamiento de la crisis asmática en adultos.

Any asthmatic patient at risk of developing exacerbations in severity from mild to very severe and rarely ends in death. Some patients have poor perception of their symptoms and can have a very significant decrease in lung function without a significant change in its manifestations so that with the exception of children under five, it is essential to measure whether the bronchial obstruction by flujometry or spirometry. There are two stages in the progression of an exacerbation of asthma: slow-onset acute asthma or type I, when predominant airway inflammation and patients show clinical and functional deterioration in hours, days and sometimes weeks. This can be between 80 and 90% of exacerbations that occur in adults. The other scenario, less commonly, bronchospasm is caused predominantly by causing an acute exacerbation or type II changes from 3 to 6 hours. In this chapter some recommendations about the treatment of patients in crisis and emphasizes the steps to be taken in different scenarios.

Heterozygosity for the H63D mutation in the hereditary hemochromatosis (HFE) gene may lead into severe iron overload in ß-thalassemic minor: Observations in a thalassemic kindred

La heterocigosidad para la talasemia ß (talasemia menor) por sí misma no conduce a sobrecarga de hierro; sin embargo, cuando coexiste con un estado homocigoto para alguna de las multiciones (H63d o C282Y) del gene de la hemocromatosis hereditaria (gen HFE), puede presentarse spbrecarga de hierro. Se describe una familia en la que el propositus, siendo doble heterocigoto para talasemia ß y para la mutación H63D del gene HFE, desarrolló sobrecarga de hierro grave y, en consecuencia, insuficiencia hepatocelular crónica con hipertensión portal. Otros miembros de la familia, con sólo talasemia o la mutación H63D no han desarrollado sobrecarga de hierro. Se discuten brevemente algunos aspectos sobre la interacción entre la talasemia ß y la hemocromatosis hereditaria y se hacen especulaciones sobre la posibilidad de que otras mutaciones genéticas que conducen a sobrecarga de hierro familiar haya sido las responsables de la sobrecarga de hierro en esta familia.