ABSTRACT
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Subject(s)
Humans , Tobacco Use Disorder/physiopathology , Coronavirus Infections/epidemiology , Smoking/adverse effects , Tobacco Smoking/adverse effects , Severe Acute Respiratory Syndrome/epidemiology , Severe acute respiratory syndrome-related coronavirus/pathogenicity , Comorbidity , Risk Factors , Pandemics/statistics & numerical data , Disease Susceptibility/epidemiology , Tobacco Use Disorder/complications , Smokers/statistics & numerical data , Electronic Nicotine Delivery Systems/statistics & numerical dataABSTRACT
Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitivity (LPMS) and dysphagia, obstructive sleep apnea, and chronic cough hypersensitivity syndrome. A previous reliability study of a new laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER) showed high intra- and inter-rater reliability; however, its accuracy has not been tested. We performed an accuracy study of the LPEER in a prospectively and consecutively recruited cohort of 118 patients at two tertiary care university hospitals. Most of the patients were suffering from dysphagia, and all of them underwent a standard clinical evaluation and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) using a new sensory testing protocol. The sensory test included determinations of the laryngeal adductor reflex threshold (LART), the cough reflex threshold (CRT) and the gag reflex threshold (GRT). Abnormalities on these reflex thresholds were evaluated for associations with major alterations in swallowing safety (pharyngeal residues, penetration, and aspiration). We evaluated the discriminative capacity of the LPMS test using ROC curves and the area under the curve (AUC-ROC) and its relationship with the eight-point penetration-aspiration scale (PAS) using the Spearman's ρ correlation coefficient (SCC). We found a positive correlation between the PAS and LART (SCC 0.47; P < 0.001), CRT (SCC 0.46; P < 0.001) and GRT (SCC 0.34; P = 0.002). The AUC-ROC values for detecting a PAS ≥7 were as follows: LART, 0.83 (P < 0.0001); CRT, 0.79 (P < 0.0001); GRT, 0.72 (P < 0.0001). In this study, the LPEER showed good accuracy for evaluating LPMS. These results justify further validation studies in independent populations.
Subject(s)
Deglutition Disorders/diagnosis , Deglutition/physiology , Endoscopy/standards , Sensory Thresholds/physiology , Endoscopy/methods , Gagging/physiology , Humans , Larynx/physiopathology , Male , Pharynx , Reproducibility of ResultsABSTRACT
BACKGROUND: There are not reliable methods for measuring laryngo-pharyngeal mechano-sensitivity (LPMS). We aimed to determine the reliability of a new method for measuring LPMS using a new laryngo-pharyngeal esthesiometer (LPEER) in a prospective cohort of dysphagic stroke and non-dysphagic patients. The patients underwent clinical and endoscopic evaluations of swallowing (FESSST). The LPMS assessments consisted of measurements by an expert and a novel rater of the laryngeal-adductor reflex threshold (LART), cough reflex threshold (CRT) and gag reflex threshold (GRT) using the LPEER. We assessed the Bland-Altman limits of agreement, the intraclass correlation coefficients (ICCs) and Spearman correlation coefficients (SCCs). For the inter-rater comparisons, we contrasted the expert and novel raters. A total of 1608 measurements were obtained from 34 dysphagic stroke patients and 33 non-dysphagic patients. The intra-rater ICCs for all reflex thresholds were >0.90. The inter-rater ICCs were 0.87 for the LART, 0.79 for the CRT and 0.70 for the GRT. The intra-rater SCCs for all reflex thresholds were above 0.88 (P < 0.0001). The inter-rater SCC were 0.80 for the LART, 0.79 for the CRT and 0.70 for the GRT (all P < 0.0001). The Bland-Altman plots revealed good agreement for the LART and CRT and moderate agreement for the GRT. The median normal value was 0.14 mN for the LART, 4.4 mN for the CRT and 11.9 mN for the GRT. The median thresholds values in patients with aspiration were LART: 1.31 mN; CRT: 32.9 mN and GRT: 32.9 mN (all P < 0.006 vs normal thresholds). The LPEER exhibited substantial to excellent intra- and inter-rater reliability.
Subject(s)
Deglutition/physiology , Gagging/physiology , Adult , Cough/diagnosis , Cough/physiopathology , Endoscopy/methods , Female , Humans , Laryngeal Diseases/diagnosis , Laryngeal Diseases/physiopathology , Larynx/physiopathology , Male , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/physiopathology , Pharynx/physiopathology , Prospective Studies , Reproducibility of Results , Sensory ThresholdsABSTRACT
Objetivo Revisar la eficacia y seguridad de medicamentos para cesación del tabaquismo en el contexto de construcción de guías de práctica clínica (GPC). Métodos Revisión sistemática de GPC para adaptación mediante ADAPTE. Los desenlaces fueron cesación ≥6 meses y seguridad de las intervenciones. Las GPC se calificaron por pares con DELBI. Se extrajeron resultados de estudios agregativos incluidos en las guías seleccionadas. Resultados Los fármacos duplican la cesación comparados con placebo (tasas de 25,0 % hasta 27,0 % al combinarse con consejería). Los mayores incrementos en cesación se obtienen con ansiolíticos y antidepresivos (8,7% a 19,4%), y los menores con terapia de reemplazo nicotínico -TRN- (5,2% a 12,9%). La nortriptilina tiene eficacia similar al bupropion (aproximadamente 10,0 %). Con limitadas excepciones (parche e inhalador, tabletas y bupropion), las combinaciones de medicamentos no incrementan la abstinencia. Conclusiones TRN, vareniclina, bupropion y nortriptilina son eficaces para dejar de fumar. Las combinaciones de medicamentos requieren más evidencia y deberían restringirse a personas con alta dependencia o con falla terapéutica inicial. Serían deseables análisis de costo-efectividad para valorar implementación de programas en países en desarrollo.
Objective To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). Methods A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. Results Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. Conclusions NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.
Subject(s)
Humans , Practice Guidelines as Topic , Smoking Cessation , Tobacco Use Cessation Devices , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Bupropion/adverse effects , Bupropion/therapeutic use , Chest Pain/chemically induced , Clonidine/adverse effects , Clonidine/therapeutic use , Colombia , Cost-Benefit Analysis , Drug Administration Routes , Drug Eruptions/etiology , Drug Therapy, Combination , Gastrointestinal Diseases/chemically induced , Mucositis/chemically induced , Nortriptyline/adverse effects , Nortriptyline/therapeutic use , Sleep Initiation and Maintenance Disorders/chemically induced , Smoking Cessation/economics , Smoking Cessation/methods , Tobacco Use Cessation Devices/adverse effects , Tobacco Use Cessation Devices/economics , Treatment Outcome , Varenicline/adverse effects , Varenicline/therapeutic useABSTRACT
En enero del año en curso se celebran cincuenta años del informe del cirujano general de los Estados Unidos, donde describían por primera vez los efectos deletéreos del cigarrillo sobre la salud. En los años siguientes se pasó de identificar una asociación entre el tabaquismo y la enfermedad cardiovascular, a un análisis epidemiológico y fisiopatológico detallado que confirmó una relación causal con la enfermedad coronaria, la enfermedad arterial periférica y el accidente cerebrovascular. Las dos moléculas implicadas en forma directa con enfermedad cardiovascular son el monóxido de carbono y la nicotina. El primero produce hipoxemia, que favorece la liberación de radicales libres y el desarrollo de placas ateroescleróticas precoces por lesión y disfunción endotelial. La segunda afecta el sistema cardiovascular mediante vasoconstricción coronaria, liberación de catecolaminas, alteración del metabolismo de los lípidos reducción del colesterol HDL y mayor oxidación del LDL e inducción de un estado de hipercoagulabilidad por alteración de la membrana plaquetaria, aumento de la trombina y el fibrinógeno. Por cada diez cigarrillos diarios que se fuman la mortalidad por enfermedad cardiovascular aumenta un 18% en los hombres y un 31% en las mujeres. En los hombres fumadores el infarto agudo del miocardio puede aparecer en promedio una década antes en relación con los no fumadores y si el consumo es mayor a veinte cigarrillos por día, puede anticiparse aproximadamente veinte años. Las mujeres no fumadoras desarrollan un primer evento coronario casi diez años después que los hombres; en cambio, las fumadoras pueden desarrollar un infarto agudo del miocardio a edades similares que los varones.
Subject(s)
Tobacco Use Disorder , Coronary Disease , Stroke , Tobacco Products , SmokersABSTRACT
OBJECTIVE: To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). METHODS: A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. RESULTS: Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. CONCLUSIONS: NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.
Subject(s)
Practice Guidelines as Topic , Smoking Cessation , Tobacco Use Cessation Devices , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/adverse effects , Antidepressive Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Bupropion/adverse effects , Bupropion/therapeutic use , Chest Pain/chemically induced , Clonidine/adverse effects , Clonidine/therapeutic use , Colombia , Cost-Benefit Analysis , Drug Administration Routes , Drug Eruptions/etiology , Drug Therapy, Combination , Gastrointestinal Diseases/chemically induced , Humans , Mucositis/chemically induced , Nortriptyline/adverse effects , Nortriptyline/therapeutic use , Sleep Initiation and Maintenance Disorders/chemically induced , Smoking Cessation/economics , Smoking Cessation/methods , Tobacco Use Cessation Devices/adverse effects , Tobacco Use Cessation Devices/economics , Treatment Outcome , Varenicline/adverse effects , Varenicline/therapeutic useABSTRACT
Introducción. El tabaquismo es el principal factor de riesgo para enfermedades crónicas que constituyen la mayor carga en Colombia. Objetivos. Generar recomendaciones de práctica clínica sobre eficacia y seguridad del tratamiento para la cesación de la adicción al tabaco en adultos colombianos. Materiales y métodos. Se hizo una adaptación basada en la metodología ADAPTE. Se buscaron guías de práctica clínica en Medline, EMBASE, CINAHL, LILACS y Cochrane. Se evaluó la cesación a seis meses para consejería breve e intensiva, terapia de reemplazo nicotínico, bupropión, vareniclina, clonidina, nortriptilina, acupuntura, hipnosis, homeopatía y la combinación de tratamientos. Se utilizó el German Instrument for Methodological Guideline Appraisal (DELBI) para evaluar las guías de prácticalínica. Se seleccionaron las guías con puntaje mayor de 60 % en rigor metodológico y aplicabilidad en Colombia. Las preguntas sin evidencia fuerte se llevaron a consenso. Resultados. Se encontraron 925 referencias, se preseleccionaron 17 guías de práctica clínica y se escogieron 5 para adaptación. La consejería breve e intensiva, la terapia de reemplazo nicotínico, el bupropión, la nortriptilina y la vareniclina son eficaces en la cesación de tabaquismo (incrementó 5,1 % a 22,7 %). Los tratamientos alternativos no tienen eficacia demostrada en la cesación. El uso simultáneo de diferentes formas de terapia de reemplazo nicotínico es la única combinación con eficacia demostrada (OR 1,9; 95%: 1,3-2,7). Conclusiones. Existen diversas alternativas con eficacia demostrada para dejar de fumar. Los incrementos en las tasas de cesación son variables y la duración del efecto necesita mayor seguimiento. Para aplicar la consejería breve e intensiva en Colombia, se deben usar formatos estándar. Se requieren evaluaciones económicas para valorar el impacto y seleccionar las mejores intervenciones en el contexto colombiano.
Introduction: Chronic diseases represent the greatest burden of disease in Colombia for which smoking is the major risk factor. Objectives: To provide clinical practice recommendations based upon efficacy and safety of smoking cessation therapies for Colombian adults. Materials and methods: An adaptation of clinical practice guidelines (CPG) based on the ADAPT methodology was performed. We searched CPG on Medline, EMBASE, CINAHL, LILACS, and Cochrane databases. Six months cessation rates were appraised for brief and intensive counseling, nicotine replacement therapy (NRT), bupropion, varenicline, clonidine, nortriptyline, acupuncture, hypnosis, homeopathy, and combined treatments. CPG were evaluated with DELBI and selected when having a score above 60% for methodological rigor of development and applicability to the Colombian health system. Formal consensus was performed for questions without strong evidence. Results: 925 references were found, 17 CPG were pre-selected and 5 selected for adaptation. Brief and intensive counseling, NRT, bupropion, nortriptyline, and varenicline are effective for smoking cessation (cessation rates augment 5.1%-22.7%). Alternative therapies have not demonstrated cessation efficacy. Concomitant use of different NRT is the only combination with demonstrated efficacy (OR 1.9, 95%CI 1.3-2.7). Conclusions: Several alternatives for giving up tobacco smoking have confirmed efficacy. The absolute difference in cessation rates is variable among therapies and duration of effect requires further research. Brief and intensive counseling necessitate standardized formats for their implementation in Colombia. Economic evaluations are required to assess costs and benefits and to select the most suitable interventions for Colombia.
Subject(s)
Humans , Smoking Cessation/methods , Colombia , Practice Guidelines as TopicABSTRACT
La etiología de la sarcoidosis es aún desconocida; sin embargo, se ha encontrado una fuerte asociación con tuberculosis dadas sus similitudes clínicas e histológicas. A continuación se presenta un caso clínico que muestra la coexistencia de las dos entidades y su posible asociación etiológica. (Acta Med Colomb 2013; 38: 36-39).
The etiology of sarcoidosis is still unknown; however, a strong association with tuberculosis has been found, given its clinical and histological similarities. We present a clinical case that shows the coexistence of the two entities and their possible etiologi-cal association. (Acta Med Colomb 2013; 38: 36-39).
Subject(s)
Humans , Male , Female , Mycobacterium tuberculosis , Sarcoidosis , TuberculosisABSTRACT
INTRODUCTION: Chronic diseases represent the greatest burden of disease in Colombia for which smoking is the major risk factor. OBJECTIVES: To provide clinical practice recommendations based upon efficacy and safety of smoking cessation therapies for Colombian adults. MATERIALS AND METHODS: An adaptation of clinical practice guidelines (CPG) based on the ADAPT methodology was performed. We searched CPG on Medline, EMBASE, CINAHL, LILACS, and Cochrane databases. Six months' cessation rates were appraised for brief and intensive counseling, nicotine replacement therapy (NRT), bupropion, varenicline, clonidine, nortriptyline, acupuncture, hypnosis, homeopathy, and combined treatments. CPG were evaluated with DELBI and selected when having a score above 60% for methodological rigor of development and applicability to the Colombian health system. Formal consensus was performed for questions without strong evidence. RESULTS: 925 references were found, 17 CPG were pre-selected and 5 selected for adaptation. Brief and intensive counseling, NRT, bupropion, nortriptyline, and varenicline are effective for smoking cessation (cessation rates augment 5.1%-22.7%). Alternative therapies have not demonstrated cessation efficacy. Concomitant use of different NRT is the only combination with demonstrated efficacy (OR 1.9, 95%CI 1.3-2.7). CONCLUSIONS: Several alternatives for giving up tobacco smoking have confirmed efficacy. The absolute difference in cessation rates is variable among therapies and duration of effect requires further research. Brief and intensive counseling necessitate standardized formats for their implementation in Colombia. Economic evaluations are required to assess costs and benefits and to select the most suitable interventions for Colombia.
Subject(s)
Smoking Cessation/methods , Colombia , Humans , Practice Guidelines as TopicABSTRACT
La nocardia es una causa de infecciones pulmonares que viene en aumento, asociado en parte al aumento de terapias inmunosupresoras para pacientes con neoplasia hematológica, transplante de órganos y en pacientes con infección por VIH. Se revisa en este artículo un caso clínico de infección pulmonar por nocardia en paciente inmunosuprimida por dosis altas de esteroide y diabetes mellitus. Posteriormente se realiza una revisión de la literatura.
Subject(s)
Nocardia InfectionsABSTRACT
Hemos realizado un trabajo descriptivo multicéntrico comparativo; para tratar de establecer si la calidad de vida en los pacientes con enfermedad renal terminal, es mejor con hemodiálisis o diálisis peritoneal, después de haber iniciado el tratamiento y comparar estos resultados con otros trabajos al respecto encontrados en la literatura. La muestra escogida fué de 80 pacientes, excluyéndose 30 pacientes, quedando una muestra de 50 pacientes de los cuales 25 pacientes pertenecían a hemodiálisis y 25 pacientes a diálisis peritoneal, de dos instituciones de nuestra Pais: Clínica San Pedro Claver y Clínica de los Comuneros de Bucaramanga. A diferencia de los resultados de otros trabajos encontrados en la literatura, el nuestro mostró una diferencia significativa con una mejor calidad de vida a favor de los pacientes tratados con hemodiálisis.
