Comparative productive performance of cows born through embryo transfer, artificial insemination and natural mating in dairy and dual-purpose herds raised in tropical conditions.

A populational, observational and longitudinal-retrospective study with records of 28 dairy-specialized and dual-purpose farms was carried out to compare the productive performance of cows born by embryo transfer (ET), artificial insemination (AI) and natural mating (NM), using the database of Centro Regional de Investigación para la Producción Animal Sostenible (CRIPAS) of cattle herds in Costa Rica. Herds (system × altitude), conception method (ET, AI and NM), genetic background (DSpB: specialized dairy breeds [Bos taurus] and crosses, GYR × HOL: Gyr × Holstein Crossbred and DSpB × BI: crosses between dairy breeds and Bos indicus), year of birth (or at calving), lactation number and days in milk were evaluated for the productive parameters age at first calving (AFC), calving to conception interval (CCI) and lactation milk yield (LMY) using a GLIMMIX procedure on SAS. The AFC, CCI and LMY were affected (p < .0001) by all factors considered in each parameter. ET has lower (p < .0001) AFC in months (33.1) than AI (35.2) and NM (36.44). NM had lower (p = .004) CCI (110 days) than AI or ET (121 days) values which were similar (p > .05). The higher LMY (p < .0001) was observed in ET (4140 kg), compared to AI (3706 kg) and NM (3595 kg). There was no difference between AI and NM. In conclusion, the method of conception in calves affected their future reproduction and production during puberty, postpartum and lactation. The effects on management decisions will require a rigorous economical study to discern whether ET would be a cost-effective alternative to AI or NM.

What factors explain the increase in obesity in Brazil? An ecological analysis of contextual and behavioural components.

OBJECTIVES: It has been suggested that contextual factors may be related to obesity; however, they have not yet been widely investigated. The main objective of this ecological time-series study was to analyse factors associated with the increase in obesity in the adult and elderly population in Brazil from 2006 to 2020. STUDY DESIGN: This is an ecological time-series study. Data were collected by the Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL), the main health survey in Brazil. METHODS: The outcome was the annual obesity growth rate (in percentage points). Independent variables were behavioural and contextual factors. Data analysis was performed using Prais-Winsten regression for temporal analyses, and Spearman correlation and crude and adjusted linear regression (beta and 95% confidence intervals [CIs]). RESULTS: The annual obesity growth rate was 0.58 percentage points (p.p.) (95% CI: 0.54; 0.63) per year. Demographic density and the percentage of the population employed showed an inverse association with the growth of obesity. Variables such as Gross Domestic Product (GDP) per capita, Gini coefficient, urbanisation rate, percentage of the population with low level of education and percentage of the population without an income were directly associated with the increase in obesity rates. The variables maintained in the final model explained 81% of the growth in obesity in Brazil over the last 15 years (2006-2020). CONCLUSIONS: The growth of obesity in Brazil was mostly explained by contextual factors, especially those of a socio-economic nature. Therefore, interventions to mitigate the increase in obesity must go beyond behavioural factors.

Exposure to pesticides and oxidative stress in Brazilian agricultural communities.

BACKGROUND: Oxidative stress may be an important mechanism linking pesticide exposure to several diseases. We evaluated the association between pesticide exposures and oxidative stress biomarkers in Brazilian agricultural workers. METHODS: A cross-sectional study was conducted in healthy agricultural (N = 52) and non-agricultural workers (N = 68) in a rural community in Rio de Janeiro State, Brazil. Regular pesticide use, sociodemographic, and lifestyle information was obtained by questionnaire. Oxidative stress biomarkers (N = 7) were measured in serum and plasma. We calculated percent differences and 95% confidence intervals (CI) in oxidative stress biomarkers for use of pesticides adjusted for sex, age, education, smoking, and alcohol consumption, using multiple linear regression. RESULTS: Living close to or in the fields was associated with glutathione peroxidase activity but not with any other markers. We observed significant positive associations between 8-isoprostane levels and activities of glutathione reductase, glutathione peroxidase, and glutathione-S-transferase with reported use of certain insecticides, fungicides, and herbicides. Our results also indicate a significant and negative association between glutathione-S-transferase activity and insecticide use. CONCLUSIONS: These findings suggest that use of pesticides may be associated with differences in oxidative stress biomarkers.

Latrogenic Cushing’s syndrome by an interaction between cobicistat and fluticasone: a case report / Síndrome de Cushing yatrogénico asociado a la interacción entre cobicistat y fluticasona: caso clínico

We report a case of iatrogenic Cushing’s syndrome associated with an interaction between cobicistat and fluticasone in a seropositive woman treated with elvitegravir/cobicistat/emtricitabina/TAF (Genvoya®). This case highlights the importance to review interactions between antirretroviral therapy and other drugs, especially when antirretroviral scheme includes protease inhibitors enhanced with ritonavir or cobicistat. These enhancers interfere the cytochrome P-450 metabolic pathway. A large number of drugs are metabolized by cytochrome P-450 and may be altered by cobicistat or ritonavir. (AU)

Presentamos un caso de síndrome de Cushing asociado a la interacción entre cobicistat y fluticasona en una mujer seropositiva en tratamiento con elvitegravir/cobicistat/emtricitabina/TAF (Genvoya®). Este caso pone de manifiesto la importancia de la revisión de las interacciones entre el tratamiento antirretroviral y otros tratamientos concomitantes, especialmente cuando el esquema antirretroviral contiene inhibidores de proteasa potenciados con ritonavir o cobicistat. Esta potenciación afecta a la ruta metabólica mediada por el citocromo P450. Un elevado número de fármacos son metabolizados por el citocromo P450, y por tanto pueden verse afectados cuando se administran con ritonavir o cobicistat. (AU)

¿Tienes lo que hay que tener?: un análisis de los factores asociados con la intención de optar por una carrera en cirugía entre estudiantes de medicina / Do you have what it takes? An analysis of the factors associated with the intention to choose a surgical career among medical undergraduates

Resumen Introducción Los cambios en la práctica profesional han transformado la intención de los estudiantes de medicina de optar por una carrera en cirugía. Objetivo Evaluar los factores asociados con esta intención en un contexto de acelerada dinámica educativa y sanitaria. Materiales y Método Evaluamos la intención de los estudiantes de diez facultades de medicina en Colombia, y los factores asociados, mediante un cuestionario (escala de Likert) desarrollado a partir de la revisión de la literatura. Identificamos la asociación entre los factores y la intención mediante un análisis de regresión lineal. Los resultados de la regresión se presentan mediante coeficientes β (p < 0,05). Resultados Un total de 252 estudiantes (65,87% mujeres) fueron incluidos en el análisis. El promedio de la intención fue 3,15 ± 1,34 (1-5). Los factores significativamente asociados fueron: identificación con el estilo de vida quirúrgico (β = 0,25); identificación con modelos (β = 0,18); atributos personales (β = 0,25) e identificación con la práctica profesional del cirujano (β = 0,16). No encontramos asociación significativa con el género (mujeres en la especialidad), prestigio, dinámica del posgrado ni recompensa futura. Conclusión Existe una intención moderada de elegir una carrera de cirugía entre estudiantes de medicina colombianos. Optar por esta carrera requiere atributos personales, modelos e identificación con el estilo de vida y práctica profesional del cirujano. Se requieren estudios cualitativos que exploren en profundidad estos resultados e intervenciones focalizadas a estimular esta intención entre los estudiantes.

Introduction The changes in the professional practice have transformed the intention of medical students to choose a surgical career. Aim Evaluate the factors associated with this intention in a context of accelerated educational and health dynamics. Materials and Method We evaluated the intention of the students of ten medical schools in Colombia, and the associated factors, through a questionnaire (Likert scale) settled from a literature review. We identify the association between the factors and the intention by using linear regression analysis. The results of the regression are presented by β coefficients (p < 0.05). Results A total of 252 students (65.87% women) were included in the analysis. The average of the intention was 3.15 ± 1.34 (1-5). The factors significantly associated were: identification with the surgical lifestyle (β = 0.25); identification with models (β = 0.18); personal attributes (β = 0.25) and identification with the professional practice of the surgeon (β = 0.16). We did not find significant associations with gender (women in the specialty), prestige, postgraduate dynamics and future rewards. Conclusion There is a moderate intention to choose a career in surgery among Colombian medical undergraduates. Choosing this career requires personal attributes, models and identification with the lifestyle and professional practice of the surgeon. Further qualitative studies are necessary to explore these results in depth, as well as interventions to stimulate this intention among students.

Comparación in vitro del espesor y homogeneidad de la capa de cementación en carillas indirectas, realizado con resina fluida vs cemento de resina fotodependiente / Comparison of thickness and homogeneity of thecementationlayer in indirectveneers, madewith fluidresin vs. light-cure resincement: in vitro study

Resumen Objetivo: Comparar el grosor y homogeneidad de la capa de cementación entre un cemento de resina fotodependiente y una resina fluida. Materiales y métodos: Para la obtención de la muestra se talló la preparación en un diente de marfilina, el cual fue escaneado y luego replicado 92 veces en un polímero ABS. La muestra se dividió en 2 grupos con 46 muestras cada uno. Se realizó la cementación de las carillas con resina fluida Tetric N-Flow en el grupo G1, y con cemento de resina fotodependiente VariolinkEsthetic en el grupo G2. Cada muestra fue previamente lavada con alcohol de 70°, luego secada y se aplicó una capa de adhesivo TetricN-Bond. Se utilizó presión digital para lograr el asentamiento final de las carillas. Finalmente se realizó un corte medial y uno paramedial para obtener muestras de 2 mm aproximadamente, las cuales se observaron y midieron en un microscopio óptico. Resultados: El promedio de grosor para Tetric N-Flow fue de 119μm en incisal, 113μm en medio y 107μm en cervical. Para VariolinkEsthetic el promedio fue de 117μm, 112μm y 110μm en incisal, medio y cervical respectivamente. La homogeneidad fue de un 93,3% para G1 y 91,3% para G2. Conclusión: No existe diferencia significativa en el grosor y homogeneidad de la capa de cementación realizado con resina fluida y con cemento de resina fotodependiente.

Abstract Objective: Compare the thickness and homogeneity of the cementing layer between a light-cure resin cementand a flowable resin. Materials and methods: To obtain the sample, the preparation was carved in a replica of tooth 1.1 (EWL modelteeth, Kavo), which was scanned and then replicated 92 times in an ABS polymerby 3D printing. The simple was divided into 2 groupswith 46 sample seach. The cementation of the veneres was performed with Tetric N-Flow flowable resin in the G1 group, and with Variolink Esthetic light-cure resin cement in the G2 group. Each simple was previously washed with 70° alcohol, then dried and a layer of Tetric N-Bond was applied. Digital pressure was used to achieve the final settlement of the veneers. Finally, a medial and a paramedial section were made to obtain approximately 2 mm thick samples. The cementation layer was observed with an optical microscope. Results: The average thickness for Tetric N-Flowwas 119μm in incisal, 113μm in medium and 107μm in cervical. For Variolink Esthetic the average was 117μm, 112μm and 110μm in incisal, middle and cervical respectively. The homogeneity was 93.3% for G1 and 91.3% for G2. Conclusion: There is no significant difference in the thickness and homogeneity of the cementing layer made with flowable resin and with light-cure resincement.

Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer.

BACKGROUND: Cancer-specific survival for patients with clinical stage I (CSI) germ cell testicular cancer (GCTC) is outstanding after inguinal orchidectomy regardless the treatment utilized. This study evaluated whether active surveillance (AS) of such patients yielded similar health outcomes to other therapeutic strategies such as adjuvant chemotherapy, radiotherapy or primary retroperitoneal lymphadenectomy as described in the literature. PATIENTS AND METHODS: Patients with CSI GCTC were screened between January 2012 and December 2016. Patients had previously undergone inguinal orchidectomy as the primary treatment and chosen AS as their preferred management strategy after receiving information about all available strategies. RESULTS: Out of 91 patients screened, 82 patients selected AS as their preferred management strategy. Relapse rate in the overall population was 20% (95% CI 12-30) and median time to relapse was 11.5 months (range 1.0-35.0). In patients with seminomatous tumors, relapse rate decreased to 13% and median time to relapse was 13 months; whereas in patients with non-seminomatous tumors, relapse rate was 33% (IA) or 29% (IB) and median time to relapse was 12 months in stage IA and 4.5 months in stage IB patients. All relapses were rescued with three or four cycles of chemotherapy and two also required a retroperitoneal lymphadenectomy. All patients are currently alive and free of disease. CONCLUSIONS: The clinical outcomes of patients with CSI GCTC managed by AS in this series were excellent. This strategy limited the administration of active treatments specifically to the minority of patients who relapsed without compromising performance.

Classification of glucose records from patients at diabetes risk using a combined permutation entropy algorithm.

BACKGROUND AND OBJECTIVES: The adoption in clinical practice of electronic portable blood or interstitial glucose monitors has enabled the collection, storage, and sharing of massive amounts of glucose level readings. This availability of data opened the door to the application of a multitude of mathematical methods to extract clinical information not discernible with conventional visual inspection. The objective of this study is to assess the capability of Permutation Entropy (PE) to find differences between glucose records of healthy and potentially diabetic subjects. METHODS: PE is a mathematical method based on the relative frequency analysis of ordinal patterns in time series that has gained a lot of attention in the last years due to its simplicity, robustness, and performance. We study in this paper the applicability of this method to glucose records of subjects at risk of diabetes in order to assess the predictability value of this metric in this context. RESULTS: PE, along with some of its derivatives, was able to find significant differences between diabetic and non-diabetic patients from records acquired up to 3 years before the diagnosis. The quantitative results for PE were 3.5878 ±â€¯0.3916 for the nondiabetic class, and 3.1564 ±â€¯0.4166 for the diabetic class. With a classification accuracy higher than 70%, and by means of a Cox regression model, PE demonstrated that it is a very promising candidate as a risk stratification tool for continuous glucose monitoring. CONCLUSION: PE can be considered as a prospective tool for the early diagnosis of the glucoregulatory system.

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could benefit from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossification following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classified according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the first MRI was studied as well as its relationship with the rate of cochlear ossification. At first postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossification. Differences were found in the time interval between surgery and first MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the first year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossification is a time-depending process, whose grounds are still to be defined.

Determinación de sangre oculta en heces (SOH) por Inmunocromatografía en estudiantes primer año de la Facultad de Ciencias Farmacéuticas y Bioquímicas de la UMSA y su entorno familiar, en la Gestión 2016 / Determination of occult blood in heces (SOH) by immunocromatography in students first year of the Faculty of Pharmaceutical and Biochemical Sciences of the UMSA and its family environment, in management 2016

El presente es un estudio de tipo descriptivo no experimental para determinar sangre oculta de heces (SOH) en población aparentemente sana. La presencia de SOH, puede estar relacionada con varias causas, como gastritis, úlcera péptica o duodenal, parasitosis intestinal, sangrado de encías o cáncer colorectal. Se analizaron 1093 muestras de heces fecales provenientes de estudiantes que cursaban la cátedra de Anatomía y Fisiología de la FCFB de la UMSA y su entorno familiar. Utilizando el método inmunocromatográfico (SUMASOHF), todos los investigadores que participaron fueron capacitados para realizar el análisis. Las muestras se procesaron, por duplicado y aquellas que dieron resultado positivo, se procesaron nuevamente. Los resultados se analizaron con el programa estadístico SPSS 22. Se encontró presencia de SOH en el 16,1% de todas las muestras procesadas. El porcentaje de casos positivos de SOH fue ligeramente superior en el género masculino y en el grupo etario de 61-80 años. En el grupo de fumadores se reveló un 24.50% de casos positivos y un 19.20% en las personas que declararon consumir bebidas alcohólicas. También se consideraron otras causas de SOH, como la insuficiencia cardiaca, la gastritis, la ingestión de medicamentos como la aspirina y el ibuprofeno. A todos los casos que dieron positivo de SOH, se recomendó consultar con su médico para realizar otros exámenes más específicos. En conclusión la pérdida de sangre por heces fecales es un problema, que puede pasar desapercibido por la ausencia de sintomatología; por lo tanto, sugerimos que esta prueba sea incluida en la evaluación rutinaria de pacientes.

A descriptive, non-experimental study was carried out to determine the presence of fecal occult blood (SOH) considering its relation with the early diagnosis of colorectal cancer. We analyzed 1093 fecal samples from students who were in the Chair of Anatomy and Physiology of the FCFB of UMSA and their family environment. Using the immunochromatographic method (SUMASOHF), all the researchers who participated were trained to perform the analysis. The samples were processed in the laboratory of Anatomy and Physiology, using a inmunocromatographic metod, (SUMASOHF). The investigatours were trained to perform the test and the samples were processed with the supervision of the professors. All samples were processed in duplicate and all positive samples were reprocessed. All results were registrated in the correspondy datasheet. The data were analysed using the a statistical program SPSS 22. We found presence of fecal occult blood in 16.1 % of the samples. The percentage of positive cases of SOH in the male gender was slightly higher compared to the number of positive cases was higher in goner of 61 to 80 age group. In the group of smokers revealed a 24.50% of positive cases and 19.20% in the group that consumes alcohol. Other causes of SOH were also investigated such as heart failure, gastritis, ingestion of drugs such as aspirin and ibuprofen. In some cases, no probable cause of bleeding was found. It was recommended to all participant with a positive test, consult their doctors for more specific diagnosis. Here were concluded that stool blood loss is a problem, which is ignored since there is absence of symptomatology, therefore, we suggest that this test be included in the routine evaluation of patients.

Serological evaluation of bovine herpesvirus 1 and 5 in cattle-breeding systems on Colombia's high plains / Evaluación serológica de Herpesvirus bovino 1 y 5 en Sistemas de cría en la Altillanura Colombiana

ABSTRACT Objective . The aim of this study was to determine the presence of Bovine herpesvirus - 1 (BoHV-1) and Bovine herpesvirus 5 (BoHV-5) neutralizing antibodies in herds on the Colombian high plains and their correlation with the level of cross-protection against both herpesviruses. Materials and methods . This study was carried out on cattle farms located around the towns of Puerto López and Puerto Gaitán in Colombia's Meta department. Sampling was made by convenience. Twenty-three farms were involved in the study; 488 sera samples were taken by random sampling. Virus neutralization test were performed according to the protocols of the OIE. Each serum was evaluated independently for each virus, BoHV-1 and BoHV-5. Results. The serological test confirmed the presence of BoHV-1 and BoHV-5 infections in the Colombian bovine population in 100% and 73.9% respectively. However, cross-reaction for both viruses was not evident in all farms evaluated. Conclusions . Alpha-herpesviruses are amongst the most significant infectious agents affecting cattle. Bovine herpesvirus 1 (BoHV-1) is found throughout the whole world and is endemic in Colombian bovine population, whereas bovine herpesvirus 5 (BoHV-5) has limited geographical distribution, mainly being reported in South-America (Brazil and Argentina), and we also confirmed the presence of BoHV-5 in Colombia.

RESUMEN Objetivo. El objetivo de este estudio fue determinar la presencia de anticuerpos para herpesvirus bovino 1 (BoHV-1) y herpesvirus bovino 5 (BoHV-5), así como también determinar el nivel de protección cruzada contra los dos herpesvirus en hatos de la altillanura colombiana. Materiales y métodos . Este estudio se realizó en fincas ubicadas en los municipios de Puerto López y Puerto Gaitán departamento del Meta. Se realizó un muestreo por conveniencia. Se emplearon 23 fincas, donde se realizó un muestreo al azar en cada una para un total de 488 muestras. Las muestras de suero fueron analizadas mediante sero-neutralización viral empleando los protocolos de la OIE. Cada uno de los sueros fue evaluado de manera independiente para cada uno de los virus BoHV-1 y BoHV-5. Resultados. Mediante la sero-neutralización viral se confirmó la presencia de BoHV-1 y BoHV-5 en la población bovina colombiana en 100% y 73.9%, respectivamente. Sin embargo, la reactividad cruzada no fue evidente en todas las fincas evaluadas. Conclusiones. Los alfa-herpesvirus bovinos se encuentran entre los agentes infecciosos más importantes del ganado bovino. Particularmente, el herpesvirus bovino 1 (BoHV-1) presenta una distribución mundial, siendo endémico en la población bovina colombiana, mientras que el herpesvirus bovino 5 (BoHV-5), presenta una distribución geográfica limitada; reportándose principalmente en Suramérica (Brasil y Argentina), comprobándose la presencia de este en los hatos colombianos.

Fisiopatología de la migraña: Teoría vascular, ¿Cierta o no? / Pathophysiology of migraine: vascular theory, true or not?

La migraña es una enfermedad de alta prevalencia, incapacitante y en algunas ocasiones de difícil manejo. Desde hace décadas se han planteado múltiples teorías para explicar su curso, su componente genético y la asociación a distintos factores de riesgo. Actualmente se desconoce una fisiopatología única y exacta que implique los eventos, y se ha encontrado fuerte evidencia que muestra que la teoría más antigua y con mayor sustento, a saber la teoría vascular, es en realidad incorrecta, pues no explica la totalidad de los eventos. Sin embargo, se han probado distintos mecanismos que, en conjunto, permiten comprender las alteraciones presentes. Entre estas se cuentan cambios estructurales, implicación de neuropéptidos, sensibilización, e inflamación neurogénica.

Migraine is a highly prevalent disease; it is disabling, and sometimes difficult to manage. For decades, many theories have been proposed to explain its course, its association with a genetic component and with different risk factors. There is currently no single and exact pathophysiology that accounts for all events, and strong evidence has been showing that the oldest theory believed to be mostly true, i.e. the vascular theory, is actually incorrect, because it does not explain the totality of the events. However, various mechanisms have been proven to exist, which together, provide insight into alterations, such as structural changes involving neuropeptides, sensitization, and neurogenic inflammation.

Use of a closed-system drug transfer device (PhaSeal) and impact on preparation time.

PhaSeal is a closed-system drug transfer device which has demonstrated to protect against occupational exposure to antineoplastic agents. Our aim was to assess the impact of the incorporation of PhaSeal on the processing time of chemotherapy. The study was a prospective simulation study which compared the processing times with the traditional open-system technique and using the closed-transfer system. Four experienced pharmacy technicians prepared six batches with each method simulating simple chemotherapy admixture operations. We compared the mean times obtained by student's t test and evaluated the "learning effect" between days by ANOVA. The average percentage of time saving with PhaSeal was 31.7% (time per batch [mean +/- SD] 6.44+0.73 vs. 9.44+0.98 minutes). Mean difference was statistically significant (3.0 min IC95% 2.50-3.50; p>0.0001). No significant learning curve effect was detected. The BD Medical/Carmel Pharma PhaSeal system, in addition to its protective properties, is able to save time in the elaboration process which leads to organization advantages for hospital pharmacy services.

Size-normalized Robustness of Dpp Gradient in Drosophila Wing Imaginal Disc.

Exogenous environmental changes are known to affect the intrinsic characteristics of biological organizms. For instance, the synthesis rate of the morphogen decapentaplegic (Dpp) in a Drosophila wing imaginal disc has been found to double with an increase of 5.9°C in ambient temprerature. If not compensated, such a change would alter the signaling Dpp gradient significantly and thereby the development of thewing imaginal disc. To learn how flies continue to develop "normally" under such an exogenous change, we formulate in this paper a spatially two-dimensional reaction-diffusion system of partial differential equations (PDE) that accounts for the biological processes at work in the Drosophila wing disc essential for the formation of signaling Dpp gradient. By way of this PDE model, we investigate the effect of the apical-basal thickness and antero-posterior span of the wing on the shape of signaling gradients and the robustness of wing development in an altered environment (including an enhanced morphogen synthesis rate). Our principal result is a delineation of the role of wing disc size change in maintaining the magnitude and shape of the signaling Dpp gradient. The result provides a theoretical basis for the observed robustness of wing development, preserving relative but not absolute tissue pattern, when the morphogen synthesis rate is significantly altered. A similar robustness considerqation for simultaneous changes of multiple intrinsic system characteristics is also discussed briefly.

Entrenamiento muscular de las extremidades inferiores en el paciente con enfermedad pulmonar obstructiva crónica / Lower extremity exercise training in the rehabilitation of patients with chronic obstructive pulmonary disease

Several studies have shown that poor exercise tolerance in Chronic Obstructive Pulmonary Disease (COPD) patients is multifactorial in origin. However, a major exercise-limiting factor in COPD is peripheral muscle dysfunction, particularly the muscles of the lower extremities, characterized by atrophic muscles and reduced fatigue resistance due to morphological and metabolic alterations of peripheral muscles. This chapter therefore evaluated the scientific evidence regarding the beneficial effect of lower extremities exercise in the pulmonary rehabilitation in COPD patients. The technical characteristics of this exercise training were also reviewed. Exercise training of lower limbs was recommended in respiratory rehabilitation of COPD patients. The lower extremities muscle exercise training provides significant benefits to patients with COPD in terms of reduction of dyspnea and improvemet in exercise capacity and in quality of life (quality level of evidence = A, strong recommendation). Higher-intensity exercise training and with interval exercise of the lower extrmities produces greater physiological benefits.

Diversos estudios han demostrado que la pobre tolerancia al ejercicio de los pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) es de origen multifactorial. Sin embargo, un importante factor limitante del ejercicio en los pacientes con EPOC es la disfunción muscular periférica, sobre todo de los músculos de las extremidades inferiores, que se caracteriza por atrofia muscular y reducida resistencia a la fatiga dado por alteraciones morfológicas y metabólicas de los músculos periféricos. En este capitulo se evaluó la evidencia científica que existe en cuanto a los beneficios del entrenamiento muscular de extremidades inferiores (EEII) en la rehabilitación respiratoria en pacientes con EPOC. También se revisan las características técnicas de dicho entrenamiento. Se recomienda la realización de entrenamiento muscular de EEII en rehabilitación respiratoria de pacientes con EPOC. El entrenamiento muscular de extremidades inferiores otorga significativos beneficios a los pacientes con EPOC en cuanto a disminuir la disnea, mejorar la capacidad de ejercicio y la calidad de vida (calidad de la evidencia A, recomendación fuerte). El entrenamiento de EEII de alta intensidad y con intervalos produce significativos beneficios fisiológicos.