Higher Number Of Subjects Research Articles

The effect of two types of stretching on flexibility in selected joints in youth soccer players

Background: The nature of soccer causes overloading of certain muscles and muscle groups that are most often involved in typical training activities of players. Often the absence of additional leisure-time activities typical for children and adolescents leads to an increased risk of muscle imbalance. Objective: We were interested in the occurrence of muscle imbalance, specifically an occurrence of muscle shortening and limited flexibility of the spine as well as decreased range of motion (ROM) in selected joints among young soccer players. Methods: The players were randomly selected to take part in the study. Twelve young soccer players took part in the first group and thirteen in the second group (age 13 years, body weight 40.5 ± 3.9 vs. 41.5 ± 7.8 kg, height 150.0 ± 5.0 vs. 153.0 ± 9.8 cm). The first team performed only static stretching exercises at the end of the training session and the other team performed, except for static stretching, also dynamic stretching exercises always at the beginning of the training session. The effect of the stretching program on range of motion in chosen joints was assessed by 2 × 2 repeated-measures ANOVA (stretching methods × time). The statistical significance of a-level was set to .05 and partial ηp2. Results: Pre-test measurements revealed an occurrence of muscle shortening and limited ROM of the spine and selected joints mostly in the pelvis and lower limbs in all study participants. Comparison of ROM in selected joints between pre-test and post-test in program including both static and dynamic stretching showed significant increase of left hip during flexion (p = .03, ηp2 = .20). The program with only static stretching showed significant decrease the ROM of ankle plantar flexion (p = .04, ηp2 = .18). We did not find any significant difference between stretching programs on ROM. As for muscle shortening, both side improvements (higher number of subjects with no muscle shortening) were found in the following muscle or muscle groups - m. trapesius, m. pectoralis major, m. rectus femoris, m. tensor fasciae latae, knee flexors and m. triceps surae. Improvements were also observed in group 1, but corrections were only asymmetrical. Conclusions: The stretching program in the group of soccer players could lead to increase of range of motion in some joints after a special program. It could serve as protection from muscle imbalance and lower limb injuries.

Medial temporal lobe atrophy scores translated to clinical practice: Editorial comment on ‘Influence of age, disease onset and ApoE4 on visual medial temporal lobe atrophy cut‐offs'

Medial temporal lobe atrophy scores translated to clinical practice: Editorial comment on ‘Influence of age, disease onset and ApoE4 on visual medial temporal lobe atrophy cut‐offs'

Dental health status and treatment needs of police personnel of a north Indian state: a cross-sectional study.

Background:Oral health is an integral part of general health. Police personnel form the backbone for safety and security of a community hence their health is of utmost importance.Aim:The present study was conducted to assess the oral health status and treatment needs of police personnel employed in police stations of three districts within 35 km radius around Maharishi Markandeshwar University, Mullana.Subjects and Methods:A cross-sectional study was conducted on all the available police personnel at various police stations. Final sample size comprised of 652 subjects. The data were recorded on modified World Health Organization format (1997).Results:The mean age of subjects was 41.02 years (standard deviation = 12.29), 98.9% (645/652) were males and 1.1% (7/652) were females. The prevalence of dental caries was 54.3% (352/652) and the mean decayed, missing and filled teeth was 3.05. Mean number of teeth requiring filling and extraction were 0.44 and 0.67 respectively. Only 2.92% (19/652) of subjects possessed prosthesis in mandibular arch and a same number of individuals possessed prosthesis in maxillary arch. Regarding highest community periodontal index (CPI) score, 23.6% (153/652) subjects had a healthy periodontium whereas maximum subjects (61.3%, 398/652) had a CPI score 2.Conclusion:Prevalence of dental caries was quite high. Despite a high prosthetic need, only a small number of subjects possessed dental prosthesis. Overall periodontal status was satisfactory with a high number of subjects having completely healthy periodontium.

Potential role of repetitive transcranial magnetic stimulation in obesity

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique with mild side effects. Some forms of obesity may arise from eating disorders and recent data suggest that rTMS treatment could have beneficial effects in eating disorders. The purpose of this comprehensive review is to hypothesize that rTMS may play a role in obesity. Articles were selected based on a search on medline using the terms "rTMS", "food craving", "eating disorders", "addiction", and "obesity". They were published between 1995 and 2013. Repetitive transcranial magnetic stimulation has been evaluated in the treatment of bulimia nervosa. It appears that it exerts its effect via the reduction of the level of craving for food. Obesity is being recognized as one of the endpoints of food addiction and craving. Besides, rTMS and transcranial direct current stimulation are brain stimulation techniques being used in the treatment of psychoactive substance addiction. Repetitive transcranial magnetic stimulation, through the reduction of food craving may be a potential treatment for a subset of individuals suffering from obesity. Further studies with a higher number of subjects are still needed to confirm the effects of rTMS on obesity.

Analysis of body composition and blood parameters on 20 subjects after 6 months of training with SuperJump

The “Jill Cooper’s aerobic accellerator system” uses high quality rebound, modified to increase the acceleration, create a more accommodating work surface, greater stability and cushioning to protect joints. Thanks to the three forces of acceleration, deceleration, and the force of gravity, for each jump, the one-way valves of the lymphatic pathways open and close pushing the lymph towards the next “closed”. This action allows the lymphatic system to make a full turn faster than usual. We investigate the effects of 6 months of training on 20 subjects (age: 37 ± 19; weight: 74 ± 19 Kg; height:164,5 ± 13,5 cm; BMI: 28,13 ± 6,876 Kg/m2; % body fat: 26 ± 14,7 Kg). Antropometric parameters were detected used a Bioimpedance analyzer (BF 302 Ormon BIA); blood samples were collected by a clinical specialized center to analyze lipid profile (total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and triglycerides) as well as white and red blood cells (WBC and RBC). All these tests were performed before and after training. At the end of the six months of training all the determinations (body composition and blood tests) was made. The results obtained suggest that this system of fitness training got a great changement both on physical form (increase lean body mass at the expense of fat mass) that in blood parameters (all had a decrease statistical significance). The most relevant data covered the variation of blood parameters and in particular of the lipid profile: HDL, Triglycerides, LDL, total cholesterol. Also as regards the blood cells, the results were detected mainly on the number of basophils, lymphocytes and eusinofili regarding the white cells. The results of this study are still preliminary, but the premises stimulate interesting to perform further investigations in this direction, with a higher number of subjects.

Hearing preservation and speech perception outcomes with electric‐acoustic stimulation after 12 months of listening experience

To report on single-center data of an FDA-approved clinical trial on the objective benefits of cochlear implantation and subsequent ipsilateral Electric-Acoustic Stimulation (EAS). Single-center data from a prospective, multicenter clinical trial. Eighteen subjects completed the 12-month EAS evaluation and were included in this evaluation. Each patient underwent cochlear implantation using a standardized hearing preservation approach. Both hearing preservation and speech perception abilities were evaluated at various intervals. Speech testing included performance measures obtained in quiet (CNC words) and noise (adaptive CUNY protocol) in three listening conditions: hearing aid (HA) alone, cochlear implant (CI) only, and combined ipsilateral EAS. Various levels of hearing preservation were achieved with cochleostomy and round-window surgical approaches in 17 of the 18 subjects. Mean CNC word scores at the 12-month interval were 14.9 ± 12.1, 45.3 ± 15.4, and 70.7 ± 11.7% correct in the HA only, CI only, and EAS conditions, respectively. Average CUNY scores at 0 dB SNR were 14.6 ± 17.2, 47.1 ± 22.1, and 72.2 ± 21.5 for the three test conditions obtained after 12 months. Data obtained during this clinical trial correlate well with previous reports. Hearing preservation appears successful in a high number of subjects, and combined EAS offers excellent speech perception abilities in quiet and in noise. 4.

AB0287 Efficacy of etanercept (etn) plus methotrexate (mtx) vs. disease-modifying anti-rheumatic drug (dmard) combinations with mtx in established rheumatoid arthritis (ra): duration of disease and disease severity vs. outcomes

ObjectivesTo assess the effect of disease duration (≤2 y vs. >2 y) and severity (moderate [mod] vs. severe [sev]) on treatment outcomes in subjects with RA receiving ETN+MTX or DMARDs+MTX.MethodsData...

Domestic Violence, Alcohol Consumption and Depression in Criminal Population

The objective of this research was to determine the differences in levels of domestic violence, alcohol and depression by type of crime committed on 259 men and 200 women inmates of the Centre for Social Rehabilitation in Mexico. To assess alcohol consumption indicators were adapted from the National Addiction Survey, the CES-D was used to measure depressive symptoms and in terms of domestic violence, we designed a 16-reactive scale evaluating: verbal aggression, physical aggression, humiliation and respect. The results showed significant differences not by gender but by type of crime committed, specifically on domestic violence, in which was found that women had higher scores than men. Furthermore, the analysis by type of crime committed found a higher number of subjects with severe consumption that health damages and homicides. Regarding depressive symptoms, the results showed that women had higher scores than men; however, these differences were not significant. In conclusion, data indicate relevant differences by gender in terms of domestic violence, depressive symptoms and substance use, but not so, on the type of crime by substance consumption, depression or family violence.

Can exit prizes induce lame ducks to shirk less? Experimental evidence

Elected representatives serving their final period face only weak incentives to provide costly effort. However, overlapping generations (OLG) models suggest that exit prizes sustained by trigger strategies can induce representatives in their final period to provide such effort. We evaluate this hypothesis using a simple OLG public good experiment, the central treatment being whether exit prizes are permitted. We find that a significantly higher number of subjects in their final period contribute when exit prizes are permitted. However, this result does not originate from use of trigger strategies. More likely explanations include gift-exchange and focal-point effects.

Tone-Burst and Click-Evoked Otoacoustic Emissions in Subjects With Hearing Loss Above 0.25, 0.5, and 1 kHz

The aim of this study was to assess the diagnostic value of click-evoked otoacoustic emissions (CEOAEs) and tone-burst evoked otoacoustic emissions (TBOAEs) in identifying the residual hearing of subjects with partial deafness (PD)--a condition in which subjects have normal thresholds at low frequencies and severe-to-profound sensorineural hearing loss at high frequencies. Otoacoustic emissions (OAEs) were measured in 23 subjects with severe-to-profound sensorineural hearing loss, 46 with PD, and 15 with normal hearing (NH). The PD subjects were divided into three subgroups according to the frequency at which hearing loss started: PD250 (NH up to 250 Hz)--20 ears; PD500 (NH to 500 Hz)--18 ears; and PD1000 (NH up to 1000 Hz)--20 ears. Standard-click stimuli, and 0.5- and 1-kHz tone bursts (average amplitude 80 ± 3 peak dB SPL, nonlinear averaging protocol), were used. The tone bursts were four cycles long with equal rise/fall times and no plateau. Recordings were performed in two acquisition windows: a standard one 20-msec wide for clicks and 1-kHz tone bursts, and one 30-msec wide for 0.5-kHz tone bursts. OAE response levels, signal-to-noise ratios, and reproducibility were examined in terms of wide-band responses and in terms of half-octave bands centered at 0.5 and 1 kHz. Receiver operator characteristic analysis was used to determine which type of stimuli best differentiates partially deaf subjects from subjects with severe-to-profound sensorineural hearing loss through the range 125 to 8000 Hz. Nearly all recordings from groups PD500 and PD1000 showed 0.5-kHz TBOAEs. By contrast, 1-kHz TBOAEs and CEOAEs were generally found only in the PD1000 group. It was also possible to detect 0.5-kHz TBOAE responses in approximately 50% of ears from the PD250 group. Receiver operator characteristic analysis demonstrated that click and 1-kHz tone bursts provide a good diagnostic measure of residual hearing even when hearing loss starts as low as 1 kHz; moreover, the 0.5-kHz TBOAE could identify residual hearing when hearing loss started just > 0.5 kHz, a situation in which clicks failed to elicit a response. In the case of partially deaf subjects, diagnosis was more accurate when OAEs were analyzed by 1/2 octave bands. Furthermore, the use of a 0.5-kHz tone burst gave responses in the highest number of subjects, even when there were hearing losses in neighboring bands. The results of this study indicate that a 0.5-kHz TBOAE is a more powerful test than the standard CEOAE when cochlear function at low frequencies is of interest. The 0.5-kHz TBOAE may be used to identify partial deafness in patients who generally fail to show a response to the commonly used clicks. In addition, use of 1/2 octave-band filtering can increase the reproducibility and power of the test.

A influência das habilidades em consciência fonológica na terapia para os desvios fonológicos

Este trabalho teve como objetivo analisar as habilidades em consciência fonológica e o progresso (inventário fonético e fonológico e as generalizações) na terapia fonológica. O grupo pesquisado foi constituído por cinco crianças com desvio fonológico, com idades entre 5:0 e 6:11, submetidas à terapia fonológica. Foram analisados os resultados obtidos na avaliação da consciência fonológica pré-tratamento, a fim de verificar o desempenho das crianças quanto ao seu conhecimento fonológico. Realizou-se a avaliação fonológica pré e pós-tratamento, em que foi possível obter os inventários fonéticos e fonológicos dos sujeitos. Após, foram analisadas as generalizações obtidas com a terapia fonológica (itens lexicais não utilizados no tratamento, outras posições na palavra, dentro de uma classe de sons, outra classe de sons). Os resultados evidenciaram que não existe relação entre o desempenho em tarefas de consciência fonológica e os progressos na terapia. Tais resultados corroboram os achados da literatura, confirmando que crianças com desvio fonológico podem ser capazes de responder adequadamente a tarefas metalinguísticas como a consciência fonológica, sem que essa condição as auxilie a corrigir os desvios de sua fala. Sugere-se que este assunto seja mais bem investigado com um número maior de sujeitos, bem como com a avaliação da consciência fonológica pré e pós-terapia, no intuito de se obter dados generalizáveis os quais serão importantes para o entendimento dos casos de desvio fonológico.

Bioequivalence of a Novel High-dose Oral Formulation of α-Dihydroergocryptine

The plasma pharmacokinetics of alpha-dihydroergocryptine (DHEC, CAS 14271-05-7) were investigated in 24 patients with Parkinson disease after the administration of repeated oral doses of 40 mg DHEC twice daily by means of a novel 40 mg DHEC tablet (Almirid 40 mg test T) and an established 20 mg DHEC tablet (Almirid 20 mg - reference R). The trial was conducted according to a randomised, controlled, open, within-subject cross-over design; steady-state was established by means of a stepwise up-titration from 5 to 40 mg b.i.d. from day D01 to D19; investigational treatments (40 mg DHEC b.i.d. by means of formulation R and T) were administered on day D20 and D21 according to a randomised, period-balanced within-subject cross-over; treatment with DHEC was down-titrated in stepwise fashion from day D22 to D34. Morning doses of 2 x 20 mg DHEC (reference) yielded a fast and relatively short lasting peak with a geometric mean Cmax of 2157 pg/mL (CV: 0.978) after a median tmax of 1.00 h. Cmin throughout the first 12 h was on average 189 pg/mL (CV: 0.908). There was a quite distinct diurnal effect: evening doses of 2 x 20 mg DHEC (treatment R), yielded a relatively lower exposure with geometric mean Cmax, Cav- and Cmin-values of 800 pg/mL (CV: 0.870), 389 pg/mL (0.813) and 177 pg/mL (CV: 0.942). In contrast, there was relatively little within-subject distinction between the two formulations: for the day profile after the morning dose, the estimated ratios of the true means (Pr:R) for Cmax Cmin and Cav were 1.18 (90% CI: 0.96 to 1.43 - CVm: 0.394), 0.96 (90% CI: 0.86 to 1.09 - CVm: 0.230) and 1.06 (90% CI: 0.93 to 1.21 - CVm: 0.254); for the night profile after the evening dose, the estimated ratio of the true means (muT:muR) for Cmax, Cmin and Cav were 1.11 (90% CI: 0.91 to 1.35 - CVm: 0.395), 1.07 (90% CI: 0.95 to 1.20 - CVm: 0.232) and 1.07 (90% CI: 0.95 to 1.20 - CVm: 0.220). In view of important medical-ethical constraints not to expose an unreasonably high number of subjects, these findings could be accepted as a sufficient demonstration of bioequivalence.

Natural history of functional gastrointestinal disorders: Comparison of two longitudinal population-based studies

BackgroundFunctional gastrointestinal disorders are common but information on their natural history is limited. AimsTo document the natural history of functional gastrointestinal disorders in a population based study and to compare with the Olmsted County study. MethodA questionnaire was mailed to the same age- and gender-stratified random sample of the Icelandic population aged 18–75 in 1996 and 2006. Results were compared to the Olmsted County study. ResultsPrevalence of functional gastrointestinal disorder symptoms was stable between these periods in time: 16.9% and 17.2% for irritable bowel syndrome, and 4.8% and 6.1% for functional dyspepsia. Onset of each disorder was more often higher in the Olmsted County study than in Iceland. Disappearance rates were similar for both studies. Transition probabilities varied across the different subgroups and were different between studies. The same proportion had the same symptoms in the initial and final studies. More subjects had no symptoms in Iceland (52% vs. 40%) and different symptoms at follow up (38% vs. 23%). ConclusionPrevalence of functional gastrointestinal disorder symptoms was stable over time but the turnover in symptoms was high. A higher number of subjects had no symptoms in Iceland than in Olmsted County and there was a greater variation in subjects having different symptoms at follow up.

Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial

ObjectiveCap-assisted colonoscopy (CAC) uses a small plastic transparent cap attached to the tip of the colonoscope that can depress and flatten colonic folds and thus improve visualisation of their proximal...

Improvement in the Adenoma Detection Rate with High Definition Colonoscopes (HD-C)

Purpose: Development of high definition endoscopes has been a recent technological advancement in endoscopic imaging. Whether these improve adenoma detection rates during screening colonoscopies(SC) is not clear. The aim of the study was to compare standard definition colonoscopes(SD-C) and HD-C for: 1. Proportion of subjects with adenomas and number of adenomas detected per subject. 2. Proportion of subjects with advanced adenomas and number of advanced adenomas detected per subject. 3. Proportion of subjects with right sided adenomas and number of right sided adenomas detected per subject. Methods: We conducted a retrospective review of all SC performed at a tertiary referral center during two different time periods by 4 experienced endoscopists with or without a trainee. Between Jan 2005 and Dec 2006, all SC were performed with SD-C (Olympus 140 and 160 series) and were included in the SD-C arm. After HD-C (Olympus 180 series) were acquired by our unit, the older generation colonoscopes were phased out. All SC performed with HD-C between Jan 2008 to Sep 2010 were included in the HD-C arm. Detailed review of the patient records, endoscopy reports and histology reports was conducted. Fisher's exact test, unpaired t test and Wilcoxon rank sum test were used for statistical analysis. Results: A total of 2,015 SC were reviewed; 1056 in SD-C arm and 959 in HDC arm. Mean age was higher in the SD-C arm compared to HD-C arm (60.4 yrs vs 58.5 yrs; p <0.001). There were higher number of males in SD-C arm (98% vs 96%; p = 0.002). 74% subjects in SD-C arm were Caucasians compared to 71% in HD-C arm (p = 0.06). There were no significant differences between the two groups with respect to the inadequacy of bowel prep (p>0.99). The proportion of subjects with adenomas, number of adenomas per subject, proportion of subjects with advanced adenomas, number of advanced adenomas per subject, proportion of subjects with right sided adenomas and right sided adenomas per subject are shown in the Table.Table: No Caption available.Conclusion: 1. HD-C detected a 10% higher number of subjects with adenomas and a 41% higher number of adenomas per subject. 2. HD-C also detected a significantly higher number of advanced adenomas and right sided adenomas. 3. HD-C is a significant advancement in endoscopic imaging that can improve adenoma detection rates and may have a positive impact on the effectiveness of colonoscopy in preventing colorectal cancer. Disclosure: Deepthi Rao - No financial relationship with Olympus. Neil Gupta - No financial relationship with Olympus. Prateek Sharma - Olympus Grant / Research support. Ajay Bansal - No financial relationship with Olympus. Amit Rastogi - Olympus Grant / Research support.

Hearing Preservation After Complete Cochlear Coverage in Cochlear Implantation With the Free-Fitting FLEXSOFT Electrode Carrier

To demonstrate the possibility of atraumatic insertion with the free-fitting FLEX electrode by evaluating the degree of hearing preservation postoperatively. Retrospective study. Academic tertiary care center. Twenty-two severely to profoundly hearing impaired subjects with measurable residual hearing preoperatively. Atraumatic implantation with the 31.5-mm-long, free-fitting, and highly flexible FLEX electrode using either the round window approach or a cochleostomy technique. Subjects were tested preoperatively in unaided condition and at varying intervals postoperatively. Preoperative and postoperative low-frequency pure-tone average (PTA) and PTA shifts were calculated. Speech perception was measured preoperatively and postoperatively using the Freiburger monosyllabic word test in quiet. Preoperative low-frequency hearing could be preserved to a certain degree in 77.3% of subjects (17/22) after insertion of the FLEX electrode up to the point of first resistance. Complete loss of residual hearing was observed in 22.7% of subjects (5/22). In 18.2% of the subjects (4/22), the preoperative PTA was preserved within 10 dB. Pure-tone average results between preoperative and most recent testing showed statistically significant differences (p < 0.001 to p = 0.031) for almost all loudness levels ranging from 125 Hz to 1.5 kHz. The maximum threshold shift was 40 dB at 250 Hz for the lower frequencies up to 1 kHz. Monosyllable testing in quiet demonstrated significant improvement over time (p < 0.001). This study showed that preservation of residual hearing is possible in a high number of subjects when a flexible electrode and atraumatic surgical techniques are used.

Síndrome de Goldenhar: uma abordagem fonoaudiológica

TEMA: o objetivo deste trabalho foi relatar o caso de uma criança portadora de Síndrome de Goldenhar em tratamento fonoaudiológico em uma clínica escola. PROCEDIMENTOS: foram coletados dados do prontuário do paciente, mediante assinatura do Termo de Consentimento Livre e Esclarecido e aprovação no Comitê de Ética da instituição, durante aproximadamente 11 meses de fonoterapia. Trata-se de uma criança de 5 anos e 11 meses de idade, do gênero masculino, apresentando ao nascimento má formação na orelha e no côndilo mandibular direitos, bem como espinha bífida. Para descrição do caso, antes e após o período de intervenção, o paciente passou por avaliações fonoaudiológicas como exame auditivo, do sistema estomatongático, medidas antropométricas faciais, exame articulatório, avaliação fonológica e da discriminação auditiva. RESULTADOS: observaram-se alterações como perda auditiva condutiva de grau moderado na orelha direita; alteração na mobilidade de lábios e língua; funções como deglutição, mastigação e respiração atípicas; medidas antropométricas faciais inferiores à normalidade, principalmente nos ramos mandibulares; bem como distúrbios na fala de ordem fonética (distorções) e fonológicas (dessonorizações). A partir de então, estabeleceu-se um planejamento terapêutico, com resultados positivos no período mencionado, principalmente no que se refere à função de mastigação. CONCLUSÃO: o paciente apresentou grande variedade de alterações fonoaudiológicas decorrentes do espectro oculoauriculovertebral, que se somatizam na associação com a respiração oral, os hábitos orais deletérios e os fatores ambientais que atuam no caso. Novos estudos mais aprofundados e com maior número de sujeitos são importantes na corroboração destes resultados.

Oral Zinc Sulphate Supplementation for Six Months in SCA2 Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

Cuban patients with Spinocerebellar Ataxia type 2 (SCA2) have reduced concentrations of zinc in serum and cerebrospinal fluid (CSF). To assess the effect and safety of zinc supplementation, 36 Cuban SCA2 patients were randomly assigned to receive daily either 50 mg ZnSO(4) or placebo, together with neurorehabilitation therapy in a randomized, double-blind, placebo-controlled clinical trial during 6 months. Outcome measures included the changes of zinc levels in CSF and serum, ataxia score, oxidative stress and saccadic eye movements. At the end of the study, the Zinc-treated group showed: (i) a significant increase of the Zn levels in the CSF, (ii) mild decrease in the ataxia scale subscores for gait, posture, stance and dysdiadochocinesia (iii) reduction of lipid's oxidative damage, and (iv) reduction of saccadic latency when compared with the placebo group. The treatment was safe and well tolerated by all subjects. This study demonstrated the efficacy and safety of Zn supplementation, combined with neurorehabilitation for SCA2 patients and therefore it may encourage further studies on the clinical effect of zinc supplementation in SCA2 based in the conduction of future clinical trials with higher number of subjects.

Lower limit of normal or FEV 1/FVC

To review the currently available literature comparing the FEV1/FVC <LLN with a fixed value of FEV1/FVC < 0.70 in diagnosing airflow obstruction in subjects aged >40 years. A structured MEDLINE, EMBASE and Cochrane search of English-language literature was conducted. Studies comparing prevalence rates according to the LLN and a fixed value were included. Attention was paid to the choice of the reference test or gold standard used. Eighteen studies met the inclusion criteria. Sixteen studies compared the rates of subjects diagnosed with airflow obstruction by either definition of airflow obstruction without using a non-independent reference standard (level 4 studies). Using a fixed value of FEV1/FVC, an overall higher number of subjects were diagnosed with airflow obstruction that increased with age. Two studies included a follow-up phase comparing risks of either hospitalization or occurrence of respiratory symptoms and mortality (level 2b studies). Adjusted risks of hospitalization (HR 2.6) or mortality (HR 1.3) were significantly larger in subjects with an FEV1/FVC below 0.70 but above the LLN (in-between group) compared to subjects with normal lung function. The prevalence of spirometry-based COPD is greater when using the fixed value of FEV1/FVC in comparison to using the LLN. Based on one longitudinal study the in-between group appears to have a higher risk of hospitalization and mortality; therefore it seems that using the LLN of FEV1/FVC underestimates COPD. In absence of a gold standard of COPD longitudinal research will be necessary to determine which criterion is better and more clinically relevant.

Estado actual en el tratamiento de la enfermedad de Chagas

Efficient drugs against Chagas' disease must have an effect on the amastigote forms or intracellular reproduction elements of Trypanosoma cruzi (T. cruzi). Trypomastigote and epimastigote forms derive from the former and their response to medications is less marked. The only drugs used in humans are nifurtimox (NF) and benznidazole (BNZ). Other useful medications are allopurinol and itraconazole. NF acts producing free radicals and BNZ inhibits the synthesis of macromolecules. There is consensus that Chagas' disease must be treated in all its periods, since T.cruzi DNA is detected by polymerase chain reaction in chronic cases, even when microscopy is negative. The pharmacological treatment modifies the natural evolution of the disease. It also helps to solve a public health problem, considering that there is a high number of subjects with Chagas' disease. Subjects with chronic chagasic cardiomyopathy with terminal heart failure are the only cases without indication for treatment. Due to the digestive and skin secondary effects of the drugs, treated patients must be controlled clinically and with complete blood counts and hepatic proiles before, during and after the therapy. Approximately 30% of patients will experience secondary effects. Children have a better tolerance to the drugs. Congenital or acquired acute, intermediate and chronic cases should be treated.