Objective: This study aimed to estimate asthma control at specialist treatment centers in four Latin American countries and assess factors influencing poor asthma control. Methods: Patients aged !12 years with an asthma diagnosis and asthma medication prescription, followed at outpatient specialist centers in Argentina, Chile, Colombia, and Mexico, were included. The study received all applicable ethical approvals. The Asthma Control Test (ACT) was used to classify patients as having controlled (ACT 20-25) or uncontrolled (ACT 19) asthma. Frequency and statistical tests were used to assess the association between hospital admissions/exacerbations/emergency department (ED) visits and uncontrolled asthma; multivariate logistic regression was used to assess the association of uncontrolled asthma with clinical/demographic variables. Results: A total of 594 patients were included. Overall controlled-asthma prevalence was 43.4% (95% confidence interval [CI]: 39.0, 47.4). Patients with uncontrolled asthma were more likely to be women (adjusted odds ratio [aOR]: 1.85; p ¼ 0.003), non-white (aOR: 2.14; p < 0.001), obese (aOR: 1.71; p ¼ 0.036), to have a low monthly family income (aOR: 1.75; p ¼ 0.004), to have severe asthma (aOR:1.59; p ¼ 0.26), and, compared with patients with controlled asthma, to have a higher likelihood of asthma exacerbations (34.5% vs. 15.9%; p < 0.001), hospital admissions (6.9% vs. 3.1%; p ¼ 0.042), and ED visits (34.5% vs. 15.9%; p < 0.001) due to asthma. Conclusions: Even in specialist ambulatory services, fewer than half of patients were classified as having controlled asthma. The proportion of uncontrolled patients varied according to clinical and demographic variables.

RATIONALE: There is no multi-country study in specialized centers investigating uncontrolled asthma and associated factors in Latin America. METHODS: Cross-sectional study, including subjects > _12 years with a diagnosis of asthma and prescription for asthma medication at 18 public/ private outpatient specialised centres in Argentina, Chile, Colombia and Mexico. The Asthma Control Test (ACT) was used to classify the patients as controlled (ACT: 20-25) or uncontrolled (ACT < _19). Multivariate logistic regression was applied to assess the association of uncontrolled asthma with clinical/demographic variables and univariate logistic regression to test the association between hospital admission/exacerbation/ emergency visit and uncontrolled asthma. RESULTS: 594 patients were included. The frequency of uncontrolled asthma was 56.6% (95%CI 52.5-60.5%). In the multivariate analysis, the uncontrolled patients were more likely to be women (62.3% vs 41.4%, ORadj: 1.8, p<0.001), non-white (68.3% vs 45.2%, ORadj: 2.01, p<0.001), with monthly family income lower than $668.5 (67.8% vs 45.6%, ORadj: 1.71, p<0.05) and obese (70.1% vs 29.9%, ORadj: 1.63, p50.057). The patients with uncontrolled asthma were more likely to have severe/moderate asthma exacerbations (28.0% vs 10.9%, ORcrude: 3.31, p<0.001), hospital admissions (6.8% vs 3.1%, ORcrude: 2.30, p50.047) and emergency visits (34.5% vs 15.9%, ORcrude: 2.79, p<0.001) due to asthma. CONCLUSIONS: Even in specialised services, more than half of the patients were classified as uncontrolled. Poorly controlled asthma was associated with an increase in the demand for healthcare in Latin America. The uneven distribution of control relative to race/ethnicity and income points to the emerging role of social factors influencing the burden of asthma.

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BackgroundThe mortality of lung cancer (LC), increases each year in the world, in spite of any advances, in development of new drugs to advance stages of LC. The high incidence of LC has been associated with smoking habit, genetic diversity and environmental pollution. Antofagasta region has been reported to have the highest LC mortality rate in Chile and its inhabitants were exposed to arsenic in their drinking water in concentrations as high as 870 μg/L. Non-invasive techniques such as biomarkers (Automatic Quantitative Cytometry: AQC and DR70) and Auto Fluorescence Bronchoscopy (AFB) might be potentially useful as a supplementary diagnostic approach and early detection. Early detection is one of the most important factors to intervene and prevent cancer progression in LC. This is a work of an ongoing prospective bimodality cancer surveillance study in high risk LC volunteers. Enrolment was done in subjects from Antofagasta and Metropolitan regions. In addition, we enrolled subjects who were suspected of having lung cancer. AQC, DR70 and AFB were used as tools in the detection of pre-neoplastic (PNL) and neoplastic lesions (NL).ResultsHalf of the samples, classified as suspicious by AFB, were confirmed as metaplasia or dysplasia by histopathology. For LC, DR70 showed a higher sensitivity (95.8%) and specificity (91.9%) than AQC. However, for PNL AQC showed a higher sensitivity (91.9%) than DR70 (27.3%), although both with low PPV values. As a pre screener, both biomarkers might be employed as complementary tools to detect LC, especially as serially combined tests, with a sensitivity of 60% and a PPV of 65.2%. Additionally, the use of parallel combined tests might support the detection of PNL (sensitivity 91.2%; PPV 49.1%).ConclusionThis work adds information on cellular and molecular biomarkers to complement imaging techniques for early detection of LC in Latin America that might contribute to formulate policies concerning screening of LC. Supported by INNOVA-CORFO, Chile.

La actual pandemia por Covid-19 (SARS-CoV-2) corresponde a una zoonosis viral altamente contagiosa que ha requerido extremar las medidas de protección personal con el fin de disminuir la transmisión del virus, tanto en ambientes hospitalarios como fuera de ellos, siendo necesaria la adopción de estrictos métodos de aislamiento tanto de contacto como aerosoles. Esto ha requerido la adopción de múltiples equipos de protección personal, dentro de los que se encuentran la protección ocular, mascarillas, escudo de protección facial, gorros, guantes, etcétera. Lo anterior ha generado un aumento en el daño de la barrera cutánea y, por lo tanto, la aparición de diversas dermatosis dentro de las que se encuentran dermatitis de contacto irritativa o alérgica, reacciones acneiformes, agravamiento de dermatosis previas, entre otras, cobrando así vital importancia el cuidado y restablecimiento de la barrera cutánea con medidas esenciales como aplicación de productos humectantes o emolientes y el correcto uso de los equipos en mención. No obstante, no solo se generan dermatosis derivadas del uso de equipos de protección personal, sino que también, dentro del amplio espectro de manifestaciones dermatológicas que puede generar la enfermedad por Covid-19 propiamente tal, incluyendo compromiso cutáneo, piloso (efluvio telógeno) o ungueal (onicomadesis). Por otro lado pero no motivo de este artículo, el compromiso cutáneo puede corresponder a la primera expresión clínica de la enfermedad o ser un predictor de su evolución. Dentro de lo anterior encontramos la urticaria aguda, exantema maculo-papular, exantema varicela-like, erupción petequial, perniosis-like y lívedo reticularis como las principales formas de afección cutánea hasta el momento.