Prevalencia y determinantes de asma en adultos en Quito: un estudio transversal

Background:

Although several epidemiological studies of asthma have been carried out in Ecuador in the last two decades, none of these has estimated the prevalence of asthma in adult populations.

Objective:

To estimate the prevalence of asthma symptoms in adults in the city of Quito and to identify possible associated factors.

Methods:

A cross-sectional study was conducted on subjects older than 18 years residing in the Metropolitan District of Quito. The Global Asthma Network (GAN) questionnaire was applied to collect information on asthma symptoms and sociodemographic and lifestyle data. Bivariate and multivariate analyses with logistic regression were used to identify asthma-related factors.

Results:

2,476 subjects answered the questionnaire (80.9% women, mean age 40 years). The prevalence of wheezing in the last 12 months, asthma ever, and asthma diagnosed by a doctor were 6.3%, 1.9% and 1.6%, respectively. The prevalence of rhinitis ever and eczema ever was 13.7% and 5.5%. The presence of mould at home (OR: 2.13; 95% CI: 1.48 -3.06; p <0.001), cat at home (OR: 1.06; 95% CI: 1.06 -2.13; p <0.022) and rhinitis at some time (OR: 3.65; 95% CI: 2.53 - 5.29; p <0.022) were associated with the presence of wheezing in the last 12 months.

Conclusions:

Our study shows that, compared to other cities in Latin America, the prevalence of asthma in adults in Quito is relatively low. Along with the presence of rhinitis, factors related to housing quality are closely linked to the occurrence of asthma in adult populations.

Trends in hospital admissions and mortality rates for asthma in Ecuador: a joinpoint regression analysis of data from 2000 to 2018

BACKGROUND

Although asthma has emerged as an important public health problem over recent decades in Latin America, there are limited published data on national hospital admission and mortality rates for asthma from countries in the region.

OBJECTIVE

To analyse trends in asthma hospitalisation and mortality rates in Ecuador over a 19-year period from 2000 to 2018.

METHODS

Hospital discharge and death certificates listing asthma, as defined in the International Classification of Diseases 10th Revision codes (J45 and J46), were used to analyse time trends in rates of hospital admissions and mortality for asthma. The data were obtained from the Ecuadorian National Institute of Statistics and Census. Crude and age-standardised rates were estimated for the entire population. Additionally, specific rates by sex, age and region were estimated. We used joinpoint analysis to identify national trends.

RESULT

During 2000-2018, a total of 58 250 hospitalisations and 1328 deaths due to asthma were identified. The average annual rates for hospitalisation and mortality attributed to asthma were estimated to be 21 (95% CI 19.3 to 22.8) and 5.2 (95% CI 4.4 to 6.0) per 100 000 population, respectively, over this period. Asthma hospital admissions decreased from 28 to 13.7 per 100 000 population between 2000 and 2018, and asthma mortality decreased from 0.8 to 0.3 per 100 000 population over the same period. Based on jointpoint analysis, two temporal trends were identified for hospital admissions. Between 2000 and 2011, hospital admissions decreased 0.8% per year and between 2011 and 2018 decreased 6.6% per year (p<0.05). On average, hospitalisation rates decreased 3.1% per year (p<0.05) over the entire study period. Mortality rate decreased 5.6% per year (p<0.05) over the 19-year period. Hospitalisation rates were higher among females, those aged 5 to 19 years and those living in the Coast region.

CONCLUSIONS

Our analysis shows a temporal trend of reduction in rates of hospitalisations and deaths attributed to asthma between 2000 and 2018 in Ecuador, consistent with similar trends elsewhere in the Latin American region. Health registration systems in Latin America need to be improved to provide reliable data for future between and within country comparisons of trends in asthma hospitalisations and deaths.

Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin‐converting enzyme 2 (ACE2). As a result of SARS‐CoV‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT₁R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT₁R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects, helpful in mitigating COVID‐19 severity.

Mechanical pinprick pain in patients with unilateral spatial neglect: The influence of space representation on the perception of nociceptive stimuli

BACKGROUND

Crossing the hands over the midline can reduce the perceived intensity of nociceptive stimuli applied onto the hands. It remains unclear to what extent intact representation of peripersonal space influences this effect. Here we used the crossed-hands paradigm in patients with unilateral spatial neglect, a neuropsychological condition characterized by the inability to detect, attend and respond to contralesional (most often left) stimuli, and spared ability to process stimuli in the non-affected space.

METHODS

Sixteen post-stroke patients without unilateral neglect and 11 patients with unilateral spatial neglect received punctate mechanical pinprick stimuli onto their crossed or uncrossed hands. We tested: (i) whether deficits in space representation reduce the possibility of observing 'crossed-hands analgesia', and; (ii) whether placing the contralesional hand, normally lying in the affected space in the healthy space would increase the number of detected stimuli.

RESULTS

Our results showed that neglect patients did not exhibit 'crossed-hands' analgesia, but did not provide strong evidence for an improvement in the number of detected stimuli when the contralesional hand was in the healthy space.

CONCLUSION

These findings uphold the notion that the perception of nociceptive stimuli is modulated by the relative position of the hands in space, but raise questions about the conditions under which these effects may arise.

SIGNIFICANCE

We show that deficits in space representation can influence the processing of mechanical pinprick stimuli. Our results raise several questions on the mechanisms underlying these effects, which are relevant for the clinical practice.