Introduction Decompensated heart failure (DHF) is the main cause of cardiovascular hospitalization. During 1-year follow-up (FU), at least one rehospitalization occurred in 56.6% of patients with HF. In Mexico, HF places great burden on patients, caregivers, and healthcare systems. New strategies are essential for early diagnosis and treatment of DHF. Hypothesis: Use of a digital tool is effective for remote monitoring of patients with CHF to reduce the number of hospitalizations and/or unscheduled visits to the ER. Methods: A mixed digital model of HF (MDM-HF) care has been developed. It included an app in patient’s mobiles (CardioEnlace) that allowed real time monitoring of key parameters. These data were transferred into HF Unit portal and integrated into the patient's clinical file. CardioEnlace allowed detection of decompensation events through 1) alerts by patient′s text messages and 2) system alerts when variables were out of security limits on three or more consecutive days. If a patient showed signs of DHF, he/she was reached to provide medical instructions and/or scheduled an early appointment. Results: MDM-HF care was deployed in July 2021. Up to date 131 patients have been included. The median of age is 58 years (interquartile range 47.5-65.5) and 77.1% were male. Cardiovascular risk factors (CVRF) frequencies are shown in Table 1. HF was secondary to ischemic condition in 44.5% of the patients. At least one hospitalization in the previous 2 years was reported in 73.5% of the subjects. Cardio Enlace parameters are shown in Fig 1. A blood pressure <140/90 mmHg was reported in 89.5% of patients and the average exercise time was 32 min/day. CardioEnlace alerts from January 2022 to date, were 82. Reasons are shown in Table 2. Adjustments to the treatment were done immediately and none of the patients had been hospitalized. Discussion: MDM-HF care model supports an early detection of DHF and monitorization of CVRF treatment which affect around 50% of the patients. Follow-up evaluations would allow to assess its impact on hospitalizations/emergency admissions. MDM-HF care model is part of the HF National Mexican Registry that will integrate data-driven solutions to reduce lead times from diagnosis to therapy adjustments and reduce the economic burden of DHF.

Background: Cystic fibrosis (CF) is a chronic disease with an impact on the quality of life. Self-reported symptoms of depression and anxiety were assessed in the Spanish cohort of the International Epidemiological Study on Depression and Anxiety in patients with CF (International Depression-Anxiety Epidemiological Study) and their relationship with health status and health-related quality of life (HRQoL) was evaluated.Methods: This cross-sectional study recruited adult patients with CF at 10 Spanish centers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Revised Cystic Fibrosis Questionnaire. Demographic and health data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS >= 8).Results: Of the 336 participants recruited (mean age, 28.1 years; 48.2% women), 41 (12.2%) had elevated depression-related scores, and 100 (29.7%) had elevated anxiety-related scores (HADS >= 8). After adjusting for confounders, only less education, intravenous antibiotics, psychiatric medications and psychotherapy were significantly associated with elevated psychological symptoms. Specifically, regardless of lung function, patients who were depressed or anxious reported worse HRQoL.Conclusions: The prevalence of elevated symptoms of depression and anxiety was high in Spanish adult patients with CF, and these symptoms were associated with a decreased HRQoL. (C) 2016 Elsevier Inc. All rights reserved.

Objectives: The purpose of this work is to implement non-invasive prenatal diagnosis (NIPD) of cystic fibrosis, based on analysis of cellfree fetal DNA (cffDNA) present in maternal peripheral blood. NIPD of CF was performed by detection of the F508del mutation. Methods: cffDNA occurs in plasma only in form of short fragments. By targeting the shorter DNA molecules, the fractional concentration of cffDNA is enriched. cffDNA was isolated from maternal plasma by the QIAamp DNA Mini Kit and Clean Circulating DNA Kit. Quality of the cffDNA isolation was evaluated by automate capillary electrophoresis on Fragment AnalyzerTM. For confirmation of cffDNA in a sample, we evaluated three approaches: fetal gender determination, comparison of STRs in maternal and fetal genome, and methylation analysis of the maspin gene promoter. In cooperation with TIBMolBiol, we designed HRM-based LightSNiP assays to detect the F508del. PCR amplicons needed to be shorter than 200bp to be able to analyze short fragments of cffDNA. Real-Time PCR is performed by using the DyNamo ColorFlash Probe qPCR Kit, Xceed qPCR Probe 2x Mix No-ROX and SensiFASTTM Probe No-ROX Kit. Results: Based on our results, we concluded that the cffDNA isolation performed by the evaluated kits does not differ in cffDNA yield, but the Clean Circulating DNA Kit separates the larger fragments (predominantly maternal) more effectively. We concluded that there is no significant difference between performances of three Real-Time PCR mastermixes used. Conclusion: It is currently possible to detect the F508del mutation in cffDNA samples; and analysis of more CF mutations for NIPD of CF should be implemented in the future.

Las bronquiectasias son una dilatación irreversible de la luz bronquial. La etiología más frecuente de las bronquiectasias no debidas a fibrosis quística es la postinfecciosa, seguida de las secundarias a enfermedades crónicas respiratorias. La patogenia se basa en el círculo de Cole, caracterizado por la alteración del aclaramiento mucociliar-infección-inflamación. Ha de sospecharse en aquellos pacientes con broncorrea diaria, asociada o no a tos y con infecciones respiratorias de repetición. Puede vincularse con enfermedades sistémicas, por lo que habrá que realizar una anamnesis detallada además de las pruebas complementarias pertinentes. El diagnóstico se realizará mediante una tomografía computarizada torácica, donde serán de ayuda los criterios de Naidich. Durante el seguimiento, es imprescindible realizar cultivos de esputo seriados para poder iniciar de forma precoz el tratamiento dirigido, sobre todo frente a Pseudomonas aeruginosa. La fisioterapia respiratoria es la base del tratamiento para mejorar el drenaje bronquial, además hay que abordar aspectos nutricionales y de las complicaciones. La fibrosis quística se diagnosticará con la determinación de 2 mutaciones en el estudio genético y una prueba del sudor positiva. Además del tratamiento de las bronquiectasias, recientemente se han comercializado fármacos dirigidos a tratar el defecto proteico, estos son los moduladores del CFTR.Bronchiectasis is an irreversible dilation of the bronchial lumen. The most common etiology of bronchiectasis not due to cystic fibrosis is post-infection bronchiectasis followed by those secondary to chronic respiratory diseases. The pathogenesis is based on Cole's «vicious circle hypothesis», characterized by abnormality in mucociliary clearance-infection-inflammation. It should be suspected in patients with daily bronchorrhea associated or not with cough and with repeated respiratory infections. It can be associated with systemic diseases. Therefore, a detailed medical history must be taken in addition to the pertinent additional tests. A diagnosis is made by means of a computed tomography scan of the chest, in which the criteria described by Naidich et al. are of help. During follow-up, it is essential to perform serial sputum cultures to be able to start targeted treatment early, especially treatment for Pseudomonas aeruginosa. Respiratory therapy is the pillar of treatment for improving bronchial drainage. In addition, nutritional aspects and factors related to complications must be addressed. Cystic fibrosis will be diagnosed with the determination of two mutations on the genetic study and a positive sweat test. In addition to treating the bronchiectasis, drugs targeted at treating the protein defect (CFTR modulators) have recently come onto the market.

Se estableció un diagnóstico etiológico en 154 de 439 adultos afectos de neumonía extrahospitalaria estudiados consecutivamente durante un año. Coxiella burnetii fue el agente causal más frecuente con 71 casos (16,2% del total); el segundo patógeno en frecuencia fue el Streptococcus pneumoniae con 32 casos (7,3% total). Las neumonías producidas por gérmenes del grupo II (M. pneumoniae, C. burnetii, Cl. psitacci, virus y Legionella p.) afectaban a pacientes jóvenes (x=34 años); la incidencia de la fiebre Q fue mayoritaria en el primer semestre 91%, frente al resto de neumonías (67%, p < 0,01). La técnica diagnóstica más rentable fue el estudio serológico que proporcionó el diagnóstico en 105 casos. Aparecieron complicaciones en 62 pacientes (14,9%), la más frecuente fue la insuficiencia respiratoria. Se produjeron 6 empiemas pleurales. La resolución radiológica se completó en el 46,3% de los casos a los 30-días, en el 79% a los 45 días y en el 94% a los 60 días. La mortalidad global fue del 5,7%. No hubo mortalidad entre las neumonías producidas por gérmenes del grupo II. Etiologic diagnosis was achieved in 154 of 439 adults with community acquired pneumonía who were consecutively evalu-ated during one year. Coxiella burnetii was the most com-mon causative agent (71 cases, 16,2% of the overall series); the second most common pathogen was Streptococcus pneumoniae (32 cases, 7,3%) The pneumonias caused by group II organisms (M. pneumoniae, C. burnetii, Cl. psittaci, viruses and Legionella p.) were seen in young patients (x = 34 years); the incidence of Q fever predominated during the first semester (91%), as opposed to the rest of pneumonias (67%, p < 0,01). Serological assay was the most useful technique; through it diagnosys was achieved in 105 cases. Complications appeared in 62 patients (14.9%), being respiratory failure the most frequent. 6 cases showed pleural empyema. Complete radiological resolution ocurred in 46.3%, 79% and 94% of the cases at 30, 45 and 60 days respectively. Global mortality rate was of 5.7%. None of the patients with pneumonia caused by group II organisms died.

One hundred and sixty four cases of Q fever pneumonia are reviewed. Coxiella burnetti is responsible for 18.8% of pneumonias acquired in the community in our region with an extremely high seasonal variation. 91% of the cases occur between January and June. 88.5% of the patients are less than 40 yrs of age and 77% are male. The most common clinical symptoms are high fever, cough, cephalalgia and myalgias. 46.5% of the patients have no respiratory symptoms although 34% of the cases report pleural pain. The radiological signs are nonspecific. With regard to laboratory data, it is often observed that the white blood cell count (WBC) is normal and the liver enzymes are abnormal (45%). Treatment with doxycycline reduces the fever more quickly than erythromycin.