Altitude, a factor not considered in most reference equations for single-breath diffusing capacity of the lung for carbon monoxide (DLCOsb), plays a crucial role in its assessment. This variable is particularly relevant for Latin American populations residing at different altitudes. This analytical, prospective, multicentre study was conducted in Latin American adults living at low and high altitudes with normal spirometry. Healthy, asymptomatic subjects were identified through the PLATINO survey. To determine the model with the best performance based on standard estimated error (SEE), predicted DLCOsb values were obtained using the Vásquez García, Crapo, García Rio, and Global Lung Function Initiative (GLI) equations. A total of 269 subjects were included: 90 at low altitude and 179 at high altitude. Women comprised 66.9% (180/269), and the median age was 34 years (IQR 25-51). At both sea level and high altitude, the Vásquez García equation, which includes haemoglobin (Hb), showed the best predictive performance. In both settings, GLI-predicted values were lower than measured values (SEE: 2.158 at low altitude and 5.1 at high altitude). Although with wide limits of agreement for all models, Vázquez-García's equation shows the best performance in the interpretation of DLCOsb in Latin American populations residing at any altitude. Even with adjustments for altitude and Hb, the GLI model underestimates the predicted values of DLCOsb and could require an adjustment factor or inclusion of the altitude variable in the model's new version.

Purpose: To compare the level of knowledge in vaccination against influenza and pneumococcus of patients with chronic obstructive pulmonary disease (COPD) who are managed in an Integrated Care Program (ICP) with those who receive usual care (UC). Methods: A telephone survey of patients diagnosed with COPD registered in public care networks or private institutions was done. A descriptive and comparative analysis of the characteristics of the ICP and UC groups was carried out. The relationship between belonging to an ICP and the level of knowledge about vaccination was evaluated using Propensity Score Matching (PSM) and multivariate logistic and ordinal regression models. Results: Of 674 study participants, 27.2% were from the ICP group. ICP patients were older, more frequently men, from a higher socioeconomic stratum and a higher educational level (p< 0.05). 75.5% of the patients in the ICP group had a high level of vaccination knowledge compared to 42.7% in the UC group (p< 0.001). In the multivariate analysis, adjusting for sociodemographic variables, years of COPD diagnosis, and comorbidities, belonging to the ICP was associated with a higher probability of answering questions about vaccination correctly and having a high level of knowledge (OR 3.397, IC 95% 2.058– 5.608, p< 0.001). Conclusion: Patients with COPD managed in an ICP have a higher level of knowledge in vaccination against influenza and pneumococcus, compared to patients in usual care.

Background: In the general population without COPD, indoor air pollution from biomass is a causal factor of cognitive impairment (CI). CI is also common in patients with tobacco smoke COPD and has been associated with hypoxemia and cardiovascular comorbidities. CI and its risk factors have not been evaluated in COPD patients living at high altitude, who experience greater hypoxemia and frequent exposure to wood smoke. Methods: Patients with COPD residing at high altitude with FEV1/FVC <0,70 and COPD risk factors (wood smoke, Tobacco smoke or combined exposure). Measurement of the Mini-Mental State Examination to assess CI, educational level, comorbidities, exacerbations, arterial blood gases, diffusion (DLCO), and 6-min walk test (6MWT). Comparisons between groups with and without CI using the X2 test and unpaired t-test. Logistic regression with odds ratio (OR) calculation was used to evaluate the association of CI with the variables of interest. Results: In the 199 patients included, 16.1% had CI, the majority with mild involvement (68.8%). Those with CI had more frequent exposure to wood smoke (p<0.001), older age (p=0.017), lower educational level, PaO2 (p=0.032), DLCO (p=0.036), and fewer meters in the 6MWT (p=0.007), with no differences in sex, severity of obstruction or comorbidities. Adjusting for the other variables, exposure to wood smoke was associated with CI [OR and 95% CI: 4.82 (1.62-14.33). Conclusions: In patients with mild to moderate COPD living at high altitude, regardless of hypoxemia, age, educational level, comorbidities, and lung function, exposure to wood smoke was associated with CI.

Introducción: El impacto de clínicas especializadas en asma grave en el control de la enfermedad, en países de ingresos medios como Colombia, es limitado. Objetivo: Determinar el impacto de ASMAIRE REXPIRA, en una cohorte de pacientes con asma grave en términos de desenlaces clínicos. Métodos: Estudio de mundo real, retrospectivo, observacional, diseño antes-después, en pacientes ≥ 18 años con asma grave (ICS/LABA a dosis alta, paso 5 GINA 2020) que ingresaron en 2022 y completaron 2 años de seguimiento. Se comparó el año previo al ingreso con el primero y segundo año: exacerbaciones que requirieron corticosteroides orales (OCS), atención en urgencias u hospitalización, síntomas (ACT y ACQ-5), VEF1 pre y post broncodilatador (BD) y calidad de vida (miniAQLQ). Resultados: Se incluyeron 196 pacientes, 80,1% mujeres, edad promedio 51,9 años, IMC 27,8. Al primer año, el porcentaje de pacientes con asma controlada aumentó de 49,7% a 64,1%, manteniéndose en 70,4% al segundo año (p<0,001). La tasa de exacerbaciones que requirieron OCS, urgencias u hospitalizaciones disminuyó 67%, 69% y 78%, respectivamente, el primer año y continuó disminuyendo el segundo año. La calidad de vida mejoró significativamente al primer y segundo año (p<0,001). No se observaron diferencias significativas en el VEF1. Conclusiones: El manejo interdisciplinario y sistemático del asma grave en una clínica especializada como ASMAIRE REXPIRA mejora significativamente el control de la enfermedad. Este modelo de atención podría representar una alternativa costo-efectiva que requiere evaluación económica formal y puede promoverse en otros centros de Latinoamérica para reducir la carga de la enfermedad.

Background: The management of sedative and analgesic infusions in intensive care units (ICUs) represents a global clinical challenge. Clinical decision support systems (CDSSs) have emerged as an approach to facilitate protocol standardization and mitigate adverse effects associated with prolonged sedation and analgesia. Objective: To evaluate the usability and technical quality of UCISAB, a CDSS designed to optimize sedoanalgesia in the ICU. Methods: A multicenter, cross-sectional, mixed-methods usability evaluation was conducted. A prototype was evaluated using the System Usability Scale (SUS) and the User Mobile Application Rating Scale (uMARS), complemented by a qualitative analysis of open-ended comments. Results: A total of 31 physicians participated (attending physicians and residents). The mean SUS usability score was 66.13 (SD ±21.26), categorized as “Marginal High.” On the uMARS, the median scores were 4.28 for objective quality (good), 3.75 for subjective quality (acceptable), and 4.33 for impact (good). The stated willingness to apply the tool’s recommendations in clinical practice reached 93.5%, with a median intention-to-use score (uMARS) of 4.0 (good). Exploratory analysis revealed no significant difference in SUS scores between residents and attending physicians (p = 0.072). In these exploratory comparisons, statistically significant differences by professional role were found only in the uMARS dimensions: objective quality (p < 0.001), subjective quality (p = 0.023), and impact (p = 0.036). Qualitative feedback suggested that the tab-based architecture may increase cognitive load among expert users, highlighting a need for interface simplification. Conclusions: UCISAB showed favorable perceived quality and a high stated willingness to use, while usability remained marginal; further interface and pharmacological refinements, together with prospective clinical validation in real-world settings, are required before routine implementation. Professional role may influence perceived quality, suggesting the potential value of adaptive interface designs; however, this association requires confirmation in future studies. Developing systems that optimize sedation and analgesia in critical care remains an unmet need in ICUs.

IntroductionOsmophobia is associated with a greater intensity of the headache, a more significant presence of affective symptoms, and the appearance of cutaneous allodynia.ObjectivesTo determine the sociodemographic and clinical characteristics of patients with episodic and chronic migraine associated with osmophobia.MethodsA cross-sectional analytical observational study, 100 patients were included.Results65% of the patients presented osmophobia, 64.6% of patients with osmophobia had chronic migraine, and 35.4% had episodic migraine without statistically significant differences p=0.120. Regarding the clinical characteristics, pulsatile pain was the most frequent in 49%, and severe intensity was present in 81%. Statistically significantrelationships were found between osmophobia and photophobia [(95.4 vs 77.1]; p=0.005), phonophobia ([96.9 vs 74.3); p=0.001) and allodynia ([75.4 vs 45.7); p=0.002). The that become chronic factors were more frequent in the group with osmophobia, in which an association with the excessive use of analgesics ([43.8%vs. 22.9%]; p=0.029) and a history of anxiety and depression ([32.8% vs. 14.3%]; p=0.045). In the multivariate model, the variables associated with osmophobia with statistically significant differences were photophobia, allodynia, and botulinum toxin application.ConclusionsIn this first study of osmophobia in migraine in Colombia, osmophobia is a frequent symptom in patients with chronic migraine; it has related to markers of central sensitization; it is also related to that become chronic factors and the use of botulinum toxin. Therefore, it is likely that osmophobia can predict the risk of that factor, causing the disease to become chronic.