[Risk of osteoporotic fracture and hip fracture in patients with chronic obstructive pulmonary disease]. / Riesgo de fractura osteoporótica y de cadera en pacientes con enfermedad pulmonar obstructiva crónica.

AIM: Osteoporosis is a frequent comorbidity in patients with chronic obstructive pulmonary disease (COPD). We have studied the risk of major osteoporotic fracture and hip fracture in patients with COPD. PATIENTS AND METHODS: A multicenter cross-sectional study was performed in Spain in 26 hospitals of 16 regional communities. Patients diagnosed with COPD who required admission to the Internal Medicine Service due to exacerbation of their respiratory disease were enrolled. COPD was confirmed by post-bronchodilator spirometry in stable state: maximum expiratory volume in the first second (FEV1) < 80% of the theoretical value and quotient FEV(1)/FVC < 0.70 and percent predicted after the administration of a bronchodilator. Dyspnea was evaluated with the modified Medical Research Council (mMRC) dyspnea scale. The principal variable was the likelihood of fracture evaluated with the FRAX® tool for the Spanish population. RESULTS: Three hundred and ninety two patients, 347 (88%) men, with a mean (SD) age of 73.7 (8.9) years and a mean FEV1 of 1.23 liters (43.3% of predicted) were enrolled. Only 37 patients (9.4%), 27 men and 10 women had been diagnosed previously of osteoporosis. Overall, 1.8% (95% CI: 0.9-3.6) had a 10-year probability of major osteoporotic fracture ≥ 20% and 49.7% (95% CI: 44.8-54.7) had a probability of hip fracture ≥ 3%. No relationship was observed between the probability of fracture and GOLD stage or mMRC dyspnea scale. CONCLUSIONS: The diagnosis of osteoporosis is uncommon in our COPD patients. However, half of them have a high probability of a hip fracture in the next 10 years.

[Fiber optics bronchoscopy yield and predictive clinical, analytical, and radiologic factors in the etiologic diagnosis of pulmonary pathology in patients with HIV infection]. / Rendimiento de la fibrobroncoscopia y factores predictivos clínicos, analíticos y radiológicos en el diagnóstico etiológico de la patología pulmonar en pacientes con infección por VIH.

UNLABELLED: The aim of this study was to assess the diagnostic performance of fibrobronchoscopy (FBS) in the pulmonary pathology of HIV-positive patients, in order to study the effect of several factors on such performance and to evaluate if these factors could guide the etiologic diagnosis. A retrospective study of 49 FBS with bronchoalveolar lavage (BAL) was performed in 44 HIV-positive patients. The diagnostic performance of FBS with BAL was 71.4%, with no significant modifications caused by previous prophylactic or empirical therapies, time of clinical evolution, radiological pattern, presence of hypoxemia or CD4 count. On the contrary, a high LDH was associated to a higher diagnostic performance. DIAGNOSIS: Pneumonia by Pneumocystis carinii (36.7%), M. tuberculosis (28.6%) and bacterial pneumonias (16.3%). The presence of biliary adenopathies, evolution longer than 1 week and pO2 > 80 mm Hg had a high sensitivity of 28.5% and a specificity of 97% for the diagnosis of tuberculosis, with a positive predictive value of 80% and a negative predictive value of 77.7%.