Assessment of pathogenic protozoa in a drinking water treatment plant with UV treatment.

Controlling drinking water treatment processes is essential to address water contamination and the adaptability of certain pathogenic protozoa. Sometimes, standard treatment methods and chlorine disinfection may prove insufficient in eliminating pathogenic protozoa. However, ultraviolet (UV) radiation has proved to be more effective than chlorine. This study aims to characterize the eukaryotic community of a drinking water treatment plant that applies a final UV disinfection treatment, focusing on pathogenic protozoa. Fifty water samples (raw water, before and after UV treatment) were evaluated to comply with regulation parameters and identify relevant protozoa. Despite physicochemical and microbiological parameters meeting the regulation, some potentially pathogenic protozoa, such as Blastocystis or Cryptosporidium, were still detected in very low relative abundances in treated water. It was found for the first time in Spain the pathogenic amoebae Naegleria fowleri in one river water, which was not found after the treatment. Moreover, Blastocystis subtypes ST1-ST6 were detected in this study in raw, before and after UV water samples. Blastocystis was only found in 2 two samples after UV treatment, with a very low abundance (≤0.02%). Obtained results demonstrate the effectiveness of water treatment in reducing the prevalence of pathogenic protozoa.

Characterization of eukaryotic microbiome and associated bacteria communities in a drinking water treatment plant.

The effectiveness of drinking water treatment is critical to achieve an optimal and safe drinking water. Disinfection is one of the most important steps to eliminate the health concern caused by the microbial population in this type of water. However, no study has evaluated the changes in its microbiome, specially the eukaryotic microbiome, and the fates of opportunistic pathogens generated by UV disinfection with medium-pressure mercury lamps in drinking water treatment plants (DWTPs). In this work, the eukaryotic community composition of a DWTP with UV disinfection was evaluated before and after a UV disinfection treatment by means of Illumina 18S rRNA amplicon-based sequencing. Among the physicochemical parameters analysed, flow and nitrate appeared to be related with the changes in the eukaryotic microbiome shape. Public health concern eukaryotic organisms such as Blastocystis, Entamoeba, Acanthamoeba, Hartmannella, Naegleria, Microsporidium or Caenorhabditis were identified. Additionally, the relation between the occurrence of some human bacterial pathogens and the presence of some eukaryotic organisms has been studied. The presence of some human bacterial pathogens such as Arcobacter, Mycobacterium, Pseudomonas and Parachlamydia were statistically correlated with the presence of some eukaryotic carriers showing the public health risk due to the bacterial pathogens they could shelter.

[Evolution over time in over perceivers of dyspnea in asthma]. / Evolución temporal de la percepción exagerada de disnea en los pacientes con asma.

OBJECTIVE: In previous studies we identified a subgroup of patients whose perception of breathlessness was exaggerated during acute bronchoconstriction and who were termed "over perceivers" or "hyperperceivers". In this study we aimed to determine whether such over perception is sporadic or stable over time. We also examined whether there is an association between over perception of dyspnea and hyperventilation syndrome. PATIENTS AND METHODS: The subjects were 22 stable asthmatics (11 men, 11 women) who had been over perceivers of dyspnea in a study 9 years earlier. After a medical history was taken, a patient performed forced spirometry and a severity classification was made according to the criteria of the Global Initiative for Asthma (GINA). A bronchial histamine challenge was then administered to measure dose-related perception of dyspnea on a Borg scale, according to a procedure that was similar to the one used 9 years earlier by the same investigator. The patients were also asked for a subjective assessment of the severity of their asthma (scale, 0-10) and to respond to items on the Nijmegen hyperventilation questionnaire and the trait form of the State-Trait Anxiety Inventory. RESULTS: The overall perception of severity of disease, level of anxiety, and perception of dyspnea at rest were lower after 9 years (P<.001). No change was observed in bronchial hyperresponsiveness (dose of inhaled histamine required to provoke a 20% decline in forced expiratory volume in the first second [FEV1]-PD20) or objective parameters of severity (FEV1 and GINA classification). Fourteen asthmatics (64%) were still over perceivers and the other patients had changed: 6 were normal perceivers and 2 were "poor perceivers". Only subjective perception of disease severity improved for the patients who were still over perceivers; the other patients, on the other hand, showed improvements in subjective assessments, objective ones (except PD20), and anxiety. Finally, those who remained over perceivers had higher scores for anxiety (24 vs 15; P<.05) and hyperventilation (18 vs 13; P= not significant). CONCLUSIONS: Most over perceivers of dyspnea remain so over the years and this trait is related to anxiety. We have been unable to demonstrate an association with hyperventilation syndrome.

Diagnostic value of the bronchial provocation test with methacholine in asthma. A Bayesian analysis approach.

The Bayesian analysis was used in this study to investigate the diagnostic value of the bronchial provocation test with methacholine in patients with asthma. The best cutoff value of accumulated concentration of methacholine administered that caused a 20 percent fall in FEV1 post-saline (PC20) in our sample, determined with a receiver operator characteristic curve, was 15 mg/ml. The interval security of the test was established by a pretest probability between 0.16 and 0.87 and the best test results were obtained when pretest probability was 0.48. The positive final diagnostic gain of the test was maximal at this pretest probability. We conclude that the application of Bayes' theorem, considering the pretest probability of asthma and the sensitivity and specificity of the individual PC20 obtained, increases the accuracy of the bronchial provocation test with methacholine in the diagnosis of asthma.

Pathogenesis of the lung in restrictive defects of Klinefelter's syndrome.

Patients with Klinefelter's syndrome show a high incidence of restrictive lung defects, the pathogenesis of which is not clear yet. We investigated the respiratory muscle force (PImax) and lung compliance in 13 patients with Klinefelter's syndrome who had not been receiving hormonal therapy for at least one year prior to being studied. Eleven were smokers and two were nonsmokers. None showed abnormalities of the chest wall. Five had normal lung volumes and eight showed a restrictive defect (TLC < 80 percent, VC < 85 percent, FEV1/FVC percent within normal values); DCOSB and arterial blood gases were within normal limits. PImax was similar in restricted (-115.9 +/- 26.7 cm H2O) and not restricted patients (-115.4 +/- 20.3 cm H2O), all within reference values. Lung compliance, however, was significantly decreased in the four patients studied (0.13 +/- 0.08 cm H2O-1) compared with five normal control subjects (0.29 +/- 0.05 cm H2O-1). We conclude that the likely cause of the lung restriction is a decrease of compliance of the lung matrix, probably related to the absence of testosterone.

Noninvasive positive pressure home ventilation in restrictive disorders: outcome and impact on health-related quality of life.

Noninvasive positive-pressure home ventilation (NIPPHV) improves arterial blood gases, dyspnea and health-related quality of life (HRQL) in patients with restrictive thoracic diseases. Whether these changes persist during the follow-up remains unclear. The aim of this study was to investigate the long-term effects of NIPPHV upon dyspnea, HRQL, lung function and hospitalization rate in 35 patients with kyphoscoliosis and 27 individuals with several neuromuscular disorders. So, we measured dyspnea, HRQL, lung function and nocturnal oxygen saturation (SaO2) before and after 3, 6, 9, 12 and 18 months after NIPPHV. Dyspnea was assessed with the Borg scale and HRQL was measured using the Spanish validated version of the SF-36 questionnaire. The kyphoscoliosis group showed significant improvement of PaCO2 and SaO2 at 3 months and minor dyspnea changes at 6 months after NIPPHV had been started. These patients also showed improved health status in the following categories: "physical role" and "emotional role" at 3 months and in the categories "social functioning", "vitality" and "mental health" at 6 months after NIPPHV; some of these changes persisted at 9, 12 and 18 months. In the neuromuscular group, a significant improvement of SaO2 was observed at 3 months and this persisted for 18 months. Changes of HRQL in this group included a significant improvement in "physical role" at 3 months, "emotional role" and "social functioning" at 6 months and "physical functioning" at 9 months. The hospitalization rate decreased significantly in all patients from a mean annual admission rate of 1.1 (1.4) before NIPPHV to 0.6 (1.1) after 12 months of ventilatory support (P<0.005). We conclude that: (a) NIPPHV had a higher impact on arterial blood gases, dyspnea and health-related quality of life in patients with kyphoscoliosis than in those with neuromuscular disorders; (b) most clinical and functional changes persisted at long term and (c) a significant decrease in the hospitalization rate after NIPPHV occurred in both groups.

Respiratory disorders in common variable immunodeficiency.

Common variable immunodeficiency (CVID) is a heterogeneous immunodeficiency syndrome characterized by hypogammaglobulinemia, recurrent bacterial infections, and various immunologic abnormalities. The clinical presentation is generally that of recurrent pyogenic sinopulmonary infections. Our objectives were to study the prevalence of lung involvement and the response to intravenous immunoglobulin replacement therapy in 19 patients with CVID. Nineteen patients (12 men) with a mean age (SD) of 33.1 (17.1) years had a previous diagnosis of CVID and were treated with intravenous immunoglobulin replacement. All patients underwent complete pulmonary function tests and high-resolution computed tomography (HRCT) examination. Bronchiectasis was diagnosed in 11 (58%) patients and eight (42%) were multi-lobar bronchiectasis. Chronic airflow limitation (CAL) was present in 10 (53%) patients and a restrictive pattern was seen in one case. Eleven patients (58%) presented a decrease in single-breath carbon monoxide diffusing capacity of the lung (DL(CO)). Before intravenous immunoglobulin replacement therapy (INIRT), 84% of patients had suffered from at least one episode of pneumonia. Episodes of lower respiratory tract infection decreased significantly from 0.28 per patient and year before replacement therapy to 0.16 per patient and year after treatment. The mean duration of replacement therapy was 7.5 years. In conclusion lung involvement was frequent in patients with CVID. Long-term administration of intravenous gammaglobulin resulted in a substantial reduction of pneumonic episodes.

[Multicenter prospective study of respiratory patient education and instruction in the use of inhalers (EDEN study)]. / Estudio multicéntrico y prospectivo de "educación y enseñanza" del procedimiento de inhalación en pacientes respiratorios (estudio EDEN).

OBJECTIVES: To evaluate patients' knowledge of the inhalers they use and to assess the effect of knowledge acquired in an instruction session on correct technique. MATERIAL AND METHODS: Multicentric, prospective, descriptive study before and after one instruction session dealing with the technique to apply in using an inhaler: a pressurized canister, an inhalation chamber Autohaler, or one of two dry powder inhalers (the Turbuhaler or the Accuhaler). We studied 349 patients who used their inhalers regularly to treat their respiratory diseases. After assessing their theoretical knowledge of the airways (common), of the particular device they used, and their inhalation technique, we gave instruction in correct technique. Both types of knowledge were then evaluated 2 and 8 months after instruction. RESULTS: Before instruction, common theoretical knowledge was 3.2 (1) on a 6-point scale and knowledge of the device used was 2.7(1) on a 4-point scale. Technique was assessed as 77 (21) on a 100-point scale. After instruction both theoretical knowledge and technique improved significantly. Common knowledge after instruction was assessed as 5.1 (1) at 2 months and 5.2 (1) at 8 months; knowledge of the inhaler was 3.5 (0.6) and 3.6 (0.7), respectively. Technique was assessed at 95 (11) and 96 (11) at 2 and 8 months, respectively. CONCLUSIONS: The EDEN study demonstrates that knowledge of inhalers in a large sample of the population of respiratory disease patients in Spain, although acceptable, can be improved by an appropriate instruction program. After a standardized instruction program, correct use of all the inhalers studied was achieved. We believe that we thereby contribute to improving symptoms and quality of life of respiratory disease patients.

[Arterial puncture in Spain. A follow-up of the SEPAR 1987 guideline. Sociedad Española de Neumología y Cirugía Torácica]. / La punción arterial en nuestro ámbito. Seguimiento de la normativa SEPAR 1987.

This study sought to evaluate the procedures used for measuring arterial gases in our hospitals and determine the level of compliance with the 1987 SEPAR guidelines. Questionnaires covering the obtention, transport, storage and analysis of samples, as well as familiarity with the guidelines were distributed to 150 pneumology, internal medicine, intensive care and emergency services; 78 centers responded (71% from pneumology departments). General information obtained was as follows: arterial puncture is carried out by nurses without anesthesia and using syringes for gases; the radial artery is used; with post-puncture pressure provided by the patient; the sample is analyzed within 15 minutes and cold storage is used. The department's own automatic analyzer is used. Buffered gases and solutions are used for calibration and quality control measures are rare. Some aspects of the guidelines are unfamiliar. We believe that an effort should be made to extend application of the guidelines in order to improve arterial blood gas analysis.

[Ventilation pattern at rest and respiratory response to hypercapnic stimulation after lung transplantation]. / Patrón ventilatorio de reposo y respuesta ventilatoria a la estimulación hipercápnica tras el trasplante pulmonar.

We aimed to assess breathing pattern at rest by studying occlusion pressure after the first 100 miliseconds (P0.1) and ventilatory response to hypercapnia after lung transplantation. Seven transplanted patients were compared with a control group of 7 healthy subjects. The breathing pattern at rest after transplantation included a significant increase in minute volume (VE) at the expense of an increase in tidal volume (VT) and above all of mean inspiratory flow (VT/Ti). There were no significant differences in ventilatory response to hypercapnia between the 2 groups, although the response curves of both VE and VT to CO2 tended to slope downward. These results can be explained by the mechanics of ventilation in some subjects studied and by the effect of pulmonary denervation on ventilatory control.

[Compliance with the "recommendations SEPAR" on spirometry]. / Cumplimiento de las "recomendaciones SEPAR" sobre la espirometría.

The objective of this study was to assess Spanish performance of spirometry and to determine the extent to which practice is in accordance with the 1985 SEPAR recommendations. To that end we formulated a questionnaire with 31 items in two sections, 10 covering basic aspects of compliance with necessary techniques and 21 general questions. The questionnaire was sent to all SEPAR members. One hundred eight responses were received. The results show that the typical spirometric measurement was forced expiration without a bronchodilator test by way of a pneumotacograph, with simultaneous representation of the flow/volume curve. Calibration, when performed, is done daily with a 3 1 syringe and atmospheric data are checked. Spirometric measurements are usually obtained by a registered nurse, who also collects anthropometric data directly from the patient. The patient is usually seated with the nose occluded. At least three and at most eight satisfactory readings are obtained. The criteria for starting and ending the maneuver and the reference values used are those recommended by SEPAR. The equipment is washed weekly with soap and water; calibrations and equipment incidences are not recorded. The level of compliance with 1985 SEPAR norms for forced spirometry is adequate with respect to some technical equipment questions but deficient on basic procedure and quality control.

[Long-term effects of nasal continuous positive airway pressure on ventilatory patterns of patients with obstructive sleep apnea syndrome]. / Efectos a largo plazo de la CPAP nasal sobre el patrón ventilatorio de los pacientes con síndrome de apnea obstructiva del sueño (SAOS).

We studied 20 patients with obstructive sleep apnea syndrome (OSAS) prospectively, before and after administering continuous positive airway pressure through a nasal mask (CPAPn) at night for 10 months, with the aim of determining the effects of ventilatory pattern of long-term treatment with CPAPn in OSAS patients. The following data were collected for all patients: anthropometric variables, lung function test results, arterial gasometric readings at rest, oxygen alveolar-arterial differential [Dif(A-a)O2)], central respiratory function variables at rest and during hypercapnic stimulus. Mean duration (range) of treatment with CPAPn was 12.5 (10-18) months. We observed a significant increase in PaO2 (p = 0.01) and a decrease in PaCO2 (p = 0.02) with slight variations in body weight and no changes in lung mechanics or in Dif(A-a)O2. The ventilatory pattern at rest showed an increased in VE and in respiratory frequency (p = 0.0003 and p = 0.033, respectively) with non significant changes in VT. The VT/Ti ratio increased (p = 0.015) and P0.1 decreased slightly (p = 0.025). We found no significant changes in the CO2 response slopes of VE or P0.1. In conclusion, CPAPn improves hypoxemia and hypercapnia in OSAS patients, above all by increasing baseline basal ventilation. The exact mechanisms implicated are poorly understood, but our data suggest a certain direct or indirect effect on respiratory muscles, reducing muscle fatigue, thus favoring greater availability during sleep.

[Efficacy of an antibacterial filter for preventing contamination of respiratory function diagnostic equipment]. / Eficacia de un filtro antibacteriano en la prevención de la contaminación de equipos de exploración funcional respiratoria.

OBJECTIVES: Devices to assess lung function are a potential source of nosocomial infection. Our aims in this study were: 1) to determine the efficacy of an antimicrobial filter to prevent contamination of a multifunctional device; 2) to assess the ability of the filter to prevent cross contamination of individuals being tested; and 3) to evaluate the efficacy of the recommendations of the Spanish Society of Respiratory Diseases and Thoracic Surgery for disinfecting lung function equipment. DESIGN: In this prospective, randomized study in two phases we used filters in phase 1 but not in phase 2. A pharyngeal swab culture was started within 7 days of a patient's lung function test. Swab samples for culturing were taken from three different places in the equipment at the beginning and end of each working day. PATIENTS: Sixty-five patients (31 in phase 1 and 34 in phase 2) were studied. Thirty-two (49.2%) were men and the mean age was 49.4 15.7 years. RESULTS: Significantly less equipment contamination was found in phase 1 (4.2%) than in phase 2 (21%). We detected no cases of cross contamination using the criteria in this study. No cultures from any of the samples taken before exploration were positive. CONCLUSIONS: a) The antimicrobial filter used is effective for preventing the contamination of lung function testing equipment, b) throughout both phases of the study, we observed no cross contamination of patients tested, such that we cannot conclude that the antimicrobial filter is effective for preventing possible nosocomial infections, c) the recommendations of SEPAR for disinfecting lung function equipment are effective.

Airway inflammation and cough sensitivity in cough-variant asthma.

BACKGROUND: Mechanisms underlying cough and bronchoconstriction in patients with cough-variant asthma (CVA) are not well established. Differences in location or degree of activation of eosinophils and allergic cytokines have been suggested as the likely causes. To address this issue, we have carried out a comparative study of airway inflammatory markers between patients with CVA and classic asthma (CA). The relationship between these markers with airway hyperresponsiveness (AHR) and cough sensitivity has also been studied. METHODS: Twenty-seven non-smokers and steroid-naive patients with CVA (12) and CA (15) were examined. Capsaicin challenge, histamine bronchoprovocation test, nitric oxide levels in exhaled air and sputum induction were performed in all of them. Differential cell sputum recount and supernatant concentrations of eosinophil granule-derived cationic proteins (ECP), interleukin (IL)5, IL8 and tumour necrosis factor (TNF)-alpha were also measured. RESULTS: There were no significant differences in either the inflammatory pattern of soluble markers or differential cell counts between CA and CVA. Histamine PC20 was correlated with IL-5 in CVA, whereas it was associated with sputum eosinophilia in CA. Cough sensitivity (log C5) and histamine PC20 were inversely related in CA. CONCLUSIONS: Although the pattern of inflammatory sputum markers in patients with asthma and cough-variant asthma is similar, its relation with bronchial hyperreactivity and cough sensitivity is different in each group.

Effect of cyclosporin on lung diffusing capacity in renal transplant patients.

A prospective lung function study pre- and postrenal transplantation was performed on 21 patients in order to evaluate whether cyclosporin decreased the lung diffusing capacity due to lung toxicity. Initial inclusion criteria were absence of respiratory symptoms and normal findings in both chest X-ray and pulmonary function tests. Participants had to be nonsmokers. We determined spirometry including lung volumes, arterial blood gases, carbon monoxide diffusing capacity by the single breath method (DLCOSB), and rate of CO uptake per unit of lung volume (KCO) before and 3, 6, and 12 months after transplantation. Immunosuppression consisted of prednisone and cyclosporin, maintaining total blood levels between 100 and 250 ng/ml. Spirometric and blood gases data remained within reference levels during the follow-up. Hemoglobin (Hb) pretransplant concentrations remained low, returning to their normal levels post-transplantation. Pretransplant DLCOSB levels were slightly decreased but fell within the therapeutic range after correction for Hb concentration, unlike the mean KCO levels which remained slightly diminished despite their correction. In post-transplant controls, the values obtained for both DLCOSB and KCO were significantly higher at the different post-transplant intervals (P < 0.005) than pretransplantation but only when compared without Hb correction. No significant differences for DLCOSB were found when corrected values were compared, and an improvement in the KCO appeared to be significant at 12 months posttransplantation. Based on these findings, we feel that when serum levels are within the therapeutic range, cyclosporin fails to alter the respiratory function or the pulmonary diffusing capacity of the lung.

Ventilatory pattern at rest and response to hypercapnic stimulation in patients with obstructive sleep apnea syndrome.

We studied the ventilatory pattern and mouth occlusion pressure (P0.1) at rest and the response to awake hypercapnic stimulation in 27 patients with obstructive sleep apnea syndrome (OSAS). The respiratory pattern was characterized by both increased P0.1 and VT/Ti (p < 0.05), with a higher VE (p < 0.01) due to a slight increase in VT. Ventilatory response to hypercapnic stimulation showed no significant differences with respect to the control group. Our findings reveal that OSAS patients show an increased minute output secondary to a mild degree of hyperstimulation on the baseline central ventilatory control and that there is a subgroup of patients with a decreased ventilatory response to CO2.