Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial).

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Kidney Transplantation in Patients With Chronic Kidney Disease After a Previous Lung Transplantation.

BACKGROUND: The development of chronic kidney disease is a common complication after a lung transplantation, especially since the introduction of immunosuppressive treatments based on calcineurin inhibitors. Many of these patients reach end-stage renal disease and even need renal replacement therapy. Among the different options of renal replacement therapy, we consider kidney transplantation as a feasible option for these patients. METHODS: A single center, observational retrospective study including 8 lung transplanted patients who have received a kidney transplant in the period between 2013 and 2017 with at least 1 year of follow-up was used. RESULTS: Seven patients maintained an adequate function of the graft 1 year after kidney transplantation, and 1 patient died because of a pulmonary condition in spite of a previous kidney transplant. Two patients presented delayed graft function in the first days after surgery. CONCLUSIONS: The kidney transplantation is a technique of renal replacement therapy that should be considered in patients with previous lung transplantation. Experienced centers in double sequential lung and kidney transplantation should be established to assess and treat these types of patients.

[Survival of lung transplant at the Puerta de Hierro Clinic]. / Análisis de la supervivencia del trasplante pulmonar en la Clínica Puerta de Hierro.

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

[Cholesterol in pleural fluid. Its usefulness in differentiating between exudates and transudates]. / Colesterol en líquido pleural. Utilidad en la diferenciación entre exudados y trasudados.

To analyze the usefulness of cholesterol levels in the differentiation of exudates and transudates. A 3.5-year prospective study of 170 patients with pleural discharge. Clinical microbiological and cyto-histological criteria were used for diagnosis. Exudates were classified by Light's criteria, by cholesterol > or = 45 mg/dl in pleural liquid, by a cholesterol in pleural liquid/cholesterol in serum quotient > or = 0.3 and by a finding of both LDH and cholesterol in pleural fluid. These criteria were compared with the final etiological diagnosis. Only pleural discharges with confirmed etiological diagnoses were analyzed. In the 130 pleural discharges for which certain etiological diagnoses were obtained, 33 were transudates and 97 were exudates. Light's criteria allowed accurate classification of 92 (95%) of the 97 exudates and 30 (91%) of the 33 transudates. The cholesterol in pleural liquid/cholesterol in serum quotient was the most productive and useful parameter (96% sensitivity, 97% specificity), better than pleural fluid cholesterol and the Light's criteria. The association of LDH and pleural fluid cholesterol classified 100% of the exudates, with efficacy similar to that of Light's criteria. The cholesterol in pleural fluid/serum quotient was the most useful biochemical variable. Cholesterol levels were about as useful as Light's criteria. The association of LDH and cholesterol allows us to bypass blood analyses for the diagnosis of exudates.