[Local recurrence after non-small cell lung cancer surgery: prognosis variables]. / Recidiva local tras la cirugía del cáncer de pulmón no microcrítico: factores pronósticos.

OBJECTIVES: Retrospectively to analyse the influence of clinical and histo-pathological characteristics in the local recurrence after non-small cell lung cancer surgery. METHOD: 146 patients were included and studied during a minimum of two years. The free survival of disease function (FSD) was constructed according to the Kaplan-Meier method. The univariant comparison of the FSD by Mantel-Haenszel means of logarithmic ranks test and the multivariant analysis by Cox regression model. RESULTS: In the univariant analysis 20 months of FSD and the following predicting factors of a smaller FSD: Radiological contact of the tumour with the pleura (p=0.005), peritumoral margin affectation (p=0.001), pleural affectation (p=0.006), T stratification factor (p=0.04) and N factor (p=0.002). Other factors like age, initial symptoms, second neoplasias, radiological spiculations or cavitations, transtoracic puncion, type of surgery, peribronquial affectation, so large margin tumorlike and histological type, did not show statistically significant differences in the FSD. In the multivariant study they maintain its value prognosis the pleural affectation (p=0.0014), ganglionary affectation (p=0.02) and degree of differentiation (p=0.03). CONCLUSIONS: The most important prognosis factor of local recurrence after surgery in these patients were the infiltration of the pleura, followed of the hilio-mediastinic ganglionary affectation and the degree of histological differentiation.

Allele and haplotype distribution for 16 Y-STRs (AmpFlSTR Y-filer kit) in the state of Chihuahua at North Center of Mexico.

The AmpFlSTR Y-filer kit, including 16 Y-STRs was analyzed in 326 males from Chihuahua, at North Central, Mexico. Allele frequencies and gene diversity for each locus were estimated. Four allele duplications, namely DYS389II, DYS390, DYS391 and DYS439; and one allele null at DYS448 were observed in the sample. The haplotype diversity was 99.97+/-0.3%. The AMOVA results, including a previous report from West of Mexico (Jalisco), showed that most of the genetic variability between these Mexican populations is attributable to intrapopulational differences (99.87%). This result supports a low-genetic differentiation between males from North and West regions of Mexico.

Recursos y propuestas de mejora en el manejo de la Apnea Obstructiva del Sueño en Andalucía / Resources and proposals for improvement in the management of obstructive sleep apnea in Andalusia

Título abreviado: Se exponen los recursos asistenciales del Sistema Sanitario Público de Andalucía relacionados con el diagnóstico, tratamiento y seguimiento de los pacientes con apnea obstructiva del sueño. Igualmente se describen propuestas para una optimización en el manejo de esta entidad enfatizando la necesidad de recursos y colaboración entre diferentes niveles asistenciales. Objetivo: Determinar en el Sistema Sanitario Público de Andalucía (SSPA) los recursos actuales en la apnea obstructiva del sueño (AOS) e identificar propuestas de mejora. Método: Estudio transversal, basado en encuestas realizadas en 49 hospitales del SSPA. Se registraron variables relacionadas al diagnóstico, tratamiento y seguimiento de la AOS, distinguiendo entre centros que realizaban polisomnografía y los que no. Incluimos un apartado sobre propuestas de mejora. Resultados: Un 97% de los centros realizan poligrafía y un 29% polisomnografía, y sólo el 39,5% disponen de consulta específica. La demora diagnóstica para la poligrafía es de 169 ± 163,4 días y para la polisomnografía de 173 ± 152,5 días. Se realizan un total de 1.113 ± 1.004,6 pruebas por 100.000 habitantes y año, de ellas 235 ± 166,2 son poligrafías diagnósticas. La presión eficaz se titula en un 49% con auto-CPAP y el control terapéutico lo realiza frecuentemente la empresa suministradora (77%). Entre las propuestas de mejora, destacan la falta de un protocolo de derivación y coordinación entre diferentes niveles asistenciales (90% de los encuestados), y la demora diagnóstica, atribuible en un 63% de los casos al déficit de recursos físicos y de personal. Conclusión: El número de pruebas diagnósticas aún son insuficientes y la demora diagnóstica es excesiva. Sobre todo, en el control terapéutico la empresa suministradora tiene un papel relevante. Se propone la realización de protocolos entre diferentes unidades asistenciales y aumentar los recursos actuales. (AU)

Short title: The healthcare resources of the Andalusian Public Health System related to the diagnosis, treatment and follow-up of patients with obstructive sleep apnea are presented. Proposals for optimizing the management of this entity are also described, emphasizing the need for resources and collaboration between different levels of care. Objective: Determine the current resources in the Public Health System of Andalusia (SSPA) in obstructive sleep apnea (OSA) and identify proposals for improvement. Method: Cross-sectional study, based on surveys conducted in 49 SSPA hospitals. Variables related to the diagnosis, treatment, and follow-up of OSA were recorded, distinguishing between centers that performed polysomnography and those that did not. We include a section on proposals for improvement. Results: 97% of the centers perform polygraphy and 29% polysomnography, and only 39.5% have a specific consultation. The diagnostic delay for polygraphy is 169 ± 163.4 days and for polysomnography 173 ± 152.5 days. A total of 1,113 ± 1,004.6 tests are performed per 100,000 inhabitants per year, of which 235 ± 166.2 are diagnostic polygraphs. The effective pressure is titrated in 49% with auto-CPAP and therapeutic control is frequently carried out by the supplying company (77%). Among the proposals for improvement, the lack of a protocol for referral and coordination between different levels of care (90% of those surveyed), and the diagnostic delay, attributable in 63% of cases to the lack of physical and personnel resources, stand out. Conclusion: The number of diagnostic tests are still insufficient and the diagnostic delay is excessive. Above all, in therapeutic control, the supplier company has a relevant role. It is proposed to carry out protocols between different care units and increase current resources

Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure.

BACKGROUND: Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF. METHODS: A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended. RESULTS: Fifteen patients were included in the study: 10 males, mean age 68+/-12. APACHE-II score was 17.6+/-6.5. pH and pCO2 before NIV were 7.22+/-0.11 and 110+/-72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward. CONCLUSIONS: NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.

Recomendaciones para la normalización gradual en la enfermedad COVID-19 en las unidades de trastornos respiratorios del sueño de Andalucía / No disponible

No disponible

[Non-small cell lung cancer. Survival after radiotherapy and prognostic factors]. / Carcinoma no microcítico de pulmón. Supervivencia y factores pronósticos del tratamiento radioterápico.

OBJECTIVE: To analyze the results of radiotherapy for non-small cell lung cancer and identify the clinical and therapeutic variables that might influence prognosis. PATIENTS AND METHODS: In a population base of 109 patients, 87 met the enrollment criteria. The patients received thoracic radiotherapy over the macroscopic tumor volume and lymph drainage areas, using conventional fractions. Systemic cytostatic therapy was also given to 61% of the patients. RESULTS: Staging was as follows: 33% (28/87) I and II, 20% (18/87) IIIA and 47% (41/87) IIIB. The mean radiotherapy dose was 66.7 Gy (95% CI, 65-67). Full clinical remission was achieved by 22% (18/87), half of whom later suffered recurrences. Partial remission was achieved by 26% (21/87). No response was observed in 52% (42/87). Statistically significant differences in actuarial survival rates were found for staging and tumor response. Mean survival for stages I and II was 29 months (95% CI, 19-39), for IIIA it was 22 (95% CI, 16-28) months, and for IIIB 16 months (95% CI, 12-20). The most common complications were cutaneous, esophageal and pulmonary, with a low incidence of grade 3 toxicity (less than 3%) and absence of grade 4. CONCLUSIONS: No differences in survival were observed for age, tumor location or histological type. Local control of the disease decisively influenced patient survival.

[Effects of portable liquid oxygen therapy on walking]. / Efectos de la oxigenoterapia líquida portátil sobre la deambulación.

The effect on walking of portable liquid oxygen therapy (PLOT), which involves carrying a tank, remains unclear. Our aim was to evaluate the repercussion of PLOT on performance in the 6 minute walking test. We enrolled 30 patients receiving home oxygen therapy in a randomized crossover study, collecting data on arterial blood gases at baseline, spirometry, and performance on the 6 minute walking test at baseline and at later sessions with PLOT and with compressed air simulating oxygen. During the tests we measured peak heart rate, distance walked and time that oxygen saturation remained over 89%. For compressed air, no improvement over baseline values was observed for any of the parameters measured. During the PLOT tests, however, patients walked farther than at baseline and arterial oxygen saturation rose to the prescribed flow rate. Dyspnea was not significantly affected.

[Effectiveness of continuous positive airway pressure in the long-term treatment of the obstructive sleep apnea syndrome]. / Eficacia de la presión positiva continua en la vía aérea en el tratamiento a largo plazo del síndrome de apnea obstructiva del sueño.

Eight patients with obstructive sleep apnea syndrome were treated with continuous positive airways pressure by nasal route. The treatment was carried out in the hospital during the initial days. If the procedure was effective and the tolerance was good, the patients were discharged to continue with treatment at home. Polygraphic sleep recordings carried out 2-4 months after the beginning of therapy showed normalization of the structure and the phases of sleep, apnea and desaturation being virtually absent. After a mean follow up of 18 months the patients are asymptomatic. The treatment has been well tolerated and significant side effects have not developed.

[Comparison of two models of education for asthmatic patients]. / Comparación de dos modelos de educación para pacientes asmáticos.

BACKGROUND: The education programs have demonstrated to be an important point in the management of asthmatic patients. The aim of the present study was to assess if an intensive group asthma education program was able to improve a simplified and individual asthma education program, both with a self-management plan included. PATIENTS AND METHOD: A prospective randomised controlled trial was conducted over 12 months and 73 moderate-severe asthmatic patients were included. Patients were randomly assigned to control or study group. Patients in control group received individual and simplified education with a self-management plan and patients in study group attended an <> in small groups where they received a three hours education program in three weeks.The outcome measures were: number of hospital admissions, observation unit admissions, emergency visits and unscheduled general practice consultations. Knowledge, adherence to treatment, ability with inhaler devices, airway function, environmental control measures and quality of life. They were assessed at the beginning and the end of the study. RESULTS: At the end of the study period the outcome of morbidity had improved in both groups but the number of observation unit admissions (p = 0.028) and unscheduled general practice consultations (p = 0.022) was substantially lower in study group. This group also demonstrated improvement in environmental control measures and better inhaler technique and knowledge (p = 0.007). In adherence, lung function or quality of life there were no differences between groups. CONCLUSIONS: In patients with asthma better results can be obtained with an intensive group asthma education program than with the individual and simplified program.

[Pulmonary carcinosarcoma with skin metastasis]. / Carcinosarcoma pulmonar con metástasis cutánea.

We describe a case of lung carcinosarcoma in a 70-years-old patient with chronic obstructive pulmonary disease. Pulmonary carcinosarcoma is an unfrequent lung tumor, and usually histologic diagnosis is carried out by microscopic examination of the resected tumor. We observed these situation in our patient that was diagnosed of squamous cell carcinoma before the surgical resection by transthoracic needle aspiration. One month after surgery he developed a lesion in the infranasal area that was identified as a skin metastasis of lung carcinosarcoma. There is no previously reported case of skin metastasis of this rare tumor of the lung, that contain an admixture of malignant epithelial and mesenchymal elements. Clinical symptoms of pulmonary carcinosarcomas are not different from other lung tumors. The treatment when it is possible is the surgical resection of the tumor. We review histologic, diagnostic and therapeutic features of lung carcinosarcomas.

Automatic prediction of chronic obstructive pulmonary disease exacerbations through home telemonitoring of symptoms.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease of the lung with a great prevalence and a remarkable socio-economic impact on patients and health systems. Early detection of exacerbations could diminish the adverse effects on patients' health and cut down costs burdened on patients with COPD. A group of 16 patients were telemonitored at home using a novel electronic daily symptoms questionnaire during a 6-months field trial. Recorded data were used to train and validate a Probabilistic Neural Network (PNN) classifier in order to enable the automatic prediction of exacerbations. The proposed system was able to predict COPD exacerbations early with a margin of 4.8 ± 1.8 days (average ± SD). Detection accuracy was 80.5% (33 out of 41 exacerbations were early detected); 78.8% (26 out of 33) of theses detected events were reported exacerbation and 87.5% (7 out of 8) were unreported episodes. The proposed questionnaire and the designed automatic classifier could support the early detection of COPD exacerbations of benefit to both physicians and patients.

Utilidad de la monitorización transcutánea de CO2 durante el registro polisomnográfico en una unidad de sueño / The usefulness of transcutaneous monitoring of CO2 during a sleep study in the sleep disorder unit

Los trastornos respiratorios del sueño son frecuentes en la población general y generan un alto consumo de recursos por ingresos, consultas y uso crónico de las terapias ventilatorias. La medición de CO2 transcutánea (tcCO2 ) ha mostrado buena correlación con la presión arterial de CO2 (PCO2 ) y es superior al pulsioxímetro para detectar hipoventilación. Su uso está poco extendido en nuestro medio. Nuestro objetivo fue valorar su utilidad en estudios de sueño basales y en titulaciones de CPAP y BIPAP, aplicadas a pacientes con síndrome de apneas del sueño (SAHS) y síndrome de obesidad-hipoventilación (SOH). Usamos el medidor tcCO2 en polisomnografías (PSG) basales de pacientes con sospecha de patología respiratoria del sueño y en titulaciones de CPAP o BIPAP de pacientes ya diagnosticados. Se realizaron 102 estudios a 89 pacientes. Hubo 45 estudios basales, 21 titulaciones de CPAP y 34 de BIPAP. La patología más frecuente fue el SAHS. La presión media de las titulaciones de CPAP fue de 9,6 cmH2 O. En las titulaciones de BIPAP la IPAP media fue de 15,7 y la EPAP media de 7,4. El índice de desaturación (IDH) medio fue de 27. La SpO2 media fue de 91,8% y el CT90 del 22,9%. La tcCO2 media fue de 45,6 y la máxima de 49,2. No hubo efectos secundarios a la monitorización tcCO2 . Conclusiones: observamos hipercapnia latente en muchos pacientes y el medidor fue bien tolerado. Creemos que la monitorización tcCO2 puede ser útil como método no invasivo para detectar hipoventilación, aun con cifras normales de SpO2

The transcutaneous CO2 (tcCO2 ) monitoring has demonstrated a good correlation with the arterial CO2 value, and is better than pulsioxymeter for to detect hypoventilation episodes. The tcCO2 monitoring is not routine in our environment. The aim of our study was to evaluate the utility of tcCO2 monitoring in our sleep unit, in basal studies and in non invasive ventilation settings. We performed a prospective study. We measured the tcCO2 values in basal polisomnografies (PSG) and in CPAP or BIPAP settings in patients with diagnosis of OSAS, obesity-hypoventilation Syndrome and COPD. We included 102 studies in 89 patients. There were 45 basal studies, 21 CPAP settings and 34 BIPAP settings. The most frequent pathology was OSAS. The mean pressure in CPAP settings was 9.6 H2 Ocm, while in BIPAP settings the mean IPAP was 15.7 and the mean EPAP was 7.4. The mean desaturation index was 27, the mean peripheral O2 value was 91.8%, and the mean cumuled time under 90% (CT90) of O2 peripheral saturation was 22.9%. The mean tcCO2 was 45.6 and the maximum was 49.2. Conclusions: tcCO2 monitoring is a non invasive method for to detect hypoventilation episodes in patients with sleep pathology and in non invasive ventilation settings, although the peripheral oxygen saturation remains in normal values