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1.
BMC Med ; 16(1): 33, 2018 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-29495970

RESUMEN

BACKGROUND: External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores for 3-year all-cause mortality in mostly multimorbid patients with COPD. METHODS: We relied on 24 cohort studies of the COPD Cohorts Collaborative International Assessment consortium, corresponding to primary, secondary, and tertiary care in Europe, the Americas, and Japan. These studies include globally 15,762 patients with COPD (1871 deaths and 42,203 person years of follow-up). We used network meta-analysis adapted to multiple score comparison (MSC), following a frequentist two-stage approach; thus, we were able to compare all scores in a single analytical framework accounting for correlations among scores within cohorts. We assessed transitivity, heterogeneity, and inconsistency and provided a performance ranking of the prognostic scores. RESULTS: Depending on data availability, between two and nine prognostic scores could be calculated for each cohort. The BODE score (body mass index, airflow obstruction, dyspnea, and exercise capacity) had a median area under the curve (AUC) of 0.679 [1st quartile-3rd quartile = 0.655-0.733] across cohorts. The ADO score (age, dyspnea, and airflow obstruction) showed the best performance for predicting mortality (difference AUCADO - AUCBODE = 0.015 [95% confidence interval (CI) = -0.002 to 0.032]; p = 0.08) followed by the updated BODE (AUCBODE updated - AUCBODE = 0.008 [95% CI = -0.005 to +0.022]; p = 0.23). The assumption of transitivity was not violated. Heterogeneity across direct comparisons was small, and we did not identify any local or global inconsistency. CONCLUSIONS: Our analyses showed best discriminatory performance for the ADO and updated BODE scores in patients with COPD. A limitation to be addressed in future studies is the extension of MSC network meta-analysis to measures of calibration. MSC network meta-analysis can be applied to prognostic scores in any medical field to identify the best scores, possibly paving the way for stratified medicine, public health, and research.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Índice de Severidad de la Enfermedad
2.
Arch Bronconeumol (Engl Ed) ; 57(4): 256-263, 2021 Apr.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32107115

RESUMEN

BACKGROUND: The survival of women with cystic fibrosis (CF) is lower than that of men by approximately 5 years. While various factors have been put forward to account for this discrepancy, no specific reasons have been established. Our hypothesis was that anatomical-structural involvement is more pronounced in women with CF than in men and that this is reflected in thoracic HRCT findings. MATERIAL AND METHODS: We performed a prospective multicentre study, in which adult patients were consecutively included over 18 months. Chest HRCT was performed, and findings were scored by 2 thoracic radiologists using the modified Bhalla system. We also studied respiratory function, applied the CFQR 14+ questionnaire, and collected clinical variables. RESULTS: Of the 360 patients followed up in the participating units, 160 were eventually included. Mean age was 28 years, and 47.5% were women. The mean±SD global score on the modified Bhalla score was 13.7±3.8 in women and 15.2±3.8 in men (p=0.024). The highest scores were observed for sacculations, bronchial generations, and air trapping in women. Women had lower BMI, %FEV1, %FVC, and %DLCO. Similarly, the results for the respiratory domain in CFQR 14+ were worse in women, who also had more annual exacerbations. CONCLUSIONS: This is the first study to provide evidence of the implication of sex differences in HRCT findings in patients with CF. Women with CF present a more severe form of the disease that results in more frequent exacerbations, poorer functional and nutritional outcomes, deterioration of quality of life, and greater structural damage.


Asunto(s)
Fibrosis Quística , Adulto , Fibrosis Quística/diagnóstico por imagen , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Estudios Prospectivos , Calidad de Vida , Caracteres Sexuales , Tomografía Computarizada por Rayos X
3.
Rev Esp Salud Publica ; 942020 Jul 29.
Artículo en Español | MEDLINE | ID: mdl-32724033

RESUMEN

Despite the progress achieved in recent decades, tuberculosis continues to be a major public health problem in wide areas of the world geography, and caused more than 1.6 million deaths in 2017. The eruption of cases with multidrug-resistant tuberculosis and extremely resistant hinders its healing and its progressive eradication. Fortunately, in the past few years, molecular techniques capable of diagnosing the disease in a few hours have been introduced, also detecting genetic mutations that encode resistance to the most active drugs in its cure. With the incorporation of bedaquiline and delamanide, we count on new shorter, more effective and less toxic treatment schemes for resistant cases. The future of the fight against tuberculosis must be based on clinical suspicion in the most vulnerable groups (elderly, immunosuppressed and immigrants), an accurate and early diagnosis, a short treatment with oral drugs and the inclusion of solidarity socioeconomic strategies that improve the situation of the most vulnerable countries and groups.


A pesar de los avances obtenidos en las últimas décadas, la tuberculosis sigue siendo un importante problema de salud pública en amplias zonas de la geografía mundial, y produjo más de 1,6 millones de muertes en 2017. La irrupción de casos con tuberculosis multirresistente y extremadamente resistente dificulta su curación y su progresiva erradicación. Afortunadamente, en los últimos años se han introducido técnicas moleculares capaces de diagnosticar la enfermedad en pocas horas, detectando también mutaciones genéticas que codifican resistencias a los fármacos más activos en su curación. Con la incorporación de la bedaquilina y la delamanida contamos con nuevos esquemas de tratamiento más cortos y eficaces, así como menos tóxicos, para los casos resistentes. El futuro de la lucha contra la tuberculosis debe basarse en la sospecha clínica en los grupos más vulnerables (ancianos, inmunodeprimidos e inmigrantes), el diagnóstico preciso y precoz, el tratamiento corto con fármacos orales y la incorporación de estrategias socioeconómicas solidarias que mejoren la situación de los países y colectivos más vulnerables.


Asunto(s)
Tuberculosis/prevención & control , Antituberculosos/uso terapéutico , Diagnóstico Precoz , Humanos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/prevención & control
4.
Rev Esp Salud Publica ; 942020 May 19.
Artículo en Español | MEDLINE | ID: mdl-32425178

RESUMEN

Despite the progress made in the last years, the Tuberculosis remains a relevant public health problem in many geographic areas of the world. Tuberculosis is the paradigm of infectious disease with a high social component, and in its approach, measures aimed at reducing poverty, economic inequality and the integration of the most vulnerable groups cannot be ignored. Therefore, solidarity and social justice are terms associated with the control of this disease. The TBS Network, made up of various institutions born from civil society, tries to inform society and professionals about aspects of tuberculosis prevention, control, diagnosis, treatment and investigation, trying to avoid the stigma that still accompanies many patients. Among the activities organized by the TBS Network are, among others, the Solidarity Cinema Forum (in prisons, Red Cross premises and NGOs), Informa TB and Update Days.


A pesar de los avances obtenidos en los últimos años, la tuberculosis sigue siendo un problema relevante de salud pública en muchas zonas geográficas del mundo. La tuberculosis es el paradigma de enfermedad infecciosa con un alto componente social, y en su abordaje no pueden soslayarse las medidas tendentes a disminuir la pobreza, las desigualdades económicas y la integración de los colectivos más vulnerables. Por ello, la solidaridad y la justicia social son términos asociados al control de esta enfermedad. La Red TBS, integrada por diversas instituciones nacidas de la sociedad civil, intenta informar a la sociedad y a los profesionales sobre aspectos de prevención, control, diagnóstico, tratamiento e investigación de la tuberculosis, intentando evitar el estigma que acompaña todavía a muchos pacientes. Entre las actividades que organiza la Red TBS se encuentran, entre otras, el Cinefórum Solidario (en prisiones, locales de Cruz Roja y ONGs), Informa TB y Jornadas de Actualización.


Asunto(s)
Redes Comunitarias , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Justicia Social , Factores Socioeconómicos , Tuberculosis/prevención & control , Humanos , España , Tuberculosis/diagnóstico , Tuberculosis/economía , Tuberculosis/terapia
5.
Arch Bronconeumol (Engl Ed) ; 55(11): 559-564, 2019 Nov.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31178266

RESUMEN

INTRODUCTION: In recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors. METHODS: A retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software. RESULTS: Scedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant. CONCLUSION: Scedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown.


Asunto(s)
Fibrosis Quística/microbiología , Scedosporium/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Estudios de Cohortes , Fibrosis Quística/fisiopatología , Femenino , Humanos , Modelos Logísticos , Masculino , Pseudomonas aeruginosa/aislamiento & purificación , Capacidad de Difusión Pulmonar , Estudios Retrospectivos , Esputo/microbiología , Adulto Joven
6.
Arch Bronconeumol (Engl Ed) ; 55(9): 478-487, 2019 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30967279

RESUMEN

OBJECTIVE: To describe an evidence- and experience-based expert consensus on the most relevant issues of patients with COPD exacerbations. METHODS: The Delphi technique was used. Evidence was reviewed by a scientific committee and 60 experts. A questionnaire was prepared containing 3 sections: diagnosis of the exacerbator; treatment, and healthcare processes. The survey was answered in 2 rounds by 60 pneumologists on an online platform. Statements were scored on a Likert scale from 1 (total disagreement) to 9 (total agreement). Agreement and disagreement were defined as a score of 7-9 or 1-3, respectively, given by more than two thirds of the participants. RESULTS: A total of 48 statements were included, one of which was added in the second round. Consensus was reached in 37 items (78.7%) after the first round (agreement), and in 43 (89.5%) after the second round (42 agreement, 1 disagreement). The statements with the highest proportion of experts agreeing were as follows: in exacerbators, chronic bronchial infection favors lung function decline (93.1%); long-acting bronchodilators should not be withdrawn (93.1%); treatment must be personalized if new exacerbations occur despite optimal bronchodilator treatment (96.6%); management must be coordinated between primary care and the respiratory medicine department (93.1%), and patients must be followed up in specific integrated multicomponent programs (94.8%). CONCLUSIONS: The findings of this study could assist in the diagnosis and treatment of COPD exacerbators in our area.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Progresión de la Enfermedad , Encuestas de Atención de la Salud , Humanos , Guías de Práctica Clínica como Asunto
7.
Arch Bronconeumol ; 44(5): 233-8, 2008 May.
Artículo en Español | MEDLINE | ID: mdl-18448013

RESUMEN

OBJECTIVE: Cardiovascular disease is a common cause of death in patients with chronic obstructive pulmonary disease (COPD). It is not clear whether the high cardiovascular comorbidity is due to an increase in traditional risk factors or whether, in contrast, COPD can be considered an independent risk factor. The aim of this study was to analyze the prevalence of risk factors and cardiovascular comorbidity in a community-based population treated for COPD. PATIENTS AND METHODS: This was a concurrent multicenter, cross-sectional study that included 572 patients with confirmed diagnosis of COPD. Information on cardiovascular risk factors and comorbidity was collected by extracting data from the medical records of the participating center. RESULTS: The mean (SD) forced expiratory volume in 1 second (FEV1) was 53.7% (16.85%) of predicted and the ratio of FEV1 to forced vital capacity was 57.9% (10.9%). Hypertension was reported in 53%, obesity in 27%, dyslipidemia in 26%, and diabetes in 23% of the patients. The prevalence of risk factors was not related to disease severity, but there was a trend towards an association with age. In the study group, 16.4% had ischemic heart disease, 7% cerebrovascular disease, and 17% peripheral vascular disease. Cardiovascular disease was not associated with COPD severity, but such an association was reported for age and traditional risk factors. CONCLUSIONS: Cardiovascular risk factors are highly prevalent in patients with COPD. The prevalence of cardiovascular and cerebrovascular disease exceeds that reported in the general population. No relationship was found between the severity of airflow obstruction and the presence of cardiovascular comorbidity.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Anciano , Comorbilidad , Estudios Transversales , Demografía , Complicaciones de la Diabetes/epidemiología , Femenino , Humanos , Hiperlipidemias/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
9.
Arch Bronconeumol ; 48(10): 349-54, 2012 Oct.
Artículo en Inglés, Español | MEDLINE | ID: mdl-22705258

RESUMEN

OBJECTIVE: To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and 1 year later in comparison with the results from the younger age group (<75). MATERIAL AND METHODS: Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH<7.35 and PaCO(2)>45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 h), complications and evolution at the 1-year follow-up. RESULTS: Mean age of the sample was 80.6. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the 1-year follow-up was 63.21%. CONCLUSIONS: NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.


Asunto(s)
Acidosis Respiratoria/terapia , Ventilación no Invasiva , Unidades de Cuidados Respiratorios , Acidosis Respiratoria/sangre , Acidosis Respiratoria/tratamiento farmacológico , Acidosis Respiratoria/etiología , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Terapia Combinada , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/complicaciones , Mortalidad Hospitalaria , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Ventilación no Invasiva/estadística & datos numéricos , Oxígeno/sangre , Terapia por Inhalación de Oxígeno , Readmisión del Paciente/estadística & datos numéricos , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Unidades de Cuidados Respiratorios/estadística & datos numéricos , España/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Vasoconstrictores/uso terapéutico
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