Effectiveness of the integration of a palliative care team in the follow-up of patients with advanced chronic obstructive pulmonary disease: The home obstructive lung disease study.

BACKGROUND: Access to palliative care for patients with end-stage chronic obstructive pulmonary disease (COPD) is still very poor. OBJECTIVES: Evaluate our palliative care program for patients with advanced COPD by assessing whether the referral criteria for advanced COPD patients were adequate in identifying patients in end-of-life care and determine the results of the palliative care team's intervention METHODS: This was a prospective observational study of patients admitted to a multidisciplinary unit for advanced COPD. Data on sociodemographic variables, survival, symptomatology, quality of life, ACP, and health resource utilization were analyzed. RESULTS: Eighty-three patients were included in this study. By the end of the follow-up period, 69 (83%) patients had died, mainly due to respiratory failure (96%). The median duration of survival from the start of follow-up was 4.27 months (95% confidence interval, 1.97-16.07). Most patients (94%) had a dyspnea level of 4. Sixty (72%) patients required opioids for dyspnea control. There were no significant differences in the quality of life of the patients during follow-up. Thirty (43%) patients died at home, 26 (38%) in a palliative care unit, and 13 (19%) in an acute care hospital. ACP was performed for 50 (72%) patients. Forty (57%) patients required palliative sedation during follow-up. Dyspnea was the reason for sedation in 34 (85%) patients. Hospital admissions and emergency room visits decreased significantly (p = 0.01) during follow-up. CONCLUSIONS: Our integrated model allows for adequate selection of patients, facilitates symptom control and ACP, reduces resource utilization, and favors death at home.

The Relation of CFTR-Genotype and Associated Comorbidities to Development of Pulmonary Atelectasis in Cystic Fibrosis Patients

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Mortalidad en pacientes hospitalizados por gripe / Mortality in hospitalized patients with influenza

OBJETIVO: La gripe es una enfermedad muy prevalente y es responsable anualmente de entre 3 y 5 millones de casos graves, que llevan a 0,3-0,6 millones de muertes y cuantiosas pérdidas económicas. Por ello, es importante analizar qué factores, complicaciones u otro tipo de características podrían existir en los pacientes ingresados por gripe que pudiesen relacionarse con la mortalidad. MÉTODOS: Estudio unicéntrico, observacional, transversal y retrospectivo de los pacientes ingresados por gripe en el Hospital Universitario La Paz en las temporadas 2013-2014 y 2014-2015, con análisis de las variables recogidas en el documento del historial clínico y de los documentos de declaración obligatoria. RESULTADOS: 16 pacientes fallecieron de los 179 ingresados por gripe en las temporadas 2013-14 y 2014-15, lo que supone un 8,9%. Los fallecidos tenían mayor edad y algún tipo de inmunodeficiencia previa. Once tuvieron neumonía, cinco distrés respiratorio, siete fallo multiorgánico y cuatro de ellos ingresaron en la Unidad de Cuidados Intensivos. Además, la duración del tratamiento antiviral fue menor en comparación con los enfermos vivos al alta. Únicamente seis estaban vacunados. Según el análisis multivariante, la edad avanzada, cualquier tipo de inmunodeficiencia, el desarrollo de neumonía y el distrés respiratorio fueron factores asociados de forma independiente a la mortalidad. CONCLUSIONES: La edad avanzada, el padecimiento de cualquier tipo de inmunodeficiencia, el desarrollo de neumonía y de síndrome de distrés respiratorio agudo constituyeron factores de riesgo independientes para la mortalidad en enfermos ingresados por gripe

BACKGROUND: Influenza is a highly prevalent disease and is responsible of three to five million cases of severe illness every year, leading to 0.3-0.6 million of deaths and important health costs. Therefore, it is important to analyze which factors, complications and other characteristics could be related with patients admitted with flu who die. METHODS: Single-center, observational, cross-sectional and retrospective study of patients admitted with influenza at La Paz University Hospital during 2013-2014 and 2014-2015 seasons, with analysis of the variables collected in the clinical history and in the documents of "notifiable diseases". RESULTS: 16 patients admitted with influenza out of 179 died in the 2013-14 and 2014-15 seasons, which represent 8.9%. These were older patients, and more frequently suffered from some type of immunodeficiency. Eleven had pneumonia, five respiratory distress, seven multi-organ failure and four of them were admitted to the Intensive Care Unit. The duration of antiviral treatment was shorter in the living patients at discharge. Only six were vaccinated. According to the multivariate analysis, advanced age, suffering from any type of immunodeficiency, the development of pneumonia and respiratory distress are factors independently associated with mortality. CONCLUSIONS: Advanced age, suffering from any type of immunodeficiency, the development of pneumonia and respiratory distress are independent risk factors for mortality in patients admitted with influenza

Características de las atelectasias como complicación pulmonar en la fibrosis quística / No disponible

Objetivos: Determinar la prevalencia de las atelectasias en la fibrosis quística (FQ) en la Comunidad de Madrid, con el fin de encontrar factores de riesgo predisponentes. Material y métodos. Se ha llevado a cabo un estudio retrospectivo en las unidades de FQ de la Comunidad de Madrid, de aquellos que habían padecido atelectasias. Se estudiaron: infecciones, complicaciones pulmonares y comorbilidades, tratamiento previo y posterior, el empleo de la fibrobroncoscopia y su respuesta, el diagnóstico mediante tomografía computarizada (TC) y la resolución o no de la atelectasia. Resultados: 16 (2,66%) pacientes habían padecido atelectasias, siete hombres (43,8%), con una edad media a la primera atelectasia de 23,81 ± 11,2 años. 14 (87,5%) presentaron infección bronquial crónica (IBC), especialmente por S. aureus meticilin-sensible y P. aeruginosa. Tres (18,8%) habían padecido aspergilosis broncopulmonar alérgica (ABPA) y uno hemoptisis (6,3%) con embolización. No hubo diferencias significativas en los tratamientos usados antes y después. En 10 (62,5%) se realizó fibrobroncoscopia, mejorando ocho pacientes. La TC demostró mejoría radiológica en un 62,5%, completa en siete pacientes. Hubo diferencias significativas entre FEV1/FVC, FEV1 y FVC en la evolución de los pacientes; entre el número total de exacerbaciones del año previo y del posterior (p= 0,012) y entre las exacerbaciones graves del año previo y las últimas registradas (p= 0,013). Cinco (31,25%) tuvieron una evolución tórpida tras el evento. Conclusiones: Una función pulmonar con obstrucción moderada-grave, y haber padecido otras complicaciones respiratorias (ABPA y IBC) podrían predisponer a padecer atelectasias en FQ. Además, esta complicación empeora las exacerbaciones y la función pulmonar

Aim: To determine the prevalence of atelectasis in cystic fibrosis (CF) in Madrid Community, in order to find predisposing risk factors. Material and methods. A retrospective study in the CF Units of Madrid Community was carried out, of the patients who suffered atelectasis We studied: infections, pulmonary complications and comorbilities, prior and subsequent treatment, the use of broncoschopy and its results; the diagnosis using computed tomography (CT), and the resolution or not the atelectasis. Results: 16 (2,66%) patients has suffered atelectasis (2,66%), 7 males (43,8%) with a mean aged with the first atelectasis was 23,81 ± 11,2 year-old 14 (87,5%) presented chronic bronchial infection (CBI), specially by meticillinsensitive S and P. aeruginosa. Three (18,8%) had suffered allergic bronchopulmonary aspergillosis (ABPA) and one (6,3%) haemoptysis with embolization. There were no significant differences with prior and subsequent treatment. A bronchoscopy was performed in 10 patients (62,5%): improving in eight cases. A radiological improve was observed using a CT in 10 (62,5%) patients, complete in seven patients. We have found significant differences in FEV1/FVC, FEV1 and FVC, in the evolution of the patients; between the total number of exacerbations of the previous year and the following one. Five (31.25%) had a torpid evolution after the event. Conclusions: Pulmonary function with moderate to severe obstruction and other respiratory complications (ABPA and CBI) may predispose to atelectasis in CF. In addition, this complication worsens exacerbations and pulmonary function

Predicting high risk of exacerbations in bronchiectasis: the E-FACED score.

BACKGROUND: Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients. OBJECTIVE: Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality. METHODS: The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts. RESULTS: A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P<0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED. CONCLUSION: E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score's simplicity and prognostic capacity for death.

[Is H1N1 flu different from seasonal flu on initial plain chest films?]. / Gripe A ¿diferente de la gripe estacional?

OBJECTIVES: To determine whether there are differences in the findings on the initial plain chest films of patients with H1N1 influenza and those of patients with flu symptoms during the flu season. MATERIAL AND METHODS: All patients underwent plain-film chest radiography in the Emergency Department for flu symptoms; 95 patients had H1N1 influenza confirmed between July 2009 and December 2009 and 95 patients were attended for symptoms of seasonal flu in January 2009. We analyzed the views obtained, the distribution and location of the radiologic findings, and patients' age, sex, and previous disease. RESULTS: Patients with H1N1 influenza were younger than those with seasonal flu symptoms (mean 40.2 vs 50.9 years; p<0.001) and fewer had prior disease (48 vs. 63; p<0.001). Plain films were acquired with patients in the standing position in 75 patients in the H1N1 group and in 77 in the seasonal flu group; pathological findings were present in nearly 50% of the patients in each group. The most common findings in the H1N1 group were multifocal patchy consolidations (41.2%; p<0.001) and peribronchial-vascular opacities (16.3%), whereas in the seasonal flu group the most common finding was consolidation in a single lobe (43.9%). CONCLUSION: We found significant differences between the radiologic findings of patients with H1N1 influenza (severe) and those of patients with symptoms of flu during the flu season: the incidence of multifocal patchy consolidation was greater in H1N1 patients and H1N1 patients were younger.

Gripe A ¿diferente de la gripe estacional? / Is H1N1 flu different from seasonal flu on initial plain chest films?

Objetivos. Determinar si existen diferencias en los hallazgos de la radiografía de tórax inicial entre un grupo de pacientes con gripe A y pacientes con síntomas gripales en periodo de gripe estacional. Material y métodos. La muestra está formada por pacientes que ingresan con síntomas gripales y a los que se les realiza radiografía de tórax en Urgencias. El grupo de estudio lo constituyen 95 pacientes con gripe A confirmada atendidos entre los meses de julio a diciembre de 2009 y el grupo control 98 pacientes con síntomas de gripe estacional atendidos en enero de 2009. Se analizan los hallazgos radiológicos, su distribución y localización, edad, sexo, enfermedad previa y proyecciones obtenidas. Resultados. El grupo de estudio presentó menor edad que el control (media 40,2 vs 50,9 años, p<0,001). Tienen enfermedad previa 48 pacientes del grupo de estudio y 63 del control (p<0,001). La radiografía se obtuvo en bipedestación en 75 pacientes del grupo de estudio y en 77 del control y muestra hallazgos patológicos en casi el 50% de los pacientes de cada grupo. Los hallazgos más frecuentes en el grupo de estudio son las consolidaciones parcheadas multifocales (41,2%, p<0,001) y las opacidades peribroncovasculares (16,3%). En el grupo control la lesión más frecuente es la consolidación de distribución lobar única (43,9%). Conclusión. Encontramos diferencias significativas entre los hallazgos radiológicos en los pacientes con gripe A (grave) y aquellos con síntomas gripales en periodo de gripe estacional, con mayor incidencia de consolidación de distribución parcheada multifocal en la gripe A y en pacientes más jóvenes (AU)

To determine whether there are differences in the findings on the initial plain chest films of patients with H1N1 influenza and those of patients with flu symptoms during the flu season. Material and methods All patients underwent plain-film chest radiography in the Emergency Department for flu symptoms; 95 patients had H1N1 influenza confirmed between July 2009 and December 2009 and 95 patients were attended for symptoms of seasonal flu in January 2009. We analyzed the views obtained, the distribution and location of the radiologic findings, and patients’ age, sex, and previous disease. Results. Patients with H1N1 influenza were younger than those with seasonal flu symptoms (mean 40.2 vs 50.9 years; p<0.001) and fewer had prior disease (48 vs. 63; p<0.001). Plain films were acquired with patients in the standing position in 75 patients in the H1N1 group and in 77 in the seasonal flu group; pathological findings were present in nearly 50% of the patients in each group. The most common findings in the H1N1 group were multifocal patchy consolidations (41.2%; p<0.001) and peribronchial-vascular opacities (16.3%), whereas in the seasonal flu group the most common finding was consolidation in a single lobe (43.9%). Conclusion. We found significant differences between the radiologic findings of patients with H1N1 influenza (severe) and those of patients with symptoms of flu during the flu season: the incidence of multifocal patchy consolidation was greater in H1N1 patients and H1N1 patients were younger (AU)

Aspergilosis pulmonar invasiva debido a Aspergillus terreus en un paciente inmunocompetente con enfermedad pulmonar obstructiva crónica / Invasive pulmonary aspergillosis due to Aspergillus terrus in an immunocompetent patient with chronic obstructive pulmonary disease

En los últimos años se ha observado con más frecuencia la presencia de aspergilosis invasiva en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). En ciertas ocasiones esta se debe a la especie Aspergillus terreus, que presenta ciertas características propias como son su rareza para producir infección invasiva pulmonar, su alta mortalidad y su resistencia a antifúngicos. Presentamos el caso de un paciente inmunocompetente con EPOC que cursó con clínica de infección respiratoria de mala evolución, causada por una aspergilosis invasiva por Aspergillus terreus (AU)

The frequency of invasive aspergillosis in chronic obstructive pulmonary disease patients has been observed more frequently in recent years. It is sometimes due to the species of Aspergillus terreus, which has some characteristic features such as it being a rare cause of this invasive disease, its high mortality and its resistance to antifungal agents. We report the case of invasive aspergillosis in a non-immunosuppressed patient with COPD who had a complicated respiratory infection caused by Aspergillus terreus (AU)

Diagnóstico de tromboembolismo pulmonar en una mujer con situs inversus / Diagnosis of pulmonary thromboembolism in a woman with situs inversus

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Empiema adquirido en la comunidad por Acinetobacter baumannii / Acinetobacter baumannii community-acquired empyema

Presentamos el caso de un paciente de 44 años de edad, sin ningún antecedente de interés y que ingresa por un cuadro de disnea y fiebre y se le detecta un empiema causado por Acinetobacter baumannii adquirido en la comunidad, lo cual no lo hemos encontrado en la bibliografía (AU)

Marcadores tumorales en el cáncer de pulmón / Tumor markers in lung cancer

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[Community-acquired empyema caused by Acinetobacter baumannii]. / Empiema adquirido en la comunidad por Acinetobacter baumannii.

We referred a fourty-four years old male, without interesting personal history and who was accepted in the hospital due to dyspnea and fever and who was diagnosed with empyema by Acinetobacter baumannii acquired in the community; we have found no references about this in the medical literature.

[Free radicals in the bronchoalveolar lavage]. / Radicales libres en el lavado broncoalveolar.

Free radicals are usually reactive species, characterized by the possession of one or more unpaired electrons. This molleculles are involved in the pathogenesis of various respiratory diseases. Free radicals have been evaluated in the bronchoalveolar lavage to understand the importance of its role in lung cancer, adult respiratory distress syndrome, interstitial pulmonary diseases, tobacco induced pulmonary damage, hyperoxia and drug-induced lung toxicity. There are evidences suggesting that these agents play an important role in lung injury. These findings could lead the development of new, and more effective, therapeutic agents in some respiratory diseases.

Radicales libres en el lavado broncoalveolar / Free radicals in the bronchoalveolar lavage

Los radicales libres son moléculas inestables caracterizadas por tener uno o más electrones desapareados en su orbital externo. Estas moléculas están implicadas en la patogenia de numerosas enfermedades respiratorias. Los radicales libres han sido estudiados en el lavado boncoalveolar con el fin de determinar la importancia de su papel en distintos procesos como son el cáncer de pulmón, la toxicidad por fármacos, el síndrome del distrés respiratorio del adulto, las enfermedades pulmonares intersticiales, el daño pulmonar por el tabaco o por la hiperoxia. En la mayoría de los estudios realizados se encuentran evidencias de que estas sustancias están implicadas en la producción de la lesión pulmonar. En neumología, la comprensión de los mecanismos íntimos de actuación de estos agentes podría permitir el desarrollo de nuevos, y más eficaces, tratamientos en un gran número de enfermedades (AU)

[Kartagener's syndrome. Diagnosis in a 75 year-old woman]. / Síndrome de Kartagener. Diagnóstico en una paciente de 75 años.

Kartagener's syndrome is an inherited disease characterized by the clinical triad of bronchiectasis, sinusitis and situs inversus caused by an ultrastructural defect in the cilia that results in impaired mucociliary clearance. It is usually diagnosed during childhood, with a small number of cases discovered in adults and even fewer among patients over 60 years of age. Prompt, appropriate treatment of respiratory infections can minimize irreversible lung damage. We report the case of a woman with bronchiectasis, sinusitis and situs inversus diagnosed of Kartagener's syndrome based on clinical signs at age 75 years.

[The sleep apnea syndrome as a health problem. An estimation of its prevalence and morbimortality]. / El síndrome de apneas durante el sueño como problema sanitario. Valoración de su prevalencia y morbimortalidad.

The sleep apnea syndrome (SAS) is a frequent health problem and has severe consequences. In some reports, their main symptoms like habitual snoring, excessive daytime sleepiness and nocturnal respiratory pauses can affect up to 65, 22.2 and 27.9% of men, respectively, being less frequent in women. The incidence of SAS ranges between 4 and 7% of adult general population. Patients without treatment have an increased mortality (37% to 8 years). Between the complications that made this adverse outcome are cardiovascular problems (arterial hypertension, coronary artery disease, sudden death), cerebral infarctions and other derived from sleepiness like traffic crashes.

El síndrome de apneas durante el sueño como problema sanitario. Valoración de su prevalencia y morbimortalidad / Sleep apnea syndrome like health problem: valuation of ins prevalence and morbimortality

El síndrome de apneas durante el sueño (SAS) es un problema sanitario frecuente y con graves consecuencias. En algunos estudios, sus síntomas principales como el ronquido habitual, la somnolencia diurna excesiva y las pausas respiratorias nocturnas pueden estar presentes hasta en un 65, 22,2 y 27,9 % de hombres, respectivamente, siendo menos frecuentes en mujeres. La incidencia del SAS se sitúa en un 4 a 7 % de la población general adulta. Los pacientes sin tratamiento tienen una mortalidad aumentada (37 % a los ocho años). Entre las complicaciones que ocasionan este pronóstico desfavorable destacan las cardiovasculares (hipertensión arterial, enfermedad arterial coronaria, muerte súbita), los accidentes cerebrovasculares y otras derivadas de la somnolencia como los accidentes de tráfico (AU)