ABSTRACT
BACKGROUND: TB in low-incidence countries is characterised by changes in age distribution towards larger numbers of cases among the elderly.OBJECTIVES: To investigate clinical features and outcomes of TB treatment in older patients and identify predictors of poor outcome.METHODS: Multicentre retrospective study of new TB cases from 53 hospitals included in the registry of the Integrated Tuberculosis Research Programme of the Spanish Society of Pulmonology and Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica) between 2006 and 2020.RESULTS: We identified 731 patients aged ≥75 years from a cohort of 7,505 patients with TB. In the elderly, weight loss, disseminated disease and normal X-rays or infiltrates without cavitation were more common. All-cause mortality was 16% (5% of deaths due to TB). The elderly had higher rates of toxicity (6.7%) and hospital admissions (36%). In the multivariate analysis of predictors of TB mortality in ≥75-year-olds, only weight, age and treatment with non-standard regimens remained significant.CONCLUSIONS: TB in older patients needs more attention and remains a challenge because of a lack of specific clinical and radiological features. Standard treatment is effective, although mortality is higher than in young patients. Low weight, non-standard regimens and age are significant predictors of TB mortality.
Subject(s)
Pulmonary Medicine , Thoracic Surgery , Tuberculosis , Age Distribution , Aged , Humans , Retrospective Studies , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiologyABSTRACT
OBJECTIVE: To compare the results of applying both the 1993 and 2002 guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) to identify respiratory events during nighttime polysomnography tests. PATIENTS AND METHODS: One hundred twenty consecutive patients with medium to high suspicion of sleep apnea-hypopnea syndrome (SAHS) were included in the study. The 1993 guidelines recommended the use of a thermistor and the evaluation of only apneas and hypopneas. The 2002 guidelines, on the other hand, recommended the use of a thermistor, nasal pressure cannula, and thoracoabdominal bands so that respiratory effort related to arousals could be studied along with apneas and hypopneas. In our study we did not use an esophageal pressure catheter. We calculated the apnea index, hypopnea index, and apnea-hypopnea index (AHI) and determined the number of patients who would be diagnosed with SAHS (AH I > or =10) and the number for whom initiation of continuous positive airway pressure treatment would be recommended (AHI > or =30) according to the 2 sets of guidelines. RESULTS: Polysomnographic tests were valid for 118 of the 120 patients (80% men). The mean (SD) age was 51 (11.6) years and the mean body mass index 31.2 (4.3). Using the 1993 guidelines, the AHI was less than 10 in 25 patients, between 20 and 29 in 38, and 30 or more in 50. In the group overall, mean apnea and hypopnea indices and AHI were all significantly higher with the 2002 guidelines than with the 1993 criteria. With the 1993 criteria, the mean AHI was 33.16 and with 2002 criteria, 45.02 (P<.05). Sixty-four percent of the studies considered normal according to the 1993 SEPAR guidelines were considered apneic according to the 2002 guidelines. Of the patients considered not to need continuous positive airway pressure according to the 1993 SEPAR guidelines, 47.61% did need therapy according to the 2002 guidelines. CONCLUSIONS: There are significant differences in AHI, and in both apnea and hypopnea indices depending on whether the 1993 or the 2002 SEPAR guidelines are applied.
Subject(s)
Polysomnography , Practice Guidelines as Topic , Respiration Disorders/diagnosis , Sleep Apnea Syndromes/diagnosis , Female , Humans , Male , Middle AgedABSTRACT
Objetivo: Comparar las normativas de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) de 1993 y 2002 mediante la lectura de los eventos respiratorios de las mismas polisomnografías nocturnas. Pacientes y métodos: Se ha incluido en el estudio a 120 pacientes consecutivos con sospecha media-alta de síndrome de apneas-hipopneas (SAHS) durante el sueño. En la normativa de 1993 se usaba el termistor y sólo se valoraban las apneas y las hipopneas, mientras que en la de 2002 se emplean el termistor, la cánula de presión nasal y las bandas toracoabdominales, y se contabilizan aquéllas y los esfuerzos respiratorios relacionados con el despertar transitorio. En nuestro estudio no se utilizó la sonda de presión esofágica. Se dedujeron los índices de apneas, hipopneas y apneas- hipopneas (IAH). Se determinó a cuántos pacientes se diagnosticaba de SAHS (IAH ≥ 10) y cuántos eran subsidiarios de tratamiento con presión positiva continua de la vía respiratoria (IAH ≥ 30) al aplicar las 2 normativas. Resultados: Fueron válidos 118 estudios. El 80% correspondía a varones y el 20% a mujeres. La edad media (± desviación estándar) de los pacientes era de 51 ± 11,6 años, y el índice de masa corporal medio de 31,2 ± 4,3. Con la normativa de 1993, 25 pacientes tenían un IAH < 10; 38 entre 10 y 29, y dicho índice era ≥ 30 en 50 sujetos. En el grupo total, el IAH, el índice de apneas y el de hipopneas fueron significativamente mayores con los criterios de 2002. El IAH medio de 1993 era de 33,16, y el de 2002 fue de 45,02 (p < 0,05). El 64% de los estudios normales con la normativa SEPAR de 1993 se consideraron apneicos con la de 2002. El 47,61% de los pacientes no tratables con presión positiva continua de la vía respiratoria según la normativa SEPAR de 1993 pasó a serlo con la de 2002. Conclusiones: Existen notables diferencias en el IAH, índice de apneas e índice de hipopneas según se aplique la normativa de la SEPAR de 1993 o la de 2002
Objective: To compare the results of applying both the 1993 and 2002 guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) to identify respiratory events during nighttime polysomnography tests. Patients and Methods: One hundred twenty consecutive patients with medium to high suspicion of sleep apnea-hypopnea syndrome (SAHS) were included in the study. The 1993 guidelines recommended the use of a thermistor and the evaluation of only apneas and hypopneas. The 2002 guidelines, on the other hand, recommended the use of a thermistor, nasal pressure cannula, and thoracoabdominal bands so that respiratory effort related to arousals could be studied along with apneas and hypopneas. In our study we did not use an esophageal pressure catheter. We calculated the apnea index, hypopnea index, and apnea-hypopnea index (AHI) and determined the number of patients who would be diagnosed with SAHS (AH I ≥10) and the number for whom initiation of continuous positive airway pressure treatment would be recommended (AHI ≥30) according to the 2 sets of guidelines. Results: Polysomnographic tests were valid for 118 of the 120 patients (80% men). The mean (SD) age was 51 (11.6) years and the mean body mass index 31.2 (4.3). Using the 1993 guidelines, the AHI was less than 10 in 25 patients, between 20 and 29 in 38, and 30 or more in 50. In the group overall, mean apnea and hypopnea indices and AHI were all significantly higher with the 2002 guidelines than with the 1993 criteria. With the 1993 criteria, the mean AHI was 33.16 and with 2002 criteria, 45.02 (P<.05). Sixty-four percent of the studies considered normal according to the 1993 SEPAR guidelines were considered apneic according to the 2002 guidelines. Of the patients considered not to need continuous positive airway pressure according to the 1993 SEPAR guidelines, 47.61% did need therapy according to the 2002 guidelines. Conclusions: There are significant differences in AHI, and in both apnea and hypopnea indices depending on whether the 1993 or the 2002 SEPAR guidelines are applied
Subject(s)
Male , Female , Middle Aged , Humans , Polysomnography , Practice Guidelines as Topic , Respiration Disorders/diagnosis , Sleep Apnea Syndromes/diagnosisABSTRACT
We report the case of a 48-year-old woman with a diagnosis of pulmonary hypertension and hyperthyroidism (Graves' disease) in whom pulmonary artery pressures became normal after treatment of thyroid disease. The possible pathogenic mechanisms involved in this association include the presence of hyperdynamic heart failure and/or the presence of immune alterations underlying both conditions.
Subject(s)
Graves Disease/drug therapy , Hypertension, Pulmonary/drug therapy , Anticoagulants/therapeutic use , Antithyroid Agents/therapeutic use , Autoimmunity , Cardiotonic Agents/therapeutic use , Digitalis Glycosides/therapeutic use , Female , Graves Disease/diagnosis , Graves Disease/immunology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/immunology , Hyperthyroidism/diagnosis , Hyperthyroidism/drug therapy , Hyperthyroidism/immunology , Middle Aged , Spain , Warfarin/therapeutic useABSTRACT
Presentamos el caso de una paciente de 48 años de edad con diagnóstico de hipertensión pulmonar e hipertiroidismo (enfermedad de Graves) en la que se objetivó la normalización de las cifras de presión en la arteria pulmonar tras el tratamiento de su enfermedad tiroidea. Los posibles mecanismos etiopatogénicos involucrados en esta asociación incluirían la presencia de un fallo cardíaco hiperdinámico y/o la existencia de una alteración de la inmunidad subyacente y común a ambos (AU)
Subject(s)
Middle Aged , Female , Humans , Spain , Antithyroid Agents , Autoimmunity , Warfarin , Anticoagulants , Cardiotonic Agents , Digitalis Glycosides , Hypertension, Pulmonary , Hyperthyroidism , Graves DiseaseABSTRACT
A problem in immunohematology is to define the antibody quality which is related to its affinity expressed by the equilibrium constant. The activity of an antibody can be measured by the strength of its interaction, related to the adhesive energy exchanged during RBC agglutination which depends on the antigen-antibody liaison strength. To estimate this adhesive energy, two methods are used in this paper. Firstly, the dissociation behaviour of suspended RBC agglutinates was analysed by laser backscattering intensity (r) in a Couette flow. Backscattered intensity issued from shear-induced mechanical dissociation is recorded and submitted to a numerical process to obtain the energy parameter (ED). Secondly, a modification of this technique is proposed for measuring specific binding energy. Samples were exposed to increasing shear stress, and backscattered intensity was recorded. A constant increase of this intensity with raising shear stress was observed, pointed to a progressive dissociation of RBC agglutinates into smaller ones. Considering that complete dissociation of agglutinates is only approached asymptotically it is assumed that the final break-up of doublets (two-cell agglutinates) is produced at a critical shear stress (tauC) reflecting the work done to breaking-up the molecular bridges between both adjacent cells. This shear stress is defined by the extrapolation of the linear part of the curves [r-log tau] to the backscattered signal (r0) corresponding to the complete dispersion of RBCs. These approaches permit to define the specific surface adhesive energy (Gamma) by using the Derjaguin relation and to assess the functional characterization of specific immunoglobulins. In conclusion, two parameters characterizing monoclonal antibody agglutination properties, ED and Gamma, were estimated by laser backscattering methods, which could be very useful for antibodies quality control.
Subject(s)
ABO Blood-Group System/immunology , Antibodies, Monoclonal/immunology , Antigen-Antibody Reactions , Cell Adhesion/immunology , Erythrocyte Aggregation/immunology , Erythrocytes/immunology , Hemorheology , Humans , Lasers , Stress, MechanicalABSTRACT
Introducción al estudio de la técnica de prótesis. Nociones previas sobre prótesis dental. Conceptos sobre técnica de prótesis. Elementos fundamentales de las técnicas de laboratorio. Las técnicas de laboratorio. El tratamiento mecánico y el tratamiento térmico de los metales. El decapado y el desoxidado. La aplicación de fuerzas mecánicas como medio de dar forma a la estructura metálica del aparato protético. La fundición como medio de dar forma al aparto protético metálico. La unión molecular de dos o más partes como medio de dar forma a la estructura metálica del aparato protético. Desvastado, pulido, bruñido, electrodepositados. La manipulación del caucho. la manipulación de las resinas sintéticas acrílicas
Subject(s)
Laboratories, Dental , Laboratories, Dental/standards , Laboratories, Dental/trends , Dental ProsthesisABSTRACT
Introducción al estudio de la técnica de prótesis. Nociones previas sobre prótesis dental. Conceptos sobre técnica de prótesis. Elementos fundamentales de las técnicas de laboratorio. Las técnicas de laboratorio. El tratamiento mecánico y el tratamiento térmico de los metales. El decapado y el desoxidado. La aplicación de fuerzas mecánicas como medio de dar forma a la estructura metálica del aparato protético. La fundición como medio de dar forma al aparto protético metálico. La unión molecular de dos o más partes como medio de dar forma a la estructura metálica del aparato protético. Desvastado, pulido, bruñido, electrodepositados. La manipulación del caucho. la manipulación de las resinas sintéticas acrílicas
