TB in the elderly: clinical features and outcomes.

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.

Carcinoma de pulmón: cambios en epidemiología y supervivencia / Lung cancer: changes in epidemiology and survival

Antecedentes y objetivo. En las últimas décadas se han descrito variaciones en la epidemiología del carcinoma de pulmón. Hemos analizado si se han producido cambios en la epidemiología y la supervivencia del carcinoma de pulmón. Pacientes y métodos. Se incluyeron todos los casos con el diagnóstico de carcinoma de pulmón, con confirmación citohistológica entre mayo de 1997 y diciembre de 2008. Para comparar las variables analizadas se dividió el período de estudio en tres cohortes comprendidas respectivamente entre los años 1997-2000, 2001-2004 y 2005-2008. Resultados. Se incluyeron 905 pacientes, 776 varones (85,7%), con una edad media (± DE) de 64,4±11,6 años. El número de mujeres se incrementó desde el 11,2% en 1997-2000 hasta el 16,2% en 2005-2008. La estirpe adenocarcinoma aumentó desde el 29,3% en 1997-2000 hasta el 34,5% en 2005-2008 (p=0,02). La mediana de supervivencia se incrementó en 10 semanas: 51 semanas en 1997-2000 y 61 semanas en 2005-2008 (p=0,2). La supervivencia se asoció de forma independiente con el grado de actividad, tratamiento recibido, comorbilidad y pérdida de peso. Conclusiones. En nuestra área se ha producido un incremento del número de casos de cáncer de pulmón en las mujeres. Ha aumentado el tipo histológico de adenocarcinoma, y apreciamos un leve aumento de la supervivencia(AU)

Background and objective. In the last decades, variations have been described in the epidemiology of lung cancer. In our study, we have analyzed if changes have occurred in the epidemiology and survival of lung cancer. Patients and methods. All the cases with the diagnosis of lung cancer having cytohistological confirmation between May 1997 and December 2008 were included. To compare the variables, the study period was divided into three cohorts, respectively including the years 1997-2000, 2001-2004 and 2005-2008. Results. A total of 905 patients, 776 males (85.7%) were included with a mean age (± SD) of 64.4±11.6 years. The number of cases in females went from 11.2% in 1997-2000 to 16.2% in 2005-2008, and adenocarcinoma from 29.3% to 34.5% (P=.2). Survival was associated independently with the performance status, treatment, comorbidity and weight loss. Conclusions. In our area, there is been an increasing number of cases of lung cancer in females. The histological type of adenocarcinoma has increased and we have observed a slight increase in survival(AU)

[Lung cancer: changes in epidemiology and survival]. / Carcinoma de pulmón: cambios en epidemiología y supervivencia.

BACKGROUND AND OBJECTIVE: In the last decades, variations have been described in the epidemiology of lung cancer. In our study, we have analyzed if changes have occurred in the epidemiology and survival of lung cancer. PATIENTS AND METHODS: All the cases with the diagnosis of lung cancer having cytohistological confirmation between May 1997 and December 2008 were included. To compare the variables, the study period was divided into three cohorts, respectively including the years 1997-2000, 2001-2004 and 2005-2008. RESULTS: A total of 905 patients, 776 males (85.7%) were included with a mean age (± SD) of 64.4 ± 11.6 years. The number of cases in females went from 11.2% in 1997-2000 to 16.2% in 2005-2008, and adenocarcinoma from 29.3% to 34.5% (P=.2). Survival was associated independently with the performance status, treatment, comorbidity and weight loss. CONCLUSIONS: In our area, there is been an increasing number of cases of lung cancer in females. The histological type of adenocarcinoma has increased and we have observed a slight increase in survival.

Role of emphysema and airway obstruction in prognosis of lung cancer.

BACKGROUND AND OBJECTIVE: It has been reported that the presence of COPD and emphysema is associated with an increased risk of lung cancer, but the prognosis significance of these two conditions is not well known. The aim of our study was to analyze the influence of COPD and emphysema in the prognosis of non-small cell lung cancer (NSCLC). METHODS: Three hundred and fifty-three patients with cytohistologic diagnosis of NSCLC were prospectively collected. The relationship between survival at two years and the following variables: age, sex, smoking habit, comorbid diseases (cardiovascular diseases, previous tumour and COPD), weight loss, presence of emphysema on CT scan, performance status (PS) and treatment, was analyzed. The Kaplan-Meier method and log-rank test were used for survival analysis. A multivariate Cox proportional hazard model, stratified by TNM stage, was used to evaluate prognostic factors. RESULTS: Emphysema was present in 110 patients, associated with COPD in 78 (70.9%). In univariate analysis, survival decreased with age>70 years (p=0.01), presence of emphysema (p=0.02), weight loss (p=0.00001), PS≥2 (p=0.00001) and symptomatic treatment (p=0.0001). Multivariate analyses identified emphysema (HR=1.49 (95% CI 1.11-2.01)), PS≥2 (HR=2.12 (95% CI 1.31-3.38)) and treatment: surgery (HR=0.3 (95% CI 0.15-0.56)) and chemotherapy (HR=0.34 (95% CI 0.31-0.57)) as independent prognostic factors. CONCLUSION: The presence of emphysema affects the prognostic outcome of patients with non-small cell lung cancer. Emphysema should therefore be considered for prognostic studies on comorbidity.

Time to culture conversion in smokers with pulmonary tuberculosis.

BACKGROUND AND OBJECTIVE: It has been reported that tobacco smoking slows the sterilisation of sputum culture in pulmonary tuberculosis, but the factors that could delay culture conversion in patients who smoke are not known. Our aim is to identify the factors influencing sputum culture conversion in smokers with pulmonary tuberculosis. METHODS: Ninety-nine patients with a smoking history and diagnosed with pulmonary tuberculosis were analysed retrospectively. The relationship between sputum culture status at the second month and the following variables: age, gender, pack-years index, comorbid diseases, number acid-fast bacilli (AFB) in sputum smear examination, radiological findings (cavitary, extensive or limited disease), drug susceptibility pattern and initial treatment, was analysed. The Student t-test, chi-square test and logistic regression model with forward stepwise conditional methods were used for statistical analysis. A p value of <0.05 was considered to be statistically significant. RESULTS: Twenty six patients (26.2%): 18 males (22.2%) and 8 females (44%) were sputum culture positive at the end of the second month of treatment. In univariate analysis, culture conversion time was significantly associated with female gender and extensive disease, but in a logistic regression analysis was only correlated with female gender (OR=5.63 95% CI 1.21-20.64-p=0.02). CONCLUSION: In current smokers with pulmonary tuberculosis, the 'time to culture' conversion relates only to the female gender.

[Transbronchial needle aspiration in bronchogenic carcinoma with visible lesions: diagnostic yield and cost]. / Punción transbronquial en el carcinoma broncogénico con lesión visible: rendimiento y coste económico.

BACKGROUND: Transbronchial needle aspiration (TBNA) is a bronchoscopic technique whose usefulness in diagnosing endobronchial lesions has not yet been clearly established. OBJECTIVE: We aimed to determine whether the diagnostic yield of fiberoptic bronchoscopy could be increased, without a negative impact on diagnostic costs, if TBNA were used in combination with conventional diagnostic techniques (bronchial washings and bronchial brushings and forceps biopsy). PATIENTS AND METHODS: The cases of 130 patients diagnosed with bronchogenic carcinoma with endoscopically visible lesions were analyzed retrospectively. All had undergone conventional diagnostic procedures; TBNA was also performed if the bronchoscopist considered it was indicated. The final cost was calculated in euros for each diagnosis as the sum of the cost of the procedures needed to reach the diagnosis, including both endoscopic procedures and others (transthoracic needle aspiration, lymph node biopsy). Diagnostic yield and costs in cases diagnosed using only conventional techniques were compared to the yield and costs in cases in which both conventional techniques and TBNA were used. RESULTS: TBNA was performed in 49 patients and provided the diagnosis in 85.7%. Conventional techniques led to cytological and histological diagnosis in 80.2% of the cases, and the combination of conventional techniques and TBNA gave a diagnosis in 89.7% (P=.01). Significant differences were observed in extrinsic compression (conventional 37.5%; conventional+TBNA 100%; P=.01), submucosal infiltration (conventional 54.6%; conventional+TBNA 85%; P=.03), and exophytic mass with necrosis (conventional 80%; conventional+TBNA 100%; P=.01). The mean (SD) cost of diagnosis was euros 381.60 (euros 156.53) using conventional techniques and euros 413.25 (euros 112.91) for conventional techniques in combination with TBNA. By adding TBNA, costs decreased for diagnoses of submucosal infiltration, exophytic mass with necrosis and extrinsic compression, although the saving was significant only for extrinsic compression. CONCLUSION: The diagnostic yield of TBNA is high for endoscopically visible bronchial anomalies suggesting neoplasm, particularly when the lesion is due to extrinsic compression, submucosal infiltration, or exophytic mass with necrosis.

Punción transbronquial en el carcinoma broncogénicocon lesión visible: rendimiento y coste económico / Transbronchial needle aspiration in bronchogenic carcinoma with visible lesions: diagnostic yield and cost

FUNDAMENTO: La punción transbronquial (PTB) es una técnica broncoscópica cuya utilidad en tumores con lesión endobronquial no está claramente establecida.OBJETIVO: Con nuestro trabajo pretendemos estudiar si la combinación de la PTB con las técnicas diagnósticas convencionales (aspirado, cepillado y biopsia bronquiales) incrementa el rendimiento de la fibrobroncoscopia, sin repercutir negativamente en el coste económico (CE) del proceso diagnóstico. PACIENTES Y MÉTODOS: Se analizó de forma retrospectiva a 130 pacientes diagnosticados de carcinoma broncogénico con lesión endoscópica visible, a quienes se les practicaron las técnicas convencionales, quedando a criterio del broncoscopista responsable la realización de PTB. Se calculó el coste final por proceso, en euros, constituido por la suma del coste de los procedimientos necesarios para lograr el diagnóstico, en los que se incluían los endoscópicos y otros (punción transtorácica, punción-biopsia ganglionar). Se compararon el rendimiento y el CE entre el grupo de pacientes a los que se practicaron las técnicas convencionales (ACB) y aquellos a los que se añadió PTB (ACB + PTB). RESULTADOS: La PTB se realizó en 49 pacientes y proporcionó el diagnóstico de naturaleza en el 85,7 por ciento de los casos. Con ACB se logró la filiación citohistológica en el 80,2 por ciento de los casos, y en el 89,7 por ciento con ACB + PTB (p = 0,01); se apreciaron diferencias significativas en: compresión extrínseca (ACB: 37,5 por ciento; ACB + PTB: 100 por ciento; p = 0,01), infiltración submucosa (ACB: 54,6 por ciento; ACB + PTB: 85 por ciento; p = 0,03) y masa exofítica con necrosis (ACB: 80 por ciento; ACB + PTB: 100 por ciento; p = 0,01). El CE medio fue de 381,60 ñ 156,53 euros en ACB y 413,25 ñ 112,91 en ACB + PTB; al añadir la PTB se redujo el CE en infiltración submucosa, masa exofítica con necrosis y compresión extrínseca, aunque este ahorro sólo resultó significativo en compresión extrínseca. CONCLUSIÓN: La punción transbronquial es una técnica de elevada rentabilidad en presencia de anomalías endobronquiales indicativas de neoformación, particularmente cuando la lesión visualizada corresponde a compresión extrínseca, infiltración submucosa o masa exofítica con superficie necrótica (AU)

Carcinoma broncogénico no microcítico en estadios avanzados: influencia pronóstica de la pérdida de peso e implicaciones clínicas / Non-small cell bronchogenic carcinoma in advanced stages: prognostic value of weight loss and clinical implications

OBJETIVOS: Se diseñó un estudio en carcinoma broncogénico no microcítico en estadios avanzados, con los siguientes objetivos: a) identificar factores pronósticos recogidos en el momento del diagnóstico, y b) precisar si la pérdida de peso es un parámetro útil para seleccionar a los sujetos que obtendrían un mayor beneficio del tratamiento oncológico. PACIENTES MÉTODOS: Se incluyó a 81 pacientes diagnosticados de carcinoma broncogénico no microcítico en estadios III-b y IV y con grado de actividad menor de 2 según ECOG. Las variables a estudiar fueron: edad, sexo, antecedentes de tabaquismo, comorbilidad, datos clínicos (pérdida de peso, disnea, síndrome de vena cava superior), parámetros de laboratorio (hemoglobina, albúmina sérica, linfocitos totales, lactatodeshidrogenasa sérica, calcemia y enzimas hepáticas), tipo histológico, grado de actividad, estadificación tumoral (TNM), tratamiento recibido y supervivencia en semanas. Se analizaron dos grupos: grupo general, formado por todos los pacientes, y grupo sin pérdida de peso, constituido por los sujetos en que estaba ausente este síntoma. Para el estudio estadístico y de supervivencia se utilizaron las siguientes pruebas: t de Student, 2, Kaplan-Meier, test de rangos logarítmos y modelos de regresión de Cox. RESULTADOS: La mediana de supervivencia fue de 29 semanas (rango: 21-37). En el grupo general presentaban una relación significativa con la supervivencia los siguientes parámetros: pérdida de peso, linfocitos totales, LDH sérica, TNM y grado de actividad. De éstos, sólo mantenían implicación pronóstica en el estudio multivariado de pérdida de peso (HR: 1,48 [1,14-1,92]; p = 0,002) y la TNM (HR: 0,72 [0,54-0,96]; p = 0,02). En el grupo sin pérdida de peso en el univariado tienen relación significativa el tratamiento recibido y la TNM, conservando ambas una correlación con el pronóstico al incluirlas en modelos de regresión de Cox. CONCLUSIONES: En nuestra experiencia, en carcinoma de pulmón en estadios avanzados subsidiarios de tratamiento oncológico, la pérdida de peso es la variable con mayor poder pronóstico, por lo que podría ser conveniente considerarla de manera rutinaria, conjuntamente con el grado de actividad, para intentar identificar a los pacientes que obtendrían un mayor beneficio del tratamiento citostático (AU)

Toxicidad pulmonar por maprotilina: a propósito de un caso / Pulmonary toxicity due to maprotiline: a case report

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[Community-acquired pneumonia (CAP) with hospital treatment. The value of the clinical picture and complementary exams in predicting its etiology]. / Neumonía adquirida en la comunidad (NAC) con tratamiento hospitalario. Interés de la clínica y exámenes complementarios en la predicción de la etiología.

We studied 162 patients with community-acquired pneumonia admitted for hospital treatment, in order to determine the utility of clinical and ancillary examinations for predicting etiology and guiding the most appropriate empirical treatment. Acute first appearance of symptoms, purulent expectoration, chest sounds indicating lung condensation, pleuritic chest pain and leukocytosis over 12,500/ml were statistically significant in differentiating typical pneumonias from those with atypical behavior patterns. The last two features were the most relevant according to multivariate analysis. We conclude that careful taking of case histories and basic blood testing continue to be relevant and must not be considered anachronistic for the differential diagnosis of community-acquired pneumonias.