Prevalencia y características clínicas de la enfermedad pulmonar intersticial difusa sintomática en la artritis reumatoide en una población española / Prevalence and clinical characteristics of symptomatic diffuse interstitial lung disease in rheumatoid arthritis in a Spanish population

Antecedentes y objetivos: En España, los estudios epidemiológicos de prevalencia de enfermedad pulmonar intersticial difusa (EPID) en artritis reumatoide (AR) son escasos y limitados. Nuestro objetivo fue estimar la prevalencia de EPID sintomática en AR y sus características en nuestra área. Materiales y métodos: Se diseñó un estudio observacional longitudinal prospectivo en la consulta interdisciplinar de Reumatología y Neumología, en el que incluimos AR con síntomas respiratorios y EPID confirmada por tomografía computarizada de alta resolución. Resultados: De las 2.729 personas con AR de nuestra área, 47 presentaban EPID sintomática, estimándose una prevalencia de EPID sintomática en AR del 1,72% (intervalo de confianza del 95%: 1,26-2,29) con una edad al diagnóstico de AR de 57,3±13,3 años. Fue más frecuente en hombres, el 60,6% tenía antecedente de tabaquismo y el 84,3 y el 84,7% factor reumatoide y anticuerpos antipéptidos cíclicos citrulinados, respectivamente. El patrón más frecuente fue neumonía intersticial usual (NIU) en 28 (31,1%), la neumonía intersticial no específica (NINE) fue más frecuente en mujeres y el síndrome combinado enfisema-fibrosis (SCEF) exclusivamente en hombres. Conclusiones: En este estudio hemos analizado la prevalencia de AR-EPID sintomática en nuestra área, la cual está por debajo de lo esperado, probablemente en relación con las definiciones utilizadas. Así mismo, hemos descrito que el patrón NIU es el más frecuente en la AR, seguido del NINE y analizado por primera vez la prevalencia de SCEF en la AR, que alcanza el 13% (AU)

Background and objectives: In Spain, epidemiological studies of the prevalence of diffuse interstitial lung disease (ILD) in rheumatoid arthritis (RA) are limited. Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area. Materials and methods: In our hospital's interdisciplinary rheumatology and pulmonology clinic, a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography. Results: Of the 2,729 people with RA in our area, 47 had symptomatic ILD, estimating a prevalence of symptomatic ILD in RA of 1.72% (95% CI 1.26 - 2.29) with an age at diagnosis of RA of 57.3±13.3 years. It was more frequent in men, 60.6% had a history of smoking, and 84.3% and 84.7% had rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies, respectively. The most frequent pattern was usual interstitial pneumonitis (UIP), appearing in 28 (31.1%). Nonspecific interstitial pneumonia (NSIP) was more frequent in women, while the combined pulmonary fibrosis-emphysema (CPFE) syndrome presented exclusively in men. Conclusions: We have analysed the prevalence of symptomatic RA-ILD in our area, which is lower than expected, probably in relation to the definitions used. We have also described that the UIP pattern is the most frequent in RA in our environment, followed by the NSIP. Lastly, we have analysed the prevalence of CPFE in RA, which reaches 13%, for the first time (AU)

Prevalence and clinical characteristics of symptomatic diffuse interstitial lung disease in rheumatoid arthritis in a Spanish population.

BACKGROUND AND OBJECTIVES: In Spain, epidemiological studies of the prevalence of diffuse interstitial lung disease (ILD) in rheumatoid arthritis (RA) are limited. Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area. MATERIALS AND METHODS: In our hospital's interdisciplinary rheumatology and pulmonology clinic, a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography. RESULTS: Of the 2729 people with RA in our area, 47 had symptomatic ILD, estimating a prevalence of symptomatic ILD in RA of 1.72% (95% CI 1.26-2.29) with an age at diagnosis of RA of 57.3 ±â€¯13.3 years. It was more frequent in men, 60.6% had a history of smoking, and 84.3% and 84.7% had rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies, respectively. The most frequent pattern was usual interstitial pneumonitis (UIP), appearing in 28 (31.1%). Nonspecific interstitial pneumonia (NSIP) was more frequent in women, while the combined pulmonary fibrosis-emphysema (CPFE) syndrome presented exclusively in men. CONCLUSIONS: We have analysed the prevalence of symptomatic RA-ILD in our area, which is lower than expected, probably in relation to the definitions used. We have also described that the UIP pattern is the most frequent in RA in our environment, followed by the NSIP. Lastly, we have analysed the prevalence of CPFE in RA, which reaches 13%, for the first time.

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

Should we consider paranasal and chest computed tomography in severe asthma patients?

BACKGROUND: It is essential to recognize and treat findings that can simulate or worsen symptoms to improve asthma control and thereby to reduce costs. Guidelines highlight a paranasal (PS) and chest computed tomography (CT) scan as a tool for disease evaluation and, although they suggest its indication in patients whom presentation is atypical, there are not well-defined criteria. OBJECTIVES: To describe the most common findings in the PS and chest CT in severe asthma patients and to analyse the characteristics of asthmatics with the finding of nasal polyps or bronchiectasis. METHODS: We retrospectively reviewed the medical records of 161 adults with confirmed severe asthma who had undergone to PS and/or chest CT. Clinical data from their electronic health record and the findings from a PS and/or chest CT within the last five years were collected. RESULTS: In the PS CT, 70.5% of patients presented mucous thickening and 46.7% presented nasal polyps. Both findings were associated with male gender and level of blood eosinophils. In chest CT, 28% of individuals showed atelectasis, 16.5% air trapping, 17.7% affectation of the small airway, 11.6% pulmonary infiltrates and 10.4% emphysema. Bronchiectasis were identified in 60.4% of subjects, who were older and had poorer lung function. CONCLUSION: Paranasal and thoracic computed tomography are important tools in the treatment of severe asthma because they allow us to detect highly prevalent findings in this disease that can lead to poorer control of it.

Tuberculosis cutánea y pulmonar en paciente inmunocompetente / No disponible

La tuberculosis continúa siendo, en la actualidad, una enfermedad frecuente en nuestro medio debido principalmente a dos factores, la inmigración y la coinfección con el virus de la inmunodeficiencia humana. La afectación cutánea por Mycobacterium tuberculosis es muy poco habitual y, concretamente, la forma periorificial o ulcerosa, que se asocia a tuberculosis pulmonar extensa, es excepcional. Sin embargo, su incidencia puede aumentar en el futuro debido a los factores anteriormente citados junto a la inmunodepresión asociada al envejecimiento de la población y a los tratamientos inmunosupresores, por lo que se hace imprescindible incluir dicha enfermedad en el diagnóstico diferencial de las lesiones cutáneas en pacientes con tuberculosis pulmonar. Su diagnóstico requiere el aislamiento en el cultivo o la positividad en la técnica de reacción en cadena de la polimerasa de M. tuberculosis, y su tratamiento es el mismo que el de la tuberculosis pulmonar

Tuberculosis remains today a common disease in our daily lives mainly due to two causes, immigration and coinfection with the human immunodeficiency virus. Skin involvement by Mycobacterium tuberculosis is highly unusual, and particularly periorificial or ulcer form, which is associated with extensive pulmonary tuberculosis, is uncommon. However, its appearance may increase in the future due to the causes mentioned above, as well as immunosuppression associated with an aging population, and immunosuppressive treatments. Therefore, it is essential to include this disease in the differential diagnosis of skin lesions in patients with pulmonary tuberculosis. Diagnosis requires culture isolation or positivity of the M. tuberculosis polymerase chain reaction technique. Its treatment is the same as that of the pulmonary tuberculosis

Tuberculosis pulmonar y cerebral en un paciente inmunocompetente / No disponible

La infección por Mycobacterium tuberculosis tiene una alta prevalencia y está en íntima relación con la migración. Afecta fundamentalmente al pulmón, pero también a otros órganos, como el sistema nervioso central, conllevando una alta morbilidad y mortalidad. Se considera a los tuberculomas una forma de presentación a nivel cerebral, diagnosticándose mediante punción-aspiración o biopsia quirúrgica cuando es accesible o a través de técnicas de imagen. En caso de afectación meníngea, es obligado el estudio del líquido cefalorraquídeo. En función de la clínica, el tratamiento de los tuberculomas será quirúrgico o predominantemente farmacológico con cuatro antituberculostáticos y corticoides. Para la prevención de complicaciones, especialmente en inmunocomprometidos, es fundamental el diagnóstico precoz así como el tratamiento inmediato ante la mínima sospecha clínica. Presentamos el caso de un paciente varón de 41 años inmunocompetente que, tras estudio radiológico y microbiológico, se diagnosticó de tuberculosis pulmonar y cerebral y que mejoró satisfactoriamente

Infection with Mycobacterium tuberculosis is highly prevalent and is closely related to migration. It mainly affects lungs, but can also involve other organs such as the central nervous system. This neurologic complication is accompanied by a high morbidity and mortality. Tuberculomas are considered one form of presentation in the brain, and could be diagnosed by needle aspiration or surgical biopsy when they are accessible, or through imaging techniques. In the case of meningeal involvement, study of the cerebrospinal fluid is required for the diagnosis. Anti-tuberculosis drugs and corticosteroids are mainly used for the treatment of tuberculomas, but depending on the clinical situation, surgical procedures could also be performed. To prevent complications, especially in immunocompromised patients, early suspect and diagnosis is important to start immediately the administration of anti-tuberculosis drugs. We report the case of a 41-year-old-man immunocompetent who was diagnosed of pulmonary and cerebral tuberculosis and who was effectively treated

Diagnóstico de supuesto cáncer pulmonar asociado al uso de metotrexato / Diagnosis of the supposed lung cancer associated to the use of methotrexate

Resumen. La atritis reumatoide es una enfermedad que engloba manifestaciones articulares y extraarticulares como la neumonitis. Igualmente, ciertas medicaciones usadas para su tratamiento, como el metotrexato, se han asociado a neumopatías y a la presencia de atipias epiteliales y bronquiales. Reportamos el caso de una mujer de 63 años, diagnosticada de artritis reumatoide y con tratamiento con metotrexato, que presentó una neumonía intersticial, la cual inicialmente fue etiquetada de carcinoma pulmonar (AU)

Abstract. Rheumatoid arthritis is a disease that includes articular and extraarticular manifestations such as pneumonitis. Equally, certain medications used for its treatment, such as methotrexate, have been associated to lung diseases and the presence of epithelial and bronchial atypias. We report the case of a 63-year old woman diagnosed of rheumatoid arthritis and under treatment with methotrexate, who had interstitial pneumonia, which was initially labeled as lung cancer (AU)

[Functioning of hospital Ethics Committee before and after entry in force of new Royal Decree 223/2004 on Clinical Trials with Drugs]. / Funcionamiento de un Comité Etico de Investigación Clínica hospitalario antes y después de la entrada en vigor del nuevo Real Decreto 223/2004 de Ensayos Clínicos con Medicamentos.

Correct functioning of the Ethics Committee (EC) guarantees respect to the rights of the subjects participating in clinical research. The European transposition of the clinical trial guidelines by the Royal Decree (RD) 223/2004 February 6 speeds up and simplifies the administrative procedures for the authorization of clinical trials. However, it is clear that it has meant a considerable effort on the work and administrative load of the ECs. An account is made on the adaptation procedures of the EC of the Hospital La Paz to apply the new Royal Decree and a short reflection is made on the most immediate consequences and repercussions in the EC activity.

Morfología de la vía aérea superior en el síndrome de apnea obstructiva del sueño / Morphology of upper airways in the obstructive sleep apnea syndrome

No disponible

Tratamiento y pronóstico de la reagudización grave en la enfermedad pulmonar obstructiva crónica / Treatment and prognosis of the severe exarcebation in the chronic obstructive pulmonary didease

No disponible

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

No disponible

Manejo de la obesidad en atención primaria / Management of obesity in Primary Health Care

La obesidad es uno de los problemas médicos más frecuentes y factor de riesgo para enfermedades como la hipertensión, la diabetes, la artrosis y los eventos cardiovasculares. Es causa de importante morbilidad y mortalidad y genera grandes costes sociales y sanitarios. Además, la obesidad infantil, p recede a gran número de complicaciones metabólicas en la edad adulta. El tratamiento, sobre todo en el síndrome metabólico, debe estar dirigido a la pérdida de peso. Las más recientes recomendaciones se centran en ayudar a los pacientes a perder un 510 por ciento de su peso basal y mantener estas pérdidas a largo plazo. Por esto, escoger el correcto tratamien to es muy importante. En este artículo, se revisan las nuevas recomendaciones sobre la pérdida de peso, y se ofrecen sugerencias para el manejo de estos pacientes. También se discuten las nuevas opciones de tratamiento y su aplicación en Atención Primaria (AU)

Síndrome de apnea obstructiva del sueño / The obstructive sleep apnea syndrome

El síndrome de apnea obstructiva del sueño (SAOS) es una enfermedad conocida desde hace pocos años que está siendo objeto de múltiples trabajos. Su alta prevalencia y su asociación a complicaciones que pueden ser resueltas o mejoradas con tratamiento, hace que tenga que ser tenida en cuenta y sospechada por el médico de familia. En este artículo se revisan los aspectos más novedosos sobre etiopatogenia, clínica, complicaciones, criterios y métodos diagnósticos aceptados, así como el tratamiento (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.

[Angiotensin-converting enzyme in pulmonary thromboembolism as a marker of vascular lesion]. / Enzima conversora de la angiotensina en tromboembolia pulmonar como un marcador de lesión vascular.

UNLABELLED: In pulmonary thromboembolism (PTE) metabolic changes can occur, as in serum levels of angiotensin converting enzyme (ACE); therefore, the measurement of serum levels of this enzyme might be useful for PTE evaluation. The objective of this study was to determine changes in serum ACE in patients with PTE and their possible variations after therapy. MATERIALS AND THERAPY: Thirty-one patients with PTE were studied (15 males and 16 females). The mean age was 56 +/- 16 years (range 19-82 years). The patients were included if they had: a) a suspect diagnosis of PTE; b) confirmed by high probability V/Q gammagraphy, or c) data of intermediate or low probability with positive lower limb phlebography. Patients with associated diseases, under therapy with ACE inhibitors or lost during the six months of therapy were excluded from the study. STUDY DESIGN: Patients were evaluated in the acute phase of PTE and after therapy (six months later). Biochemical, gasometric, spirometric, V/Q gammagraphy and ACE parameters were investigated. All of them were compared with reference values and those obtained in both phases of PTE. STATISTICS: The Student "t" test was used for independent parameters with the Bonferroni correction for multiple contrast and a = 0.05. The Pearson regression analysis was used for correlations. The ROC curve was used to study its usefulness at diagnosis. RESULTS: ACE decreased by a 20.5% in the acute phase (31.69% +/- 10.34 mumol/min/l) and turned to normal values (39.91 +/- 9.75 mumol/min/l) at post-therapy phase. This decrease was related with acute hypoxia and a decrease in the lung vascular bed. The analysis of the ROC curve showed an area of 0.69 and a negative predictive value of 91.67% for ACE values higher than 46 mumol/min/l. CONCLUSIONS: ACE activity is a marker for pulmonary pathology which might be indicative of injury and/or decrease of the lung vascular bed; its measurement can be useful in the clinical follow-up of PTE. A return to normal values should be interpreted as improvement in the perfusion of the lung vascular bed.