Pilates en pacientes con espondilitis anquilosante: repercusión en la función pulmonar / Pilates physiotherapy for ankylosing spondylitis patients: Impact on lung function

Objetivo: Evaluar el impacto de la fisioterapia basada en el método de Pilates en la función pulmonar de pacientes con espondilitis anquilosante (EA). Material y método: Se realiza un ensayo clínico aleatorizado (ECA) con 49 pacientes diagnosticados de EA según los criterios de Nueva York modificados. Se establecen al azar 2 grupos de trabajo. Se aplicó ejercicio terapéutico en 26 pacientes, 17 semanas, días alternos y 1h de duración, supervisado por un fisioterapeuta. El grupo control (23 pacientes) realizó un programa de ejercicios convencionales en el domicilio. Terminan el estudio 45 de los 49 pacientes que iniciaron el ECA. Las variables analizadas son: expansión costal, capacidad vital forzada (CVF), volumen espirado forzado (FEV1) y el cociente FEV1/CVF. Resultados: No hay diferencias significativas en los valores de expansión costal entre ambos grupos (p valor=0,686) ni diferencias en el grupo experimental antes y después de la intervención (p valor=0,780). Los valores de la espirometría se comportan de forma similar. La CVF aumenta de forma discreta en el grupo experimental no de forma significativa (p valor = 0,122). Conclusiones: El impacto de los ejercicios basados en pilates sobre los valores espirométricos y la expansión costal es escaso, a pesar de la tendencia del grupo experimental a mejorar su CVF después de la intervención. Se debe considerar, para su aplicación clínica, implementar este tipo de protocolos con fisioterapia respiratoria específica

Aim: To evaluate the impact of physiotherapy, based on the Pilates Method, on the lung function of patients with Ankylosing Spondylitis (AS). Material and methods: A randomised clinical trial (RCT) was performed with 49 patients diagnosed with AS according to the modified New York criteria. Two groups were randomly established. Therapeutic Pilates-based exercise was performed by 26 patients for 17 weeks, in 90minute sessions on alternative days, supervised by a physiotherapist. The control group (23 patients) used a conventional exercise program at home. The variables analysed were: rib cage expansion, forced vital capacity (FVC), forced expiratory volume (FEV1), and the FEV1/FVC ratio. Results: No significant differences were found in the values of rib cage expansion between control and experimental groups (P=.686), while there were differences before and after intervention in the experimental group (P=.780). The values of spirometry were similar in both control and experimental groups. No-significant increase in FVC was observed in the experimental group (P=.122). Conclusions: The impact of Pilates-based exercises on spirometry values and rib cage expansion is limited, although there was a tendency to improve FVC after Pilates exercises. These types of exercise protocols should be considered, for their clinical application, in specific respiratory physiotherapy

Recomendaciones sobre el diagnóstico y manejo de la enfermedad pleural y pulmonar por asbesto / Recommendations for the diagnosis and management of asbestos-related pleural and pulmonary disease

Asbesto, también conocido en España como amianto, es el término utilizado para nombrar a un conjunto de silicatos minerales que suelen romperse en fibras. Su uso ha comportado la aparición de numerosas enfermedades, especialmente pleuropulmonares, todas ellas caracterizadas por su prolongada latencia. El asbesto es, además, un carcinógeno del grupo IA reconocido por la OMS desde 1987. En España está prohibido desde 2002. La publicación en 2013 de la 3.ª edición del protocolo de vigilancia sanitaria específica del amianto junto con la aparición de nuevas técnicas diagnósticas han motivado al grupo EROM de SEPAR a promover la elaboración de esta normativa que revisa aspectos clínicos, radiológicos y funcionales de las diferentes enfermedades relacionadas. También establece recomendaciones para el diagnóstico y seguimiento de los pacientes expuestos. Dichas recomendaciones han sido establecidas mediante sistema GRADE.(AU)

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.(AU)

[Pegfilgrastim in hematopoietic stem cell transplantation]. / Pegfilgrastim en el trasplante hemopoyético.

Pegylation implies progress in filgrastim therapy. The addition of one molecule of polyethylene glycol (PEG) increases the drug's half-life by reducing renal excretion. A single dose of pegfilgrastim is equivalent to a daily administration of G-CSF for recovering from neutropenia after cancer chemotherapy. Pegfilgrastim is also useful to mobilize hematopoietic stem cells. Several studies have researched its efficacy in this context, in patients with myeloma or lymphoma. Outcomes suggest that it has an efficacy similar to daily G-CSF. In allogeneic donors, a single 12-mg dose of pegfilgrastim produces sufficient increase of CD34+ in peripheral blood, with acceptable toxicity. There is interest on the data about the various functional and biologic properties of hematopoietic stem cells mobilized with pegfilgrastim compared to G-CSF, and on the effect that these differences may have on the graft composition. The administration of a single dose of pegfilgrastim after autologous transplantation has been shown to shorten the time for leukocyte recovery in a manner similar to G-CSF

Community-acquired pneumonia: aetiologic changes in a limited geographic area. An 11-year prospective study.

The aim of this study is to describe the changes in the aetiology of hospitalised patients with community-acquired pneumonia (CAP) during an 11-year observational period in a limited geographic area. Eight hundred and one (801) adult patients with CAP hospitalised were included. The patients were divided into three groups according to the time of presentation. Comprehensive microbiological laboratory tests were performed and differences in aetiology were analysed. In 228 patients (31%), a pathogen was detected, with Coxiella burnetii being the most common (20.1%). Significant variations in the prevalence of Chlamydophila pneumoniae were found between groups but not in other pathogens. In conclusion, long-term epidemiological studies may contribute to the knowledge of actual CAP aetiology.

[Cryotherapy with nitrous oxide in primary care]. / Crioterapia con óxido nitroso en atención primaria.

OBJECTIVE: To study the efficacy, tolerance and safety in primary care of the cryotherapy technique using nitrous oxide. Design. Descriptive, observational and transversal study. SETTING: Mariñamansa-A Cuña Health Centre, Ourense. PARTICIPANTS: All the patients who consulted for cutaneous lesions caused by cryotherapy between March and April 2000 (n=130). MAIN MEASUREMENTS: Age, sex, diagnosis, location, size of lesion, duration of application of the cryogenic agent, previous treatment, side-effects observed, and evolution of the lesion. RESULTS: Mean age was 36.65 (95% CI, 32.57-40.74), of whom 53.8% (95% CI, 44.80-62.50) were women. The most common lesions were common warts (68.5%), actinic Keratosis (12.3%) and plantar warts (7.7%). We found that most lesions were located on an upper limb (50.8%). The mean size of lesions was 8.65 mm2 (95% CI, 4.50-12.80). 69.7% of warts were scraped prior to cryotherapy; and 16.2% received prior keratolysis. We found no side-effects in 32.3% of the patients; the commonest side-effect detected was blisters. Mean number of cryotherapy sessions was 2.82 (95% CI, 2.39-3.29). The technique was tolerated well in 83.8% of cases. We found total cure in 87.7%. Most of the cutaneous lesions that failed were common warts. CONCLUSIONS: Nitrous oxide is effective in most lesions caused by cryotherapy. The technique is tolerated well, can be handled easily and can be used in primary care.

Crioterapia con óxido nitroso en atención primaria / Cryotherapy with nitrous oxide in primary care

Objetivo. Estudiar la eficacia, tolerancia y seguridad de la técnica de crioterapia con óxido nitroso en atención primaria. Diseño. Estudio descriptivo observacional, transversal. Emplazamiento. Centro de Saúde Mariñamansa-A Cuña, Ourense. Participantes. Todos los pacientes que consultaron por lesiones cutáneas subsidiarias de crioterapia entre marzo y abril de 2000 (n = 130).Mediciones principales. Edad, sexo, diagnóstico, localización, tamaño de la lesión, tiempo de aplicación del agente criogénico, tratamiento previo, secundarismos observados y evolución de la lesión. Resultados. La edad media fue de 36,65 años (IC del 95 per cent, 32,57-40,74); un 53,8 per cent (IC del 95 per cent, 44,80-62,50) eran mujeres. Las lesiones más frecuentes fueron verrugas vulgares (68,5 per cent), queratosis actínica (12,3 per cent) y verrugas plantares (7,7 per cent).Observamos que la mayoría de las lesiones se localizó en miembro superior (50,8 per cent). El tamaño medio de las lesiones fue de 8,65 mm2 (IC del 95 per cent, 4,50-12,80). Se realizó raspado previo a la crioterapia en el 69,7 per cent de las verrugas y un 16,2 per cent recibió queratolítico previo. No observamos secundarismos en el 32,3 per cent de los pacientes; de los secundarismos detectados el más frecuente fue la ampolla. La media de sesiones de crioterapia fue de 2,82 (IC del 95 per cent, 2,39-3,29). La técnica fue bien tolerada en el 83,8 per cent de los casos. Obtuvimos una curación global de un 87,7 per cent; las lesiones cutáneas que fracasan son sobre todo verrugas vulgares. Conclusiones. El óxido nitroso es eficaz en la mayoría de los lesiones subsidiarias de crioterapia y es una técnica bien tolerada y de fácil manejo que puede aplicarse en atención primaria (AU)

[Assessment of drug treatment for hypertension in a health centre as a function of associated chronic pathologies and degree of control of the hypertension]. / Valoración del tratamiento farmacológico antihipertensivo en un centro de salud en función de las patologías crónicas asociadas y grado de control de la HTA.

OBJECTIVE: To assess the suitability of whatever hypertension medication is prescribed for the associated pathology in each patient, and to analyse the monitoring of blood pressure figures. DESIGN: A cross-sectional descriptive study.Setting. Urban health centre. PATIENTS: The target population were the hypertension patients being treated with medication and monitored at the health centre. Stratified random sampling by quotas of the total number with hypertension was performed. The sample numbered 219 patients. MEASUREMENTS: The clinical history of each patient selected was reviewed. To evaluate the hypertension treatment, we established three levels of suitability with regard to the accompanying pathology of each patient (suitable, intermediate, unsuitable), using the 1999 Hypertension Protocol of the Spanish Society of Family and Community Medicine. RESULTS: Out of 219 cases, treatment was suitable in 71 (32.4%), intermediate in 91 (41.6%), and unsuitable in 57 (26%). The most frequently indicated drug group was the angiotensin converting enzyme inhibitor (ACEI) group and, jointly, ACEI and diuretics. Regarding the monitoring of blood pressure: 66.5% had very good monitoring, 23.2% partial and 9% poor. CONCLUSIONS: Most treatments are at an intermediate level of suitability: without beneficial or undesirable effects on the associated pathology. This makes us think we need to optimize the drug indicators for hypertension.

Valoración del tratamiento farmacológico antihipertensivo en un centro de salud en función de las patologías crónicas asociadas y grado de control de la HTA / Assessment of drug treatment for hypertension in a health centre as a function of associated chronic pathologies and degree of control of the hypertension

Objetivos. Valorar la adecuación del tratamiento farmacológico antihipertensivo prescrito según la patología asociada en cada paciente y analizar el control de cifras tensionales. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud de área urbana. Participantes. La población diana fueron los pacientes hipertensos en tratamiento farmacológico y controlados en el centro de salud. Se realizó muestreo aleatorio estratificado por cupos del total de hipertensos, y la muestra fue de 219 hipertensos. Mediciones. Se revisó la historia clínica de los pacientes seleccionados. Para la evaluación del tratamiento antihipertensivo establecimos tres niveles de adecuación (adecuado, intermedio y no adecuado) basándonos en el protocolo de hipertensión arterial de 1999 de la Sociedad Española de Medicina de Familia y Comunitaria, teniendo en cuenta la patología concomitante en cada paciente. Resultados. De 219 casos, el tratamiento fue adecuado en 71 (32,4 por ciento), intermedio en 91 (41,6 por ciento) y no adecuado en 57 (26 por ciento). El grupo farmacológico más frecuentemente indicado fue el de inhibidores de la enzima de conversión de la angiotensina (IECA) y en asociación: IECA + diuréticos. Respecto al control de tensión arterial, un 66,5 por ciento presentó un control óptimo, el 23,2 por ciento un control parcial y un 9 por ciento mal control. Conclusiones. La mayoría de los tratamientos se encuentran en un nivel de adecuación intermedio: sin efectos beneficiosos ni indeseables sobre la patología asociada. Esto nos hace pensar en la necesidad de optimizar las indicaciones farmacológicas antihipertensivas (AU)

[Community-acquired pneumonia: influence of the duration of intravenous antibiotic therapy on hospital stay and the cost-benefit ratio]. / Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad.

UNLABELLED: Intravenous antibiotic therapy (IVAT) is usually prescribed for patients hospitalized with community-acquired pneumonia (CAP). Studies have associated prolonged IVAT with longer hospital stays and higher costs. The aim of this study was to determine the factors that influence the expense generated by and mean stay of patients hospitalized for pneumonia, with special attention to the influence of IVAT duration. MATERIAL AND METHODS: One hundred twenty-five CAP patients admitted to the respiratory medicine wards of our hospital were randomly assigned to five different staff physicians. IVAT was prescribed following the norms of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR). IVAT was withdrawn when the attending physician considered it appropriate. We collected epidemiological, comorbidity, clinical and analytical data. Complications were recorded and severity of CAP was classified using the model proposed by Fine. Follow-up care was given at an outpatient clinic until symptoms disappeared and chest films resolved. Multivariate analysis determined the factors predicting mean hospital stay and high cost. Costs were calculated based on data issued by the billing department. RESULTS: The mean cost of care was 307,274 pesetas, mean duration of IVAT was 5.8 days and mean hospital stay was 9.4 days. Multivariate analysis showed that cost was related to mean hospital stay and IVAT. Mean hospital stay was associated with IVAT, the presence of respiratory insufficiency and the day of the week when admission took place (with weekend admission leading to longer stays). CONCLUSIONS: The duration of IVAT in CAP influences mean hospital stay and cost, without adding any evident therapeutic benefit (in the group of patients selected). Recommendations for diagnosing and treating CAP may be advisable.

Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad / Community-acquired pneumonia: influence of the duration of intravenous antibiotic therapy on hospital stay and the cost-benefit ratio

Durante el ingreso hospitalario de los pacientes con una neumonía adquirida en la comunidad (NAC) es práctica clínica habitual el empleo de antibioterapia intravenosa (ABIV) durante un período de tiempo no determinado. Diversos estudios han relacionado la prolongación de la ABIV con una mayor estancia media y costes del proceso asistencial. El objetivo de nuestro estudio fue determinar los factores que influyen en el coste económico y en la estancia media de la neumonía que precisa hospitalización, con especial atención a la influencia que la duración de la ABIV tendría en ellos. MATERIAL Y MÉTODOS: Se estudiaron 125 casos de NAC ingresados en la sección de neumología de nuestro hospital, atendidos al azar por cinco médicos distintos de la plantilla. La ABIV se indicó siguiendo la normativa de la SEPAR y se retiró cuando el facultativo responsable lo estimó oportuno. Se recogieron datos epidemiológicos, comorbilidad y datos clínicos y analíticos. Se valoraron complicaciones, y la gravedad de la NAC se clasificó con el modelo propuesto por Fine. Los pacientes fueron seguidos de forma ambulatoria hasta su curación clínica y resolución radiológica. Se realizaron análisis estadísticos multivariados para determinar los factores predictores de estancia media y costes económicos elevados. Los costes se elaboraron a partir de los datos emitidos por el servicio de facturación. RESULTADOS: El coste medio del proceso fue de 307.274 pesetas, la duración media de ABIV, de 5,8 días y la estancia media, de 9,4 días. En el análisis multivariado, el coste económico guardó relación con la estancia media y la duración de ABIV, y por su parte, la estancia media se asoció con la ABIV, la presencia de insuficiencia respiratoria y el día de la semana en que se producía el ingreso (mayor estancia en los ingresos de fin de semana). CONCLUSIONES: La duración de la antibioterapia intravenosa en la NAC influye sobre la estancia media y el coste económico del proceso, sin añadir aparentemente beneficios terapéuticos (en grupos de pacientes seleccionados). Tal vez sería conveniente incluir algunas recomendaciones sobre este punto en futuras normativas sobre diagnóstico y tratamiento de la NAC (AU)

[Acute myocarditis caused by varicella virus]. / Miocarditis aguda por virus de la varicela.

We describe a case of acute myocarditis subsequent to varicella virus infection. We comment on the rarity of the clinical entity together with the nonspecificity of the routine diagnostic technique (EKG, X-ray, echocardiography study, routine laboratory, etc.) linked with the excellent gain of antibodies cardiac gammagraphy joined with viral serology, after the primary suspicion factor prior to the presence of skin lesions, fever and thoracic pain.

[Acute pulmonary toxicity caused by carbamazepine: apropos of a case]. / Toxicidad pulmonar aguda por carbamazepina: a propósito de un caso.

Pulmonary toxicity caused by carbamazepine seems to be a non dose-dependent process involving pulmonary infiltrates, eosinofilia and skin rash. We report a case with acute presentation that resolved successfully after the drug was withdrawn and the patient was treated with corticosteroids. Bronchoalveolar lavage showed an inversion of the lymphocyte ratio CD4/CD8 supporting the suggestion by other authors that drug-induced pulmonary toxicity.

Diabetes mellitus and bacteraemia: a comparative study between diabetic and non-diabetic patients.

OBJECTIVES: To compare the incidence, mortality, clinical characteristics and outcome between bacteraemias in diabetic and non-diabetic patients. METHODS: A prospective study of all adult patients with bacteraemia admitted to a large Spanish teaching hospital during six consecutive years (1984-1990); 152 were diabetics and 1488 non-diabetics. RESULTS: Rates per 1000 admissions when bacteraemic diabetic patients were compared with non-diabetics (p < 0.001) were respectively as follows: incidence 26.8/15.5, acquisition in the community 18.4/6.2, urinary tract source 8.7/2.2, and E. coli aetiology 8.9/3.4. Diabetes mellitus type II was found in 138 episodes. Glycosylated haemoglobin levels were 13 +/- 3%. Bacteraemia developed in association with hyperosmolar status in 14.5% of patients and with ketoacidosis in 5%. Patients in the diabetic group developed septic shock in 22% of the episodes, acute renal failure in 40%, superinfections in 22% and had an inappropriate empirical antibiotic treatment in 6%, vs 15.6%, 20%, 11% and 25% respectively of the non-diabetic bacteraemic patients (p < 0.05 for all comparisons). Overall mortality and bacteraemia-related mortality were similar in both groups. Multivariate analysis showed that the association with fatal diseases, shock and renal insufficiency negatively influenced the outcome of diabetic patients, while the nephro-urologic source and an appropriate therapy were accompanied by a better prognosis. CONCLUSIONS: A higher incidence of bacteraemia, mainly of urinary source, community-acquired, and due to E. coli was found in the diabetic patients compared to non-diabetics. The common use of rapidly effective drugs for this predominant bacteraemia conditioned similar outcome and prognosis factors in both populations, in spite of the higher incidence of septic shock and acute renal failure in the diabetic population.

The influence of agricultural run-off on bacterial populations in a river.

The microbiological quality of the River Riato (Spain) was evaluated. The influence of cattle that roam free in the warm season was marked. The degree of faecal pollution in the river was higher than predicted from the river basin geographical characteristics. The counts of faecal indicators greatly increased when the cattle were allowed to roam free. Counts of enterobacteria and faecal coliforms ranged from 10(3) to 10(6)/100 ml. Faecal streptococci counts were smaller (less than 10/100 ml). Escherichia coli and Pseudomonas aeruginosa were isolated from all samples. Streptococcus bovis was also isolated but not Strep. faecalis.