Management proposal for non-invasive respiratory support in pneumonia caused by COVID-19. From pathogenesis to clinical practice / Apoyo respiratorio no invasivo en neumonía causada por covid-19. De la patogenia a la práctica clínica

La nueva pandemia producida por un beta-coronavirus, SARS-CoV-2 presenta algunos hechos diferenciales con las pandemias anteriores también producidas por beta-coronavirus (síndrome respiratorio agudo severo - SARS y síndrome respiratorio de Oriente Medio - MERS). El soporte respiratorio consiste en oxigenoterapia convencional, oxigenoterapia nasal de alto flujo, ventilación mecánica no invasiva, CPAP (presión positiva continua en las vías respiratorias) y ventilación mecánica invasiva. Puede ser que este tipo de tratamiento haya salvado más vidas que otros tratamientos utilizados durante la pandemia. Aunque algunos componentes del apoyo no invasivo, como la oxigenoterapia nasal de alto flujo, la ventilación no invasiva y la CPAP, tenían dudas sobre su eficacia al comienzo de la pandemia, se han utilizado ampliamente en todo el mundo. Por otro lado, COVID-19 presenta hallazgos patológicos distintivos que probablemente causan cambios fisiológicos diferentes a la dificultad respiratoria clásica del adulto y, en consecuencia, pueden conducir a diferentes escalas y ajustes del soporte respiratorio. En estas líneas revisaremos la evidencia clínica de la eficacia del soporte respiratorio no invasivo en la insuficiencia respiratoria aguda hipoxémica antes de la pandemia, los cambios patológicos, patogénicos y funcionales descritos en esta neumonía y cómo estos pueden afectar también la aplicación del soporte respiratorio, como la forma en que hoy debemos aplicar el soporte respiratorio (AU)

The new pandemic produced by a beta-coronavirus, SARS-Cov-2 presents some differential facts with the previous pandemics also produced by beta-coronavirus (severe acute respiratory syndrome--SARS and Middle East respiratory syndrome--MERS). The respiratory support consists of conventional oxygen therapy, high-flow nasal oxygen therapy, non-invasive mechanical ventilation, CPAP (continuous positive airway pressure), and invasive mechanical ventilation. May be this type of treatment has saved more lives than other treatments used during the pandemic. Although some components of noninvasive support such as high-flow nasal oxygen therapy, noninvasive ventilation, and CPAP had uncertainties regarding their efficacy at the beginning of the pandemic, they have been used widely throughout the world. On the other hand, COVID-19 presents distinctive pathological findings that probably cause physiological changes different from the classical respiratory distress of the adult and consequently can lead to different scaling and adjustments of respiratory support. In these lines we will review the clinical evidence of the efficacy of non-invasive respiratory support in hypoxemic acute respiratory failure before the pandemic, the pathological, pathogenic and functional changes described in this pneumonia and how these can affect the application of respiratory support as well as the way in which today we must apply respiratory support (AU)

Seguimiento evolutivo de la influencia del cese del hábito tabáquico en una población sana sobre la concentración sérica de lípidos / Evolutive follow-up of the influence of smoking cessation in a healthy population on lipid serum concentration

Hipótesis: El tabaco repercute sobre el perfil lipídico de los fumadores. Las campañas contra el hábito de fumar han propiciado una caída en su consumo. Objetivos: Se trata de estudiar los cambios en el perfil de lípidos en sangre tras un seguimiento de once años en función de las variaciones en la prevalencia del tabaquismo. Material y métodos: Población de 1.795 varones sanos con edades comprendidas entre 30 y 50 años. Se determinó la prevalencia del hábito tabáquico, colesterol total, c-LDL, c-HDL, triglicéridos e índice de masa corporal (IMC) en los años 1995, 2000 y 2005. Resultados: Las tasas de tabaquismo inicial y final fueron del 36,1 y 19% respectivamente. Tras la caída del consumo de tabaco, los índices de masa corporal inicial y final fueron de 24,8 ± 3,2 y 25,3 ± 3,3 kg/m2, respectivamente, sin encontrarse diferencias significativas entre ambos. El colesterol descendió un 7%. El c-HDL pasó de 46,0 ± 10 a 56,0 ± 14 mg/dl. Los triglicéridos descendieron en un 12%. No hubo diferencias significativas en las concentraciones de c-LDL. Conclusiones: A lo largo de los once años de estudio, se produjo una caída en el consumo de tabaco en esta población superior a la media nacional. Se observó un incremento significativo de c-HDL y un descenso de los triglicéridos y del colesterol total. No se modificaron las cifras de c-LDL (AU)

Hypothesis: Tobacco has a repercussion on the lipid profile of smokers. Anti-smoking campaigns have brought about a fall in tobacco consumption. Objectives: It has been aimed to study the changes in the lipid profile in blood after an 11-year follow-up based on variations in smoking prevalence. Material and methods: A population of 1795 healthy males, aged 30 to 50 years. Prevalence of smoking was determined as well as total cholesterol, LDL-c, HDL-c, triglycerides and body mass index (BMI) for the years 1995, 2000 and 2005. Results: The rates of initial and final smoking habit were 36.1% and 19%, respectively. After the fall in tobacco consumption, the initial and final body mass indexes were 24.8 ± 3.2 and 25.3 ± 3.3 kg/m2, respectively, without finding significant differences between them. Cholesterol decreased by 7%. HDL-c went from 46.0 ± 10 to 56.0 ± 14 mg/dl. Triglycerides decreased by 12%. There were no significant differences in the LDL-c concentrations. Conclusions: During the 11 years of the study, there was a greater decrease in the consumption of tobacco in this population than in the national mean. A significant increase was observed of HDL-c and decrease of triglycerides and total cholesterol. The LDL-c le vels were not modified (AU)

Descripción del valor y relación de la proteína C reactiva y los lípidos según historia del tabaquismo / Description of the value and relationship of reactive C protein and lipids according to the background of smoking habit

El objetivo del estudio es comprobar si el tabaco altera la relación entre PCR y los valores de triglicéridos, colesterol total y sus fracciones, en una población fumadora sana. Material y método. Se realiza un estudio observacional transversal en 800 sujetos sanos, 200 fumadores y 344 no fumadores y 256 exfumadores. Para la determinación de la PCR se utilizó el test Tina-quanta CRP (Látex) HS. Resultados. La concentración de PCR fue mayor en los fumadores que en los no fumadores (p<0,01). La concentración de triglicéridos fue mayor en los fumadores que en los no fumadores (p<0,001), así como la cifra de LDL-c (P<0,05). No se encontraron diferencias significativas en el colesterol total entre ambos grupos. La fracción HDL-c se encontraba disminuida en los fumadores con respecto a los no fumadores (p<0,001). Existe una correlación positiva, tanto en fumadores como en no fumadores, entre PCR y cifras de triglicéridos (p<0,001), y negativa con HDL-c (p<0,001). No se encontró una asociación lineal entre la PCR y el colesterol total, ni entre la PCR y el LDL-c en no fumadores. La PCR se encuentra asociada estadísticamente con la LDL en los fumadores (p<0,001). Conclusiones. Las concentraciones séricas de PCR, triglicéridos y LDL-c se encuentran más elevadas en los fumadores que en los no fumadores sanos. Los niveles de HDL son más bajos en la población fumadora sana. Los niveles de PCR aumentan al incrementarse los triglicéridos y tienen una relación inversa con los niveles de HDL-c en ambas poblaciones. Los niveles de PCR y LDL-c se encuentran asociados estadísticamente sólo en la población fumadora (AU)

The aim of this study is to verify whether cigarette smoking alters the relation between C-reactive protein (CRP) and triglycerides, HDL and LDL-cholesterol plasma concentration in a healthy population. Population and methods. This is a cross sectional study conducted in a sample of 800 collective healthy aircraft workers, 200 smokers, 344 non-smokers and 254 exsmokers. They all undertook a complete annual clinical, psychological and analytical examination. C-reactive protein was determined by test Tina-quanta CRP (Látex) HS. Results. Serum CRP concentration was significantly higher in smokers than in non-smokers (p<0,01). Serum concentration of triglycerides and LDL levels were higher in smokers (p<0,01), as well as LDL levels (p<0,05). No statistically differences in total cholesterol levels between smokers and non-smokers were found. HDL fraction was lower in smokers compared to non smokers (p<0,01). CPR and triglycerides levels were positively correlated in both smokers as non-smokers, and there was a negative association with the HDL fraction. In non-smokers, no association was encountered between CPR and cholesterol levels, or PCR with the LDL. However, CRP was statistically related to LDL in smokers (p<0,01).Conclusion. Healthy smokers have a higher serum concentration of CRP, LDL and triglycerides, whilst HDL levels are lower. Levels of CRP increase with triglycerides and have an inverse relationship with the levels of HDL in smokers and non-smokers. Levels of CRP and LDL are statistically related only in smokers (AU)

Influencia del tabaco sobre la Proteína C Reactiva en una población aparentemente sana / Influence of tobacco on C-reactive protein in an apparently healthy population

Introducción: Es nuestro objetivo determinar en qué medida el tabaco induce elevación de Proteína C Reactiva (PCR) en suero y definir el riesgo relativo de enfermedad inflamatoria subyacente en la población fumadora según los valores publicados por The Centers for Diseases Control and Prevention y la American Heart Association.Material y métodos: El presente estudio se ha llevado a cabo en una muestra sana masculina de 544 individuos, formada por personal aeronáutico cuyas edades se sitúan entre los 19 y los 60 años, media de 40 años con desviación típica de 10. De los 544 pilotos, 344 eran no fumadores y 200 fumadores. La PCR se determinó mediante el test ultrasensible.Resultados: La concentración sérica media en individuos no fumadores es de 1,6 mg/l (Intervalo de Confianza 95%: 1,4-1,7), mientras que en fumadores es de 2,09 mg/l (Intervalo de Confianza 95%: 1,9-2,3). El 65,5% de la población fuma-dora obtenía una PCR > 1 mg/l frente al 51,5% de la población no fumadora. Los fumadores tenían 27,3% más riesgo de presentar una PCR sérica superior a 1 mg/l (Riesgo Relativo: 1,273; Intervalo de Confianza 95%: 1,103-1,470) que los no fumadores.Discusión: La PCR es un buen marcador de inflamación, pudiendo utilizarse como factor predictivo de riesgo cardiovascular y de alteración broncopulmonar.Conclusiones: Se puede estimar el valor de 1,2 mg/l para la PCR en suero como referencia en una población masculina adulta sana. La edad y sobrepeso son factores que afectan a la relación entre tabaquismo y PCR sérica, pero es el consumo de tabaco el principal factor determinante de una elevación de la PCR

Introduction: We aim to determine up to what degree tobacco induces and elevation of C-reactive protein (CRP) in serum and define the relative risk of underlying inflammatory disease in the population that smokes according to the values published by the Centers for Diseases Control and Prevention and the American Heart Association.Material and methods: The present study was conducted in a healthy male sample of 544 individuals made up of aeronautic personnel whose ages ranged from 19 to 60 years, with a mean of 40 years and standard deviation of 10. A total of 344 out of the 544 pilots did not smoke and 200 smoked. The CRP was measured with the ultrasensitive test.Results: The means serum concentration in subjects who did not smoke was 1.6 mg/l (95% Confidence Interval: 1.4-1.7) while it was 2.09 mg/l (95 % Confidence Interval: 1.9-2.3) in those who smoked. A total of 65.5% of the population who smoked obtained a CRP > 1 mg/l versus 51.5% of the population who did not smoke. Those who smoked had 27.3% more risk of having a serum CRP value greater than 1 mg/l (Relative Risk: 1.273; 95% Confidence Interval: 1.103-1.470) than those who did not smoke.Discussion: CRP is a good marker of inflammation and can be used as a predictive factor of cardiovascular risk andbronchopulmonary disorder.Conclusions: The value of 1.2 mg/l for CRP in serum can be estimated as reference in a healthy adult masculine population. Age and overweightness are factors that affect the relationship between smoking and serum CRP. However tobacco consumption is the main determining factor of an increase in CRP (AU)

The concentrations of five tumor markers in both BAL fractions in lung cancer patients in relation to cigarette smoking.

BACKGROUND: Lung cancer is the leading cause of death from cancer. Tobacco is related to the development of this type of tumor due to genetic alterations and to the secretion of certain biological markers. Bronchogenic carcinomas secrete a series of biological substances known as tumor markers. Some of these markers, such as carcinoembryonic antigen, neuron-specific enolase, tissue polypeptide antigen (TPA), tissue polypeptide-specific antigen (TPS) and CYFRA 21.1, possess clear clinical value when analyzed in bronchoalveolar lavage (BAL) of patients with lung malignancies, particularly when they are analyzed in the two BAL fractions, bronchial (BF) and alveolar (AF), being more increased in the BF. For this reason, we intend to demonstrate that smokers with cancer secrete more biological substances in the BF and that the concentrations of these markers are higher in the BAL of smokers than in that of non-smokers. METHODS: The five aforementioned tumor markers were studied in the two BAL fractions of 52 lung cancer patients (46 smokers and 6 non-smokers). We performed BAL using 150 ml of 0.9% saline solution divided in three aliquots of 50 ml. The fluid obtained from the first 50 ml was the BF. The liquid from the other two aliquots was the AF. The five tumor marker concentrations were calculated in accord with the indications of the laboratory. RESULTS: The TPA and TPS levels in the BAL of lung cancer patients were more increased in the BF than in the AF, even when the patients were divided into smokers and non-smokers. When we compared smokers with non-smokers, the smokers had higher levels of TPS in the BF and of TPA in the AF. CONCLUSIONS: Thus, we believe that the cellular alterations produced by tobacco are responsible for the secretion of these tumor markers.

Serum levels of eosinophil cationic protein and eosinophil protein x in pollen atopic patients with stable asthma and its relation with bronchial hyperresponsiveness.

Eosinophils are important effector cells in allergic inflammation described in allergic rhinitis (AR) and allergic bronchial asthma (BA). During the pollen season serum levels of eosinophil cationic protein (ECP) and eosinophil X protein/eosinophil-derived neurotoxin (EPX/EDN) are increased in BA. The aim of the present study was to evaluate the serum levels of ECP and EPC in pollen atopic patients with AR and BA during the winter. 92 patients were studied. They were divided into three groups: I 29 patients with AR, II 51 patients with BA and III 12 healthy subjects. Allergic rhinitis and bronchial asthma were diagnosed by routine clinical tests: clinical history, skin tests, total IgE and specific IgE. In addition ECP and EPX were determined in serum. All patients were asymptomatic, stable and without medical treatment. Methacholine challenge test (MCT) was performed in all patients. MCT were positive in 4 patients of group I and 45 patients of group II. ECP levels (ug/l) were: 21 (I), 24 (II) and 7 (III). EPX levels (ug/l) were 35 (I), 45 (II) and 21 (III). Statistical differences (p < 0.01) were observed both in ECP and EPX levels in patients with MCT positive in relation to patients with MCT negative, and in allergic patients (I and II) in comparison with the healthy subjects (III) (p < 0.01). ECP and EPX serum levels are increased in patients with a positive MCT in the winter, out of the pollen season, when patients are asymptomatic, stable and without treatment. This fact suggests that eosinophils play an important role in the pathogenesis of bronchial asthma.

[An early detection program for respiratory insufficiency in Duchenne's disease: the preliminary results]. / Programa de detección precoz de insuficiencia respiratoria en la enfermedad de Duchenne: resultados preliminares.

Noninvasive mechanical ventilation through a nasal mask is a recently introduced therapeutic tool that represents a noteworthy advance in home treatment for patients with respiratory insufficiency secondary to ventilatory pump failure. We present the preliminary results of a program for early detection of respiratory insufficiency in patients with Duchenne's disease. Sixteen patients (mean age 15.8 years) with this disease were evaluated between January 1994 and January 1995. Mean lung function parameters were FVC 1,440 ml (46.7%), PO2 87.3 mmHg, PCO2 40.8 mmHg, PIM 40.1 cmH2O (30.6%), and PEM 41 cmH2O (25%). Two patients had abnormal pulse oximetry readings at night and abnormal gasometric readings during the day and were started on mechanical ventilation through nasal masks. These 2 patients were older, more hypoxemic and hypercapnic, had lower FVC values and showed greater deterioration of inspiratory and expiratory muscle pressures.

[Bilateral pleural effusion and rheumatoid arthritis. Diagnostic value of pleural fluid cytology]. / Derrame pleural bilateral y artritis reumatoide. Valor diagnóstico de la citología en líquido pleural.

We present a 69 years old male patient diagnosed of rheumatoid arthritis (RA) with signs of pleuropulmonar disease. The diagnose of RA was done of 49 years and since then treated with non steroid antiinflammatory drugs and during the acute phases of RA with steroid drugs. The pleural effusions showed an exudate with pseudochilothorax criteria with acid pH acid low glucose concentrations. The cytological study of the effusion demonstrated the presence of characteristic mononuclear cells.

[Cytologic and biochemical component in 203 bronchoalveolar lavages. Reference values]. / El componente citológico y bioquímico en 203 lavados broncoalveolares. Valores de referencia.

The bronchoalveolar lavage (BAL) is considered a basic technique as a diagnostic aid in Pneumology. However, one of the main problems faced by the clinician is the lack of standardization of the technique. This has been resolved through the drafting of international standards. The other problem is the lack of what might be called a "reference" BAL. In order to establish a reference BAL, we analyzed 203 BAL divided in two groups: a control group and a pathologic group, make up by extrinsic asthma, intrinsic asthma, pulmonary infections, diffuse interstitial pneumopathies, bronchopulmonary tumors and chronic bronchitis. We have studied both the cytologic and the biochemical component of the BAL. Among the biochemical markers, we have considered; carcinoembrionary antigen (CEA), tissular polypeptidic antigen (TPA), neuronal specific enolase (NSE), ferritin (FER), calcitonin (CT), ACTH, histamin (HIS) and prostaglandin (PGE2). In order to establish the reference values, we have used the modified Baye's theorema. The BAL that we obtained was the following: volume 20 ml, cells 35 x 10(5) cells/ml, macrophages 77%, lymphocytes 22%, neutrophils 4%, eosinophils 2%, CEA 14 ng/mg, TPA 84 U/g PT, NSE 5 ng/mg PT, FER 42 ng/mg PT, CT 15 pg/mg PT, ACTH 51 pg/mg PT, HIS 1.22 ng/mg PT, PGE2 35 pg/mg PT.

[Pulmonary lymphangiomatosis associated with renal angiomyolipoma. Presentation of a case and review of the literature]. / Linfangiomiomatosis pulmonar asociada con angiomiolipoma renal. Presentación de un caso y revisión de la literatura.

The case concerned is one of lymphangiomyomatosis (LAM) in a woman aged 39, that after a episode of spontaneous pneumothorax was subject to medical research for progressive dyspnea of medium efforts and bloodstained sputum. High resolution CT showed numerous thin-walled cystic airspaces of varying sizes distributed diffusely throughout the lungs. The abdominal CT and ultrasound developed multiple right renal angiomyolipomas. The histopathological study of the sample obtained by open lung biopsy was conclusive of LAM. The main feature of this rare disease, which occurs almost exclusively in women of reproductive age, is the abnormal proliferation of immature smooth muscle at the level of the distal airway, small blood vessels and lung lymphatic system, including sometimes the mediastinal and retroperitoneal lymphatic system. The clinical, functional, radiological and differential diagnostic aspects with entities histopathologically similarities are discussed and the therapeutic possibilities are reviewed.