Cigarette smoke induces pulmonary arterial dysfunction through an imbalance in the redox status of the soluble guanylyl cyclase.

Chronic obstructive pulmonary disease (COPD), whose main risk factor is cigarette smoking (CS), is one of the most common diseases globally. Some COPD patients also develop pulmonary hypertension (PH), a severe complication that leads to premature death. Evidence suggests reactive oxygen species (ROS) involvement in COPD and PH, especially regarding pulmonary artery smooth muscle cells (PASMC) dysfunction. However, the effects of CS-driven oxidative stress on the pulmonary vasculature are not completely understood. Herein we provide evidence on the effects of CS extract (CSE) exposure on PASMC regarding ROS production, antioxidant response and its consequences on vascular tone dysregulation. Our results indicate that CSE exposure promotes mitochondrial fission, mitochondrial membrane depolarization and increased mitochondrial superoxide levels. However, this superoxide increase did not parallel a counterbalancing antioxidant response in human pulmonary artery (PA) cells. Interestingly, the mitochondrial superoxide scavenger mitoTEMPO reduced mitochondrial fission and membrane potential depolarization caused by CSE. As we have previously shown, CSE reduces PA vasoconstriction and vasodilation. In this respect, mitoTEMPO prevented the impaired nitric oxide-mediated vasodilation, while vasoconstriction remained reduced. Finally, we observed a CSE-driven downregulation of the Cyb5R3 enzyme, which prevents soluble guanylyl cyclase oxidation in PASMC. This might explain the CSE-mediated decrease in PA vasodilation. These results provide evidence that there might be a connection between mitochondrial ROS and altered vasodilation responses in PH secondary to COPD, and strongly support the potential of antioxidant strategies specifically targeting mitochondria as a new therapy for these diseases.

New evidence in severe pneumonia: imipenem/ cilastatin/relebactam.

Imipenem combined with beta-lactamase inhibitor relebactam (IMI/REL) has an extensive bactericidal activity against Gram-negative pathogens producing class A or class C beta-lactamases, not active against class B and class D. The phase 3 clinical trial (RESTORE-IMI-2), double-blind, randomized, evaluated IMI/REL vs. piperacillin-tazobactam (PIP/TAZ) for treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), demonstrated non-inferiority at all-cause mortality at 28 days (15.9% vs 21.3%), favorable clinical response at 7-14 days end of treatment (61% vs 59.8%) and with minor serious adverse effects (26.7% vs 32%). IMI/REL is a therapeutic option in HAP and VAP at approved dosage imipenem 500 mg, cilastatin 500 mg and relebactam 250 mg once every 6h, by an IV infusion over 30 min.

Tobramycin inhalation powder (TOBI Podhaler) for the treatment of lung infection in patients with cystic fibrosis.

Cystic fibrosis (CF) is an autosomal recessive inherited disease secondary to a defect in the CF transmembrane conductance regulator gene (CFTR). Mortality in CF is associated with impairment of lung function in which bacterial infection plays a fundamental role. The microorganism Pseudomonas aeruginosa (P. aeruginosa) is a marker of poor prognosis. Tobramycin was the first parenteral antibiotic to be used as inhaled medication in CF. Owing to its beneficial effects; it was subsequently used in designed inhaled formulations. The first formulation was the inhalation solution, which improved lung function, lowered hospitalization rates, and reduced the courses of intravenous antibiotic. However, the high associated costs and time necessary to administer the medication negatively affected quality of life. The recent development of tobramycin inhalation powder has optimized treatment. The dry powder inhaler is a simple device that reduces administration time and improves adherence. As there is no risk of bacterial contamination, disinfection is unnecessary.

Empiema causado por Streptococcus constellatus / Emphyema by Streptococcus constellatus

We presented a case of patient with bipolar disorder that he was admitted in the respiratory unit of our hospital by empyema produced by Streptococcus constellatus (S. constellatus). S. constellatus can produce lung infections, specially patients with airway manipulation. The response to treatment with penicillin usually are good (AU)

Presentamos el caso de un paciente diagnosticado de trastorno bipolar que ingresa en el servicio de neumología de nuestro hospital por un empiema producido por Streptococcus constellatus (S. constellatus). El S. constellatus puede producir infecciones pulmonares, especialmente en pacientes con una manipulación previa de la vía aérea. La respuesta al tratamiento con penicilinas suele ser buena (AU)

Mujer con pulmón del cuidador de aves / Women with bird breeder's lung

La neumonitis por hipersensibilidad o alveolitis alérgica extrínseca (AAE) se origina por una reacción de hipersensibilidad a antígenos inhalados sobre un pulmón con una susceptibilidad individual. En el caso del pulmón del cuidador de aves, son partículas que suelen encontrarse en el epitelio, el polvo que cubre las plumas o las heces de las aves. En la exploración física destacan los crepitantes inspiratorios a la auscultación pulmonar y los hallazgos en la radiografía de tórax pueden ser muy variables. La TC nos muestra diferentes patrones en función de la fase de la enfermedad en que nos encontremos. Respecto a las pruebas de función respiratoria, la mayoría de los pacientes presenta un patrón restrictivo. Un diagnóstico precoz será crucial en la evolución de la enfermedad, ya que la progresión puede conducir a una fibrosis pulmonar o una enfermedad pulmonar obstructiva crónica. Lo principal es eliminar la exposición a los antígenos, con ello muchos pacientes se recuperan (AU)

Hypersensitivity pneumonitis or extrinsic allergic alveolitis (EAA) originates from a hypersensitivity reaction to inhaled antigens on a lung with individual susceptibility. In the case of bird breeder's lung, they are particles that are generally found on the epithelium, dust that covers the feathers or stools of the birds. In the physical examination, the inspiratory crackling rales heard on pulmonary auscultations stand out and the findings on the chest X-ray may vary greatly. The CT scan shows us different patterns based on the disease phase in question. Regarding the pulmonary function tests, most of the patients have a restrictive pattern. Early diagnosis is crucial in the disease course since progression may lead to pulmonary fibrosis or chronic obstructive pulmonary disease. The most important is to eliminate exposition to the antigens, with which many patients recover (AU)

Paciente con esclerosis tuberosa y angiomiolipomas renales / No disponible

No disponible

Mujer joven con infecciones de repetición / Young women with recurrent infections

Resumen. La inmunodeficiencia común variable (CVID) es la inmunodeficiencia primaria que con más frecuencia encontramos en la práctica clínica. Clínicamente se define como la presencia de infecciones recurrentes y una reducción en suero de IgG (al menos 2 desviaciones estándar por debajo de los valores de referencia para su edad) y al menos otra de las Ig (IgA o IgM) y una reducción o ausencia de producción de títulos protectores de anticuerpos para vacunas de polisacáridos y antígenos proteicos. La clínica que presentan estos pacientes son múltiples infecciones sinopulmonares, infecciones bacterianas sistémicas y complicaciones gastrointestinales, siendo las infecciones sinopulmonares la manifestación clínica con que se presenta mayoritariamente. El pilar principal del tratamiento de la CVID es el tratamiento sustitutivo con inmunoglobulinas, junto con los antibióticos para las infecciones y el tratamiento adecuado de las complicaciones no infecciosas (AU)

Abstract. Common variable immunodeficiency (CVID) is the primary immunodeficiency frequently found in the clinical practice. Clinically, it is defined as the presence of recurrent infections and a reduction in IgG serum (at least 2 standard deviations before the reference values for the subject’s age) and at least another one of the Ig (IgA or IgM) and a reduction or absence of the production of antibody titers protectors for polysaccharide vaccines and protein antigens. The clinical manifestations of these patients are multiple sinopulmonary infections, systemic bacterial infections and gastrointestinal complications, the sinopulmonary infections being the clinical manifestations found most. The principal basis of the CVID treatment is the immunoglobulin replacement treatment, together with antibiotics for the infections and adequate treatment of the non-infectious complications (AU)

Aspergiloma pulmonar con buena respuesta a antifúngico / Pulmonary Aspergilloma with good response to an antifungal agent

Resumen. Aspergillus sp es una familia de hongos ubicuos que se adquieren mediante la inhalación de esporas y, en pacientes predispuestos, produce afectación pulmonar, siendo el aspergiloma la forma más común y mejor conocida. Se caracteriza por una bola fúngica constituida por hifas del hongo, células inflamatorias, fibrina, moco y restos titulares. Habitualmente, el aspergiloma se forma en una cavidad pre-existente del pulmón causada por diferentes patologías como tuberculosis, sarcoidosis, bronquiectasias, fibrosis quística, bullas, espondilitis anquilosante, neoplasias o infecciones pulmonares. Clínicamente los pacientes suelen estar asintomáticos o paucisintomáticos siendo la hemoptisis el síntoma más frecuente. El diagnóstico de la enfermedad se basa en la clínica y en los hallazgos de la radiografía, combinado con la serología y los cultivos microbiológicos. El tratamiento del aspergiloma es controvertido, dependiendo de varios factores. Presentamos dos casos de aspergiloma que han sido tratados con itraconazol con buena evolución (AU)

Abstract. Aspergillus sp is a ubiquitous family of fungi that are acquired through the inhalation of spores. Aspergilloma is the most common and best known of pulmonary involvement by Aspergillus. It is characterized by a ball made up of fungal hyphae, inflammatory cells, fibrin, mucus and debris holders. Typically, the Aspergilloma is forming in a pre-existing avity in the lung, caused by various diseases such as tuberculosis, sarcoidosis, bronchiectasis, cystic fibrosis, bullae, ankylosing spondylitis, tumors or lung infections. Clinically, patients are often asymptomatic being the hemoptisis the most common symptom. The diagnosis of the disease is based on clinical findings and in the radiography, combined with serology and microbiologic cultures. The treatment is controversial depending on several factors. We present two cases of Aspergilloma who have been treated with Itraconazole with good results (AU)

Neumotórax recidivante en paciente con fibrosis quística / Recurrent pneumothorax in patients with cystic fibrosis

La fibrosis quística (FQ) es una enfermedad multisistémica que afecta a glándulas sudoríparas, aparatos respiratorio, digestivo y reproductor, siendo la afectación de las vías respiratorias la principal causa de morbi-mortalidad. La frecuencia de aparición de neumotórax va aumentando con la edad del paciente, siendo la edad media de presentación de 21,9 años. El principal factor de riesgo para la producción de neumotórax es la obstrucción bronquial, originándose el 75% de los neumotórax en pacientes con un FEV1 menor del 40%. Entre otros factores que aumentan la probabilidad de padecer un neumotórax se han descrito: la colonización crónica por Pseudomonas aeruginosa, Burkholderia cepacia y Aspergillus, la aspergilosis broncopulmonar alérgica (ABPA), el recibir alimentación enteral por desnutrición, la hemoptisis masiva, la insuficiencia pancreática y la terapia con tobramicina o DNasa inhalada. Presentamos el caso de un paciente que ha sufrido 10 neumotórax en el transcurso de un año (AU)

Cystic fibrosis (CF) is a multisystem disease that affects sweat glands, respiratory, digestive and reproductive systems. The respiratory disease is the leading cause of morbidity and mortality. The frequency of occurrence of pneumothorax increases depending on the age of the patient being the average age of onset of 21.9 years. The main risk factor for the production of pneumothorax is chronic bronchial obstruction occur 75% of patients with a spirometry with a value in FEV1 less than 40% of the expected value. Among other factors that increase the likelihood of suffering a pneumothorax include colonization of patients by Pseudomonas aeruginosa, Burkholderia cepacia or Aspergillus, allergic bronchopulmonary aspergillosis (ABPA), enteral feeding for malnutrition, massive hemoptysis, pancreatic insufficiency and the therapy with inhaled tobramycin or dornase. We present the case of a patient who has undergone 10 pneumothorax in one year (AU)