Variation in renal parameter values after a change in antiretroviral therapy from elvitegravir/cobicistat/emtricitabine/tenofovir-alafenamide to bictegravir/emtricitabine/tenofovir-alafenamide / Variación de los valores de los parámetros renales tras un cambio en la terapia antirretroviral de elvitegravir/cobicistat/emtricitabina/tenofoviralafenamida a bictegravir/emtricitabina/ tenofovir-alafenamida

El cambio de EVG/COBI/FTC/TAF a BIC/FTC/TAF es una estrategia para optimizar la terapia antirretroviral. Nuestro objetivo fue analizar cómo variaban los parámetros analíticos renales tras cambiar tratamiento. Los objetivos secundarios fueron determinar si edad y sexo de los pacientes y el tiempo que habían tomado cobicistat previamente condicionaba la posible variación de los parámetros renales. Se realizó un estudio piloto observacional, descriptivo y ambispectivo. Los parámetros renales se obtuvieron de las analíticas previas más cercanas al cambio (considerándose este valor el basal) y después de 12, 24 semanas y 12 meses tras cambiar tratamiento. Se incluyeron 60 pacientes. En los niveles de creatinina sérica, se observó cambio a las 24 semanas (aumento medio de 0,06 mg/dL, p=0,025) y a los 12 meses (aumento medio de 0,03 mg/dL, p=0,05). Considerando la tasa de filtración glomerular (CKD-EPI), hubo bajada en los 3 períodos analizados, pero sin significación estadística. No hubo influencia del sexo, edad ni tiempo que los pacientes habían tomado cobicistat previamente. (AU)

Switching of EVG/COBI/FTC/TAF to BIC/FTC/TAF is a valid strategy for antiretroviral therapy optimization. Our aim was to analize how the variation of analytical parameters for renal function estimation after the change of their treatment. Secondary objectives were to determine if age and sex of the patients and the time they have previously taken cobicistat conditions the possible variation in renal parameters. An observational, descriptive and ambispective pilot study was performed. The renal laboratory parameters were obtained from the previous laboratory tests closest in time to the change (this value being considered the baseline) and after 12, 24 weeks and 12 months after a change in treatment with BIC/FTC/TAF. 60 patients were included. Regarding serum creatinine levels, a change in serum creatine levels was observed at 24 weeks (mean increase of 0.06 mg/dL, p=0.025) and at 12 months (mean increase of 0.03 mg/dL, p=0.05). Considering glomerular filtration (CKD-EPI), there was downward trend in the 3 periods analyzed, but statistical significance was not reached. There was no influence of sex, age and the length of time that the patients had taken cobicistat before the change. (AU)

Resultados en calidad de vida comunicados por pacientes en tratamiento antirretroviral / Health-related quality of life among people livingwith human immunodeficiency virus infection

OBJETIVO: Conocer las impresiones de los pacientes con terapia antirretroviral acerca de su calidad de vida relacionada con la salud (CVRS), salud y bienestar general respecto a la infección por VIH. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, prospectivo y transversal. Se incluyeron pacientes mayores de edad VIH positivos que recogiesen tratamiento en el Servicio de Farmacia durante 3 meses. Como medida de la CVRS, se utilizó el World Health Organization Quality of Life in HIV-infected Persons instrument (WHOQOL-HIV-BREF) versión castellano. Se midieron seis dominios: capacidad física, factores psicológicos, nivel de independencia, relaciones sociales, entorno y creencias personales/religiosas/espirituales más 5 preguntas específicas de infección por VIH/SIDA. El cuestionario fue anónimo y auto-administrado. Se recogieron edad, sexo, estado civil y nivel de educación máximo alcanzado. Se calcularon medianas y rangos intercuartílicos (IQR) para cada dominio, así como los posibles factores influyentes. RESULTADOS: Se incluyeron 69 pacientes. 72,5% varones. Edad (mediana [IQR]) = 50,4 [55,1-43] años. Nivel de educación: ninguno 5,8%; educación primaria 37,7%; secundaria 47,8%; terciaria 8,7%. Estado civil: casado/a 21,9%; en pareja 15,9%; divorciado/a 7,2%; soltero/a 47,8%; viudo/a 7,2%. Resultados para cada dominio: capacidad física (mediana [IQR]) = 75 [65-80]; factores psicológicos = 68 [57-76]; nivel de independencia = 70 [59-80]; relaciones sociales = 65 [58-80]; entorno = 70 [64-80] y creencias personales/religiosas/espirituales = 63 [55-75]. Resultado global = 67 [71-78]. La edad (≤ 50 años) se relacionó con la CVRS (diferencia de medias IC95%; p) en el dominio de capacidad física (11,41 IC95% 4,12-18,69; p = 0,03), nivel de independencia (10,47 IC95% 1,85-19,08; p = 0,018) y en el resultado global (8,33 IC95% 1,99-14,67; p = 0,011). CONCLUSIONES: La CVRS fue inferior en el dominio de creencias personales, seguida por las relaciones sociales. La edad superior a 50 años se relacionó con una peor CVRS

PURPOSE: To know about quality of life, health and general well-being among people living with HIV who take antiretroviral therapy. MATERIAL AND METHODS: Cross-sectional descriptive prospective observational study. Adults with HIV's infection and antiretroviral therapy dispensed by our Pharmacy Service during 3 months were included. World Health Organization Quality of Life in HIV-infected Persons instrument (WHOQOL-HIV-BREF) was used to explore the quality of life (QoL). The scores denote an individual's perception of QoL in six domains: physical, psychological, level of independence, social relationships, environment and spirituality. Items are rated on a 5-point Likert scale with a transformed maximum score of 100 points per item. Five questions are specific to HIV/AIDS (Q:4,8-10,17). The questionnaire was self-administered. Age (≤ 50 years), gender, civil status and level of studies was also collected. The questionnaire, anonymous and voluntary, was returned in the next visit to our centre. Median and interquartile range was calculated for each domain. Relationship among scores and demographic variables was explored. RESULTS: 69 patients were included (response rate 45.1%), 72.5% male. Age (median [IQR]) = 50.4 [55.1-43] years. Education received: none 5.8%; primary school 37.7%; secondary 47.8%; tertiary 8.7%. Civil status: married 21.9%; living as married 15.9%; divorced 7.2%; single 47.8%; widowed 7.2%. Results of domains transformed score: physical (median [IQR]) = 75 [65-80], psychological = 68 [57-76]; level of independence = 70 [59-80]; social relationships = 65 [58-80], environment = 70 [64-80]; and spirituality = 63 [55-75]. Global score = 67 [71-78]. Age (≤ 50 years) was the only variable related with test score (mean difference (IC95%; p); physical domain (11.41 (4.12-18.69); 0.03), level of independence (10.47 (1.85-19.08); 0.018) and global score (8.33 (1.99-14.67); 0.011). CONCLUSIONS: QoL score was lower regarding spirituality domain followed by social relationships. Age over 50 was statistically associated with a worse self-reported QoL

Informe de los Editores, 2014 / Report of the Editors, 2014

Los editores de Revista Clínica Española(Rev Clin Esp) informan de su actuación editorial durante los últimos 12 meses: a) Objetivos y logros en 2014; b) Actividad editorial, 2014 y c) Factor impacto 2013. Durante el año 2014 se han alcanzado los 5 objetivos trazados. Hemos publicado los 9 números programados en el año con un 103% de artículos publicados sobre los previstos en las secciones fijas habituales. Destacamos la publicación de 29 editoriales, de los cuales 21 están firmados por autores extranjeros de gran prestigio. Entre el 1 de enero y el 30 de septiembre de 2014 hemos recibido 421 manuscritos (46,8 manuscritos/mes), cifra algo inferior a la del año 2013 (50,9 manuscritos/mes). De 404 manuscritos con proceso editorial concluido hemos aceptado un 32,3% (originales, 22,4%). Hemos cursado 315 solicitudes de revisión a 240 revisores, y hemos recibido el 53,3% de las revisiones solicitadas en menos de 2 semanas (10,4 días). El tiempo medio para adoptar una decisión editorial definitiva para todos los manuscritos («aceptado» o «rechazado») ha sido de 18,3 días (más de la mitad que en 2009). Para los «originales» esta cifra ha descendido desde 56,6 días en 2009 a 26,6 días en 2014. Desde la recepción de un manuscrito hasta su publicación on-line el tiempo medio ha sido de 103 días en 2014. En el año 2014, los grupos de trabajo de la Fundación Española de Medicina Interna (FEMI) han publicado 11 manuscritos. En julio de 2014 conocimos que el Journal Citation Reports había otorgado a Rev Clin Esp un Factor Impacto de 1.314 (año 2013). Este Factor Impacto sin autocita es de 0,705 (en el año 2009, el Factor Impacto global fue de 0,584). Con el adiós al comité editorial de Rev Clin Esp damos la bienvenida al nuevo equipo editorial y damos las gracias sinceras a la sucesivas Juntas Directivas de la SEMI, a los compañeros, personal de la revista, revisores, lectores y autores, que desde el año 2009 han confiado en nuestra gestión editorial (AU)

The editors of Revista Clínica Española(Rev Clin Esp) inform on their editorial activity during the last 12 months: (a) Objectives and attainments in 2014, (b) Editorial activity, 2014, and (c) 2013 impact factor. In 2014 we achieved the 5 planned objectives. We have published the 9 programmed issues and 103% of the planned papers according to the usual fixed sections. We emphasize the publication of 29 editorials, 21 of which are signed by prestigious foreign authors. From the first January to the 30th September 2014 we received 421 manuscripts (46.8 manuscripts per month), a slight lower figure to that obtained in 2013 (50.9 manuscripts per month). The acceptance rate of the 404 manuscripts whose editorial process has been concluded was 32.3% (originals, 22.4%). We asked for 315 revisions to 240 reviewers and we received 53.3% revisions in less than two weeks (10.4 days). The mean time to adopt an editorial decision for all manuscripts («accepted»/«rejected») has been 18,3 (less than half than in 2009). For «originals» this figure has dropped from 56,6 days in 2009 to 26.6 days in 2014. The mean time elapsed from manuscript reception to its on-line publication was 103 days. In 2014 the collaboration with the working groups from the Internal Medicine Spanish Foundation (FEMI) has reported 11 published manuscripts. In July 2014 we were informed that the Journal Citation Reports gave Rev Clin Esp an Impact Factor of 1,314 (year 2013). This Impact Factor without self-citations would have been 0.705 (in 2009 the global impact factor was 0,584). With the Editorial Committee farewell we welcome the new editorial team and we sincerely thank the SEMI Steering Committee, our colleagues, journal officers, reviewers, readers and authors that since 2009 have trusted on our editorial work (AU)

Report of the editors, 2014. / Informe de los Editores, 2014.

The editors of Revista Clínica Española(Rev Clin Esp) inform on their editorial activity during the last 12 months: (a) Objectives and attainments in 2014, (b) Editorial activity, 2014, and (c) 2013 impact factor. In 2014 we achieved the 5 planned objectives. We have published the 9 programmed issues and 103% of the planned papers according to the usual fixed sections. We emphasize the publication of 29 editorials, 21 of which are signed by prestigious foreign authors. From the first January to the 30th September 2014 we received 421 manuscripts (46.8 manuscripts per month), a slight lower figure to that obtained in 2013 (50.9 manuscripts per month). The acceptance rate of the 404 manuscripts whose editorial process has been concluded was 32.3% (originals, 22.4%). We asked for 315 revisions to 240 reviewers and we received 53.3% revisions in less than two weeks (10.4 days). The mean time to adopt an editorial decision for all manuscripts («accepted¼/«rejected¼) has been 18,3 (less than half than in 2009). For «originals¼ this figure has dropped from 56,6 days in 2009 to 26.6 days in 2014. The mean time elapsed from manuscript reception to its on-line publication was 103 days. In 2014 the collaboration with the working groups from the Internal Medicine Spanish Foundation (FEMI) has reported 11 published manuscripts. In July 2014 we were informed that the Journal Citation Reports gave Rev Clin Esp an Impact Factor of 1,314 (year 2013). This Impact Factor without self-citations would have been 0.705 (in 2009 the global impact factor was 0,584). With the Editorial Committee farewell we welcome the new editorial team and we sincerely thank the SEMI Steering Committee, our colleagues, journal officers, reviewers, readers and authors that since 2009 have trusted on our editorial work.

[Report of the editors, 2013]. / Informe de los editores, 2013.

The editors of Revista Clínica Española(Rev Clin Esp) inform on their editorial activity during the last 12 months: (a) objectives and attainments, (b) editorial activity, and (c) objectives for 2014. In 2013 the most relevant modification concerning the editorial activity has been the translation into English of the 5 manuscripts with abstract contained in each issue (http://www.revclinesp.es/). From the first January to the 30th September 2013 we received 458 manuscripts (50.9 manuscripts per month), a similar figure to that obtained in 2012 (51.1 manuscripts per month). The acceptance rate of the 443 manuscripts whose editorial process has been concluded was 23.7% (originals, 11.8%). We asked for 253 revisions to 186 reviewers and we received 74.4% revisions in less than 2 weeks (10.9 days). The mean time to adopt an editorial decision for all manuscripts («accepted¼/«rejected¼) has been 20,3 (half than in 2009). For «originals¼ this figure has dropped from 56.6 days in 2009 to 22.5 days in 2013. The mean time elapsed from manuscript reception to its on-line publication was 94.8 days in 2013 (110.5 in 2012 and 155.8 in 2011). In 2013 the collaboration with the working groups from the Internal Medicine Spanish Foundation has reported 17 published manuscripts. In 2013 we were informed that the Journal Citation Reports excluded Rev Clin Esp from its impact factor journal list due to its elevated self-citations. We have taken a number of actions to reduce self-citations and we expect to be a minority in 2014. Some other data concerning the editorial policy are encouraging. In this sense, manuscript citation to Rev Clin Esp published articles has seen a substantial increase from 19% in 2008 to 29% in 2012. We work to achieve the digitalization of Rev Clin Esp from 1940 to 1999 (the journal is already digitalized since 2000). The continuous renewal of the journal sections and the working groups collaboration are necessary elements to make our journal, each day, better.

Informe de los editores, 2011 / Report of the editors, 2011

Los editores de R evista C línica E spañola (Rev Clin Esp) informan de su actuación editorial durante los últimos 12 meses (noviembre 2010 a octubre 2011): a) objetivos y consecuciones durante el año 2011; b) actividad editorial, y c) objetivos para el año 2012. Durante el año 2011 hemos perfeccionado el algoritmo editorial (evaluación por un editor de cada manuscrito enviado a revisores externos y creación de la figura de la «coordinadora editorial»), renovado los dos órganos consultivos («consejo editorial y consejo científico»), implantado la sección «imagen del mes», y se han concedido por primera vez los premios anuales Rev Clin Esp. Entre el 1 de enero y el 31 de octubre de 2011 se han gestionado 422 manuscritos (42,2 manuscritos/mes), cifra algo superior a la del año 2010 (40,4 manuscritos/mes), de los cuales han sido aceptados un 25,6% (originales, 16%). Hemos cursado 343 solicitudes de evaluación a 231 revisores, siendo aceptadas 185 de ellas. El 72% de los revisores enviaron sus comentarios en menos de dos semanas (tiempo medio de recepción de revisiones: 11 días). El tiempo medio para adoptar una decisión editorial definitiva (aceptado o rechazado) ha sido de 26 días. El tiempo medio transcurrido desde la fecha de remisión hasta la de publicación de los originales (números de septiembre, octubre y noviembre) ha pasado de 334 días en el 2010 a 254 en el 2011 (reducción del 24%). La participación de los grupos de trabajo de la Fundación Española de Medicina Interna (FEMI) ha sido próxima a dos manuscritos/número. Para el año 2012 hemos establecido los siguientes objetivos: a) mejorar el proceso de edición; b) traducir al inglés los artículos principales; c) actualizar algunas secciones (p. ej., conferencia clínica); d) incentivar la colaboración de los grupos de trabajo, y e) mejorar la formación médica continuada. R evista C línica E spañola es un foro abierto a la contribución de todos los internistas. A todos nos cabe la responsabilidad de colaborar para que nuestra revista sea, cada día, un poco mejor(AU)

The editors of R evista C línica E spañola (Rev Clin Esp) inform on their editorial activity during the last 12 months (November 2010 to October 2011): (a) Objectives and attainments during 2011, (b) editorial activity, and (c) objectives for 2012. In 2011 we have updated the editorial algorithm (revision by the responsible editor of all manuscripts sent to peer review and incorporated an «editorial coordinator»), we have renovated two advise facilities (editorial and scientific committees), we have created a new section called «monthly e-image», and we have promoted Rev Clin Esp annual prizes. From the first January 2010 to 31st October 2011 we handled 422 manuscripts (42,2 manuscripts per month, higher than the 2010 figure of 40,4 manuscript/month). Overall we have accepted 26% (originals, 16%). We asked for 343 revisions and obtained 231 (67%). Seventy two percent of the reviewers sent their comments in less than two weeks. The mean time taken to accept or reject a given manuscript has been 26 days. The mean time taken since a manuscript is received to publication (october, novembrer and december issues) has dropped from 334 days in 2010 to 254 in 2011 (24% decrease). The collaboration with the working groups has reported about 2 published manuscripts per issue. Our objectives for 2012 are: (a) to improve the editorial process; (b) main article translation into English; (c) improve some sections (i.e. clinical conference); (d) estimulate working groups collaboration; and (e) improve continued medical education. R evista C línica E spañola is an open forum for all internal medicine specialists. We all have the responsibility to make our journal, each day, better(AU)

[Report of the editors, 2011]. / Informe de los editores, 2011.

The editors of Revista Clínica Española (Rev Clin Esp) inform on their editorial activity during the last 12 months (November 2010 to October 2011): (a) Objectives and attainments during 2011, (b) editorial activity, and (c) objectives for 2012. In 2011 we have updated the editorial algorithm (revision by the responsible editor of all manuscripts sent to peer review and incorporated an «editorial coordinator¼), we have renovated two advise facilities (editorial and scientific committees), we have created a new section called «monthly e-image¼, and we have promoted Rev Clin Esp annual prizes. From the first January 2010 to 31(st) October 2011 we handled 422 manuscripts (42,2 manuscripts per month, higher than the 2010 figure of 40,4 manuscript/month). Overall we have accepted 26% (originals, 16%). We asked for 343 revisions and obtained 231 (67%). Seventy two percent of the reviewers sent their comments in less than two weeks. The mean time taken to accept or reject a given manuscript has been 26 days. The mean time taken since a manuscript is received to publication (october, novembrer and december issues) has dropped from 334 days in 2010 to 254 in 2011 (24% decrease). The collaboration with the working groups has reported about 2 published manuscripts per issue. Our objectives for 2012 are: (a) to improve the editorial process; (b) main article translation into English; (c) improve some sections (i.e. clinical conference); (d) estimulate working groups collaboration; and (e) improve continued medical education. Revista Clínica Española is an open forum for all internal medicine specialists. We all have the responsibility to make our journal, each day, better.

[2009 report from the editors]. / Informe de los editores: 2009.

The editors of the Rev Clin Esp present the editorial course of action of the journal over the past year. We have up-dated the design of the journal, its contents (sections) and computerized the editorial process. We processed 467 manuscripts and made an editorial decision on 402 of them between November 2008 and October 2009. A total of 92 manuscripts (23%) were accepted. Fifteen (13%) out of the 119 original articles for which the editorial process was completed were accepted. Our goal for the year 2010 is to make the journal available on the Internet for all those who are subscribers to the Rev Clin Esp as well as for internal medicine residents (for which they must be members of each regional society). Other objectives of the editorial team are to edit the E-cases, for the journal to be a continuing education tool and that the coordinators of the work groups develop a monographic number at least once every two years. These actions aim to increase the impact factor and the quality of the Rev Clin Esp, official publication of the Spanish Society of Internal Medicine and of Spanish-speaking internal medicine physicians.

Informe de los editores: 2009 / 2009 Report from the editors

Los editores de Revista Clínica Española (Rev Clin Esp) presentan las líneas de su actuación editorial en el último año. Hemos actualizado el diseño de la revista, sus contenidos (secciones) y el procedimiento editorial, que ha sido informatizado. Desde noviembre de 2008 hasta octubre de 2009 hemos gestionado 467 manuscritos y se ha adoptado una decisión editorial para 402. Han sido aceptados 92 manuscritos (23%). De 119 originales con proceso editorial concluido, se han aceptado 15 (13%). Para el año 2010 pretendemos que todos los suscriptores de Rev Clin Esp reciban la revista a través de Internet, al igual que los residentes de Medicina Interna (para lo cual deben ser miembros de cada sociedad autonómica). Otros objetivos del equipo editorial son la edición de e-comunicaciones clínicas, que la revista sea un instrumento de formación continuada y que los coordinadores de los grupos de trabajo promuevan un número monográfico al menos cada dos años. Estas acciones pretenden incrementar el factor impacto y la calidad de Rev Clin Esp, órgano de expresión de la Sociedad Española de Medicina Interna(AU)

The editors of the Rev Clin Esp present the editorial course of action of the journal over the past year. We have up-dated the design of the journal, its contents (sections) and computerized the editorial process. We processed 467 manuscripts and made an editorial decision on 402 of them between November 2008 and October 2009. A total of 92 manuscripts (23%) were accepted. Fifteen (13%) out of the 119 original articles for which the editorial process was completed were accepted. Our goal for the year 2010 is to make the journal available on the Internet for all those who are subscribers to the Rev Clin Esp as well as for internal medicine residents (for which they must be members of each regional society). Other objectives of the editorial team are to edit the E-cases, for the journal to be a continuing education tool and that the coordinators of the work groups develop a monographic number at least once every two years. These actions aim to increase the impact factor and the quality of the Rev Clin Esp, official publication of the Spanish Society of Internal Medicine and of Spanish-speaking internal medicine physicians(AU)

[Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors]. / Fiabilidad del diagnóstico de la EPOC en atención primaria y neumología en España. Factores predictivos.

OBJECTIVE: The aims of this study were to assess the methods used by primary care physicians and pneumologists to diagnose chronic obstructive pulmonary disease (COPD) in Spain, and to analyze the factors affecting correct diagnosis of the disease. MATERIAL AND METHODS: This observational, descriptive, cross-sectional and multicenter study enrolled a stratified randomized sample from each Spanish region from the practices of primary care physicians and pneumologists. RESULTS: Five hundred sixty-eight (63.2%) of the 898 subjects enrolled had airway obstruction, 92 (10.3%) did not fulfill functional criteria for COPD and 238 (26.5%) did not perform spirometric tests to confirm the diagnosis and establish severity of disease. Primary care physicians classified 29.3% of the patients correctly, whereas pneumologists diagnosed 84.8% correctly. Clinical and/or radiologic criteria were the basis for correct diagnosis in 38.6% of the cases managed by primary care physicians and 10.2% of those treated by pneumologists. Spirometry was available to 49.1% of the primary care physicians and 97.8% of the pneumologists' cases (p < 0.001). Moreover, only 29.9% of the primary care settings had a technician in charge of performing the study, in comparison with 97.8% of the specialized pneumology settings (p < 0.001). The use of spirometry in diagnosing COPD was related to level of patient care (primary or specialized), availability of the test in the primary care setting, place of residence and a patient's situation of temporary absence from work due to COPD. CONCLUSIONS: Many COPD patients are incorrectly diagnosed, particularly in primary care. There are differences in diagnostic procedures at the different levels of patient care. The availability of spirometry is an important factor for correctly diagnosing COPD.

Fiabilidad del diagnóstico de la EPOC en atenciónprimaria y neumología en España. Factores predictivos / Reliability of chronic obstructive pulmonary disease diagnosis by primary care physicians and pneumologists in Spain. Predictive factors

OBJETIVOS: Los objetivos de este estudio fueron evaluar la metodología empleada para el diagnóstico de la enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria y en neumología en España, y analizar los factores que determinan la realización de un diagnóstico correcto de esta enfermedad. MATERIAL Y MÉTODO: Se llevó a cabo un estudio observacional, descriptivo, transversal y multicéntrico. La selección de participantes se realizó mediante muestreo aleatorio estratificado por población regional entre médicos de familia y neumólogos. RESULTADOS: De los 898 sujetos reclutados, 568 (63,2 por ciento) tenían obstrucción al flujo aéreo, 92 (10,3 por ciento) no cumplían los criterios funcionales de EPOC y 238 (26,5 por ciento) carecían de una espirometría que permitiera confirmar el diagnóstico y establecer la gravedad del proceso. Por niveles de actuación, sólo el 29,3 por ciento de los pacientes en atención primaria fueron clasificados de forma correcta, frente al 84,8 por ciento en neumología. Del total de sujetos diagnosticados correctamente de EPOC, el 38,6 por ciento en atención primaria y el 10,2 por ciento en neumología fueron diagnosticados inicialmente por criterios clínicos radiológicos. La disponibilidad de la espirometría en atención primaria fue del 49,1 por ciento frente al 97,8 por ciento en el ámbito de la neumología (p < 0,001). Además, sólo el 29,9 por ciento de los centros en el primer nivel asistencial contaban con un técnico encargado de la realización del estudio, comparado con el 97,8 por ciento en atención especializada de neumología (p < 0,001). Los factores que determinaron el uso de la espirometría para realizar el diagnóstico de EPOC fueron el nivel de asistencia, la disponibilidad de la prueba en atención primaria, el lugar de residencia y la situación de incapacidad laboral temporal por la EPOC.CONCLUSIONES: Hay un elevado porcentaje de pacientes con EPOC erróneamente diagnosticados, sobre todo en el ámbito de la atención primaria. Existen diferencias en la metodología diagnóstica según el nivel de asistencia de los pacientes. La disponibilidad de la espirometría es un factor importante a la hora de realizar un diagnóstico correcto de EPOC (AU)

Estudio de la frecuencia de distintos factores de riesgo en pacientes con trombosis venosa profunda y/o tromboembolismo pulmonar / A study about the frequency of the different risk factors in patients with deep vein thrombosis and/or pulmonary embolism

Objetivo: estudiar la frecuencia de los diferentes factores de riesgo en pacientes con enfermedad tromboembólica de un Servicio de Medicina Interna. Diseño: observacional descriptivo, serie de casos. Material y métodos: 321 individuos diagnosticados de trombosis venosa y/o tromboembolismo pulmonar, ingresados en el Servicio de Medicina Interna del Hospital Universitario de Getafe durante un periodo de tres años. A partir de los informes de alta se obtuvieron: datos de filiación, métodos diagnósticos utilizados y factores de riesgo clínico. Los resultados del estudio de hipercoagulabilidad se hallaron en el registro del Laboratorio de Hematología del hospital. Resultados: presentaron alteraciones del sistema hemostático 36 (44 porciento) pacientes, 30 en forma de trombofilia congénita y 9 en forma de trombofilia adquirida. Entre las alteraciones congénitas se encontraron: 8 porciento déficits de antitrombina III, 15 porciento déficits de proteína C, 20 porciento déficits de proteína S y 14 porciento resistencias a la proteína C activada. Entre los pacientes con trombofilia adquirida, 6 porciento presentó títulos elevados de anticuerpos anticardiolipina IgM y 8 porciento del isopo IgG. Se detectaron factores de riesgo predisponentes de tromboembolismo en 267 (83 porciento) pacientes: 3 porciento tratamientos hormonales, 8 porciento individuos diabéticos, 12 porciento neoplasias, 15 porciento traumatismos previos al episodio, 72 porciento cirugías y 38 porciento inmovilismos. Conclusiones: existe una frecuencia sustancial de alteraciones del sistema hemostático en los pacientes diagnosticados de enfermedad tromboembólica, destacando los déficits de proteínas C y S y la resistencia a la proteína C activada. La mayoría de los fenómenos tromboembólicos que aparecen en individuos con trombofilia suceden junto con la presencia de un factor precipitante claro (AU)

[Association of lung adenocarcinoma and human immunodeficiency virus infection]. / Asociación de adenocarcinoma pulmonar e infección por el virus de la inmunodeficiencia humana.

In the past decade, few studies have reported the occurrence of lung cancer in HIV-infected patients. The true frequency of this association is known. The major features of these patients include: male gender, young age, a history of intravenous drug abuse, preponderance of adenocarcinoma cell type and advanced clinical stage at diagnosis. We describe a case of a lung cancer in a man with evidence of advanced HIV-infection and a history of intravenous drug abuse. Subsequently, we review the data reported in the literature about this association. Our patient provides further evidence that lung cancer should be included in the differential diagnosis of intrathoracic diseases in HIV-infected patients.