Multicentric study on the beta-blocker use and relation with exacerbations in COPD.

Chronic obstructive pulmonary disease (COPD) is frequently associated with chronic heart failure (CHF) or coronary artery disease (CAD). In spite of the recommendation to use beta-blockers (BB) they are likely under-prescribed to patients with concurrent COPD and heart diseases. To find out the prevalence of use of BB, 256 COPD patients were consecutively recruited by pulmonary physicians from 14 hospitals in 7 regions of Spain in their outpatient offices if they had a diagnosis of COPD, were not on long-term oxygen therapy, had CHF or CAD, and met the criteria for BB treatment. In patients with indication 58% (95%CI, 52-64%) of the COPD patients and 97% of the non-COPD patients were on BB (p < 0.001). In patients with COPD, several factors were independently related to at least one visit to the emergency room in the previous year such as use of BB, adjusted OR = 0.27 (95% CI 0.15-0.50), GOLD stage D, OR = 2.52 (1.40-4.53), baseline heart rate >70, OR 2.19 (1.24-3.86) use of long-acting beta2-agonists OR = 2.18 (1.29-3.68), previous episodes of left ventricular failure OR 2.27 (1.19-4.33) and diabetes, OR = 1.82 (1.08-3.38). We conclude that, according to what is recommended by current guidelines, BB are still under-prescribed in COPD patients. COPD patients with CHF or CAD using BB suffer fewer exacerbations and visits to the ER. GOLD stage, use of long-acting beta2-agonists, baseline heart rate and comorbidities are also risk factors for exacerbations in this population.

[The importance of genotyping of strains for the evaluation and interpretation of 5 school-based epidemic outbreaks of tuberculosis]. / Microepidemias de tuberculosis en 5 brotes escolares: importancia de la tipificación genética de las cepas en su evaluación e interpretación.

OBJECTIVE: The aim of this study was to describe 5 microepidemics of tuberculosis occurring in schools, establish the risk factors associated with the outbreaks, assess how well a concentric circles strategy for contact tracing predicts infection, and assess the usefulness of genotyping strains in the analysis of the outbreaks. MATERIAL AND METHODS: The study assessed 5 epidemic outbreaks of tuberculosis using a standard contact tracing procedure. The outbreaks occurred in 2 day nurseries and 2 high schools between 1998 and 2005. Contacts were stratified using a concentric circle system based on level of exposure. DNA fingerprints of the available strains were determined based on the restriction fragment length polymorphism (RFLP) IS6110 and compared with the contact study to interpret the transmission of the infection. RESULTS: We analyzed 5 outbreaks. Eighty-five contacts were analyzed in the first outbreak, 519 in the second, 116 in the third, 655 in the fourth, and 102 in the fifth. The rate of infection was 31%, 29%, 66%, 37.6%, and 32%, respectively. Secondary cases of active disease were detected: 9 in the first outbreak, 16 in the second, 5 in the third, 6 in the fourth, and 13 in the fifth. RFLP analysis revealed that a single strain was involved in 3 of the outbreaks, and in a fourth, at least 2 strains were involved. In outbreaks 2, 3, and 5, there was a significant association between the degree of contact and the probability of infection (P< .05). In all of the outbreaks, the relative risk of developing the disease was associated with the level of exposure. CONCLUSIONS: Analysis of contacts based on concentric circles of risk predicts the likelihood of infection. RFLP facilitates analysis of complex transmission routes that are not detected using traditional methods of contact screening.

Microepidemias de tuberculosis en 5 brotes escolares: importancia de la tipificación genética de las cepas en su evaluación e interpretación / The importance of genotyping of strains for the evaluation and interpretation of 5 school-based epidemic outbreaks of tuberculosis

Objetivo: El propósito del presente estudio ha sido describir 5 microepidemias de tuberculosis en centros escolares, establecer los factores de riesgo relacionados con su aparición, valorar la predicción de infección mediante la estrategia de círculos concéntricos y analizar la utilidad de la tipificación genética de cepa en su interpretación. Material y métodos: Se presenta el estudio de 5 brotes de tuberculosis, y su estudio convencional de contactos, ocurridos en 2 guarderías y 2 institutos de enseñanza media entre 1998 y 2005. Los contactos se estratificaron según el grado de convivencia siguiendo el sistema de círculos concéntricos. Se identificaron los perfiles genéticos (RFLP ­polimorfismo de longitud de los fragmentos de restricción­ IS6110) de las cepas disponibles y se cotejaron los resultados con el estudio de contactos para interpretar la transmisión de la infección. Resultados: Analizamos 5 brotes. En el primero estudiamos a 85 contactos; en el segundo, a 519; en el tercero, a 116; en el cuarto, a 655, y 102 en el quinto. La prevalencia de infección fue del 31, el 29, el 66, el 37,6 y el 32%, respectivamente. Se detectaron casos secundarios de enfermedad activa: 9 en el primero, 16 en el segundo, 5 en el tercero, 6 en el cuarto y 13 en el quinto. El análisis mediante RFLP identificó la coincidencia genética de todas las cepas en 3 brotes, y en el cuarto evidenció la existencia de al menos 2 cepas implicadas en su desarrollo. En los brotes 2, 3 y 5 encontramos una asociación importante entre el grado de convivencia y las probabilidades de infectarse (p < 0,05). En todos los brotes el riesgo relativo de infectarse y enfermar se asoció con la intensidad de la exposición. Conclusiones: El estudio de contactos basado en círculos de riesgo predice la probabilidad de infección. La RFLP permite aclarar vías de transmisión complejas que no son detectables mediante el estudio convencional de contactos

Objective: The aim of this study was to describe 5 microepidemics of tuberculosis occurring in schools, establish the risk factors associated with the outbreaks, assess how well a concentric circles strategy for contact tracing predicts infection, and assess the usefulness of genotyping strains in the analysis of the outbreaks. Material and methods: The study assessed 5 epidemic outbreaks of tuberculosis using a standard contact tracing procedure. The outbreaks occurred in 2 day nurseries and 2 high schools between 1998 and 2005. Contacts were stratified using a concentric circle system based on level of exposure. DNA fingerprints of the available strains were determined based on the restriction fragment length polymorphism (RFLP) IS6110 and compared with the contact study to interpret the transmission of the infection. Results: We analyzed 5 outbreaks. Eighty-five contacts were analyzed in the first outbreak, 519 in the second, 116 in the third, 655 in the fourth, and 102 in the fifth. The rate of infection was 31%, 29%, 66%, 37.6%, and 32%, respectively. Secondary cases of active disease were detected: 9 in the first outbreak, 16 in the second, 5 in the third, 6 in the fourth, and 13 in the fifth. RFLP analysis revealed that a single strain was involved in 3 of the outbreaks, and in a fourth, at least 2 strains were involved. In outbreaks 2, 3, and 5, there was a significant association between the degree of contact and the probability of infection (P<.05). In all of the outbreaks, the relative risk of developing the disease was associated with the level of exposure. Conclusions: Analysis of contacts based on concentric circles of risk predicts the likelihood of infection. RFLP facilitates analysis of complex transmission routes that are not detected using traditional methods of contact screening

Síndrome de Lady Windermere / Lady Windermere syndrome

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