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Asma/terapia , Evaluación de Procesos, Atención de Salud/normas , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Asma/diagnóstico , Asma/fisiopatología , Consenso , Prioridades en Salud/normas , Humanos , Pautas de la Práctica en Medicina/normas , Valor Predictivo de las Pruebas , España , Resultado del TratamientoAsunto(s)
Antialérgicos/uso terapéutico , Anticuerpos Antiidiotipos/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Aspergilosis Pulmonar/tratamiento farmacológico , Adulto , Anciano , Anticuerpos Monoclonales Humanizados , Evaluación de Medicamentos , Quimioterapia Combinada , Femenino , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Omalizumab , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Troponin-I (TnI) is a marker of severe pulmonary thromboembolism (PTE) in unselected patients. There are few articles that assess its usefulness in hemodynamically-stable patients. OBJECTIVES: To assess the correlation between TnI levels and both echocardiographic/radiologic signs of right ventricle (RV) dysfunction or pulmonary hypertension (PH), and the severity of the pulmonary vascular obstruction. METHODS: We selected patients from a prospective cohort of 103 consecutive patients with PTE and systolic arterial pressure ≥ 90 mmHg. Computed tomography pulmonary angiography (CTPA) and echocardiography were performed in all patients. We performed a post hoc study, analyzing the 68 cases in which TnI was measured, at the discretion of the emergency room physician. RESULTS: Patients included had a median age of 74 years and 50% were male. The patients with elevated TnI had a differentiated clinical profile, suggestive of more severe PTE. There was a significant correlation between TnI levels and systolic pulmonary artery pressure (r=0.46, P<.001), the CTPA-measured pulmonary artery diameter (r=0.48, P<.001), the CTPA-measured RV diameter (r=0.47, P=.001) and the pulmonary vascular obstruction index (r=0.39, P=.001). CONCLUSION: The higher levels of TnI in patients with hemodynamically stable PTE predicts the existence of more severe PE in hemodynamically-stable patients. This biomarker could be used in the clinical practice to select those patients who might require more intensive monitoring or additional complementary studies.
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Hemodinámica , Embolia Pulmonar/sangre , Troponina I/sangre , Anciano , Anciano de 80 o más Años , Angiografía , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Disnea/etiología , Enfermedades Pulmonares/etiología , Lupus Eritematoso Sistémico/complicaciones , Presión de las Vías Aéreas Positiva Contínua/métodos , Diafragma/fisiopatología , Disnea/fisiopatología , Disnea/terapia , Femenino , Humanos , Enfermedades Pulmonares/fisiopatología , Lupus Eritematoso Sistémico/sangre , Debilidad Muscular/fisiopatología , Pruebas de Función Respiratoria , Síndrome , Resultado del Tratamiento , Adulto JovenRESUMEN
We aimed to evaluate the accuracy of baseline exhaled nitric oxide fraction (F(eNO)) to recognise individuals with difficult-to-treat asthma who have the potential to achieve control with a guideline-based stepwise strategy. 102 consecutive patients with suboptimal asthma control underwent stepwise increase in the treatment with maximal fluticasone/salmeterol combination dose for 1 month. Then, those who remained uncontrolled received oral corticosteroids for an additional month. With this approach, 53 patients (52%) gained control. Those who achieved control were more likely to have positive skin results (60.4% versus 34%; p = 0.01), positive bronchodilator test (57.1% versus 35.8%; p = 0.02) and peak expiratory flow variability > or =20% (71.1% versus 49.1%; p = 0.04). Conversely, depression was more frequent in those who remained uncontrolled (18.4 % versus 43.4 %; p = 0.01). An F(eNO) value > or =30 ppb demonstrated a sensitivity of 87.5% (95% CI 73.9-94.5%) and a specificity of 90.6% (95% CI 79.7-95.9%) for the identification of responsive asthmatics. The current results suggest that F(eNO) can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids.
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Albuterol/análogos & derivados , Androstadienos/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/diagnóstico , Asma/tratamiento farmacológico , Pruebas Respiratorias/métodos , Óxido Nítrico/metabolismo , Corticoesteroides/uso terapéutico , Adulto , Anciano , Albuterol/uso terapéutico , Ansiedad/diagnóstico , Asma/metabolismo , Broncodilatadores , Depresión/diagnóstico , Combinación de Medicamentos , Monitoreo de Drogas/métodos , Resistencia a Medicamentos , Quimioterapia Combinada , Femenino , Combinación Fluticasona-Salmeterol , Humanos , Masculino , Persona de Mediana Edad , Ápice del Flujo Espiratorio/efectos de los fármacos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , EspirometríaRESUMEN
BACKGROUND: Several studies have focused on the safety of withholding anticoagulant therapy in patients with negative results on helical computed tomography (CT). However, these studies were either retrospective or had a selection bias, since spiral CT was performed only in selected patients. Moreover, no special attention has been directed towards an alternative diagnosis which might explain patients' signs and symptoms. OBJECTIVES: To determine the safety of withholding anticoagulants in patients with clinically suspected pulmonary embolism (PE) and negative CT results when ultrasonography (US) was performed only in patients with clinical suspicion of deep vein thrombosis (DVT). Another goal was to evaluate the effect of CT findings on the final clinical diagnosis. METHODS: Among 192 consecutive patients who underwent CT for possible acute PE, 98 patients had negative images and 88 of them-- without clinical suspicion of DVT-- were prospectively followed up for 3 months for evidence of subsequent thromboembolic disease. They did not receive anticoagulation. Clinical probability of PE was assessed applying the Geneva score. These patients were also classified into several diagnostic categories according to the CT findings and clinical presentation. In addition, all patients who were alive (or a member of his or her family) were interviewed by phone once the last patient's follow-up was completed. RESULTS: One patient was lost to follow-up. Among the remaining 87 patients (35 with low, 47 with intermediate and 5 with high clinical probability), subsequent thromboembolic disease was found in 1 (1.1%; 95%CI: 0.03-6.2%). Two patients died during the follow-up period, but no deaths were attributed to PE. Alternative diagnoses were: nonspecific thoracic pain (43.3%), nonspecific pleuritis (19.5%), pneumonia (18.4%), other (18.8%). The telephone survey was performed in 74 patients (median follow-up: 11 months; range: 4-23). None of them had newly diagnosed episodes of PE and none of them had received anticoagulation for any reason. CONCLUSIONS: With the limitations of a small single-center series, our data suggest that withholding anticoagulation in patients with suspected acute PE and negative CT results appears to be safe when the clinical probability of PE is assessed as low or intermediate. This technique also provides useful information to pose an alternative diagnosis. US could be avoided in patients without clinical suspicion of DVT.
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Anticoagulantes/uso terapéutico , Embolia Pulmonar/tratamiento farmacológico , Anticoagulantes/administración & dosificación , Esquema de Medicación , Empiema/diagnóstico por imagen , Humanos , Derrame Pleural/diagnóstico por imagen , Neumonía/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/etiología , Seguridad , Trombosis/complicaciones , Tomografía Computarizada EspiralRESUMEN
OBJECTIVE: To compare the safety and efficacy of enoxaparin and unfractionated heparin in the treatment of submassive pulmonary thromboembolism (PTE). MATERIAL AND METHODS: Fifty-six patients with PTE who did not need fibrinolytic treatment were enrolled prospectively. The patients were randomly assigned to 2 treatment groups: Group A received enoxaparin (1 mg/kg every 12 hours) and Group B received adjusted doses of unfractionated heparin. The oral anticoagulant therapy was started on confirmation of the diagnosis and continued for 6 months. Incidences of recurrence of thromboembolism and of severe bleeding were assessed at the end of this period. RESULTS: Six patients were withdrawn from the study. Twenty-nine of the 50 remaining patients were in Group A (enoxaparin) and 21 in Group B (unfractionated heparin). A recurrence of thromboembolism was diagnosed in 3 patients from Group A (10.7%) and 2 patients from Group B (9.5%). There were no significant differences. Two patients died, one death being attributed to bleeding secondary to the oral anticoagulant treatment (Group A) and the other to a process unrelated to PTE. CONCLUSIONS: Enoxaparin seems to be as effective and safe as unfractionated heparin in the initial treatment of PTE.
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Anticoagulantes/uso terapéutico , Enoxaparina/uso terapéutico , Heparina/uso terapéutico , Embolia Pulmonar/tratamiento farmacológico , Anciano , Anticoagulantes/efectos adversos , Enoxaparina/efectos adversos , Femenino , Hemorragia/inducido químicamente , Heparina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Seguridad , Resultado del TratamientoAsunto(s)
Acetatos/efectos adversos , Antiasmáticos/efectos adversos , Asma/tratamiento farmacológico , Asma/etiología , Síndrome de Churg-Strauss/inducido químicamente , Síndrome de Churg-Strauss/complicaciones , Antagonistas de Leucotrieno/efectos adversos , Quinolinas/efectos adversos , Acetatos/administración & dosificación , Acetatos/uso terapéutico , Adulto , Antiasmáticos/administración & dosificación , Antiasmáticos/uso terapéutico , Síndrome de Churg-Strauss/diagnóstico , Ciclopropanos , Humanos , Antagonistas de Leucotrieno/administración & dosificación , Antagonistas de Leucotrieno/uso terapéutico , Masculino , Quinolinas/administración & dosificación , Quinolinas/uso terapéutico , Sulfuros , Factores de TiempoRESUMEN
We report the case of a 62-year-old man who developed bronchiolitis obliterans with organizing pneumonia (BOOP) associated with acute Coxiella burnetii infection. The diagnosis of BOOP was made by fiber-optic transbronchial biopsy. Treatment with corticosteroids resulted in rapid clinical improvement and complete resolution of airspace opacities. To the best of our knowledge, this is the first well-documented case of BOOP associated with C. burnetii infection. This case suggests that this infection might trigger the development of BOOP.
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Neumonía en Organización Criptogénica/complicaciones , Fiebre Q/complicaciones , Enfermedad Aguda , Neumonía en Organización Criptogénica/patología , Humanos , Masculino , Persona de Mediana Edad , Alveolos Pulmonares/patología , Fiebre Q/diagnóstico , Fiebre Q/patologíaRESUMEN
Three cases of nodular pulmonary sarcoidosis are presented. Chest roentgenograms demonstrated multiple bilateral nodules and the diagnosis was achieved by means of biopsy specimens after other diseases capable of producing a similar histologic or clinical picture were excluded we discuss the clinical, histologic and radiographic behaviors of nodular sarcoidosis.