Lung Function, Radiological Findings and Biomarkers of Fibrogenesis in a Cohort of COVID-19 Patients Six Months After Hospital Discharge.

INTRODUCTION: Impairment in pulmonary function tests and radiological abnormalities are a major concern in COVID-19 survivors. Our aim is to evaluate functional respiratory parameters, changes in chest CT, and correlation with peripheral blood biomarkers involved in lung fibrosis at two and six months after SARS-CoV-2 pneumonia. METHODS: COVID-FIBROTIC (clinicaltrials.gov NCT04409275) is a multicenter prospective observational cohort study aimed to evaluate discharged patients. Pulmonary function tests, circulating serum biomarkers, chest radiography and chest CT were performed at outpatient visits. RESULTS: In total, 313, aged 61.12 ± 12.26 years, out of 481 included patients were available. The proportion of patients with DLCO < 80% was 54.6% and 47% at 60 and 180 days. Associated factors with diffusion impairment at 6 months were female sex (OR: 2.97, 95%CI 1.74-5.06, p = 0.001), age (OR: 1.03, 95% CI: 1.01-1.05, p = 0.005), and peak RALE score (OR: 1.22, 95% CI 1.06-1.40, p = 0.005). Patients with altered lung diffusion showed higher levels of MMP-7 (11.54 ± 8.96 vs 6.71 ± 4.25, p = 0.001), and periostin (1.11 ± 0.07 vs 0.84 ± 0.40, p = 0.001). 226 patients underwent CT scan, of whom 149 (66%) had radiological sequelae of COVID-19. In severe patients, 68.35% had ground glass opacities and 38.46% had parenchymal bands. Early fibrotic changes were associated with higher levels of MMP7 (13.20 ± 9.20 vs 7.92 ± 6.32, p = 0.001), MMP1 (10.40 ± 8.21 vs 6.97 ± 8.89, p = 0.023), and periostin (1.36 ± 0.93 vs 0.87 ± 0.39, p = 0.001). CONCLUSION: Almost half of patients with moderate or severe COVID-19 pneumonia had impaired pulmonary diffusion six months after discharge. Severe patients showed fibrotic lesions in CT scan and elevated serum biomarkers involved in pulmonary fibrosis.

INTRODUCCIÓN: El deterioro de la función pulmonar en las pruebas correspondientes y las alteraciones radiológicas son las preocupaciones principales en los supervivientes de la COVID-19. Nuestro objetivo fue evaluar los parámetros de la función respiratoria, los cambios en la TC de tórax y la correlación con los biomarcadores en sangre periférica involucrados en la fibrosis pulmonar a los 2 y a los 6 meses tras la neumonía por SARS-CoV-2. MÉTODOS: El ensayo COVID-FIBROTIC (clinicaltrials.gov NCT04409275) es un estudio de cohortes multicéntrico, prospectivo y observacional cuyo objetivo fue evaluar los pacientes dados de alta. Se realizaron pruebas de función pulmonar, detección de biomarcadores en plasma circulante y radiografía y TC de tórax durante las visitas ambulatorias. RESULTADOS: En total 313 pacientes, de 61,12 ± 12,26 años, de los 481 incluidos estuvieron disponibles.La proporción de pacientes con DLCO < 80% fue del 54,6 y del 47% a los 60 y 180 días.Los factores que se asociaron a la alteración de la difusión a los 6 meses fueron el sexo femenino (OR: 2,97; IC del 95%: 1,74-5,06; p = 0,001), la edad (OR: 1,03; IC del 95%: 1,01-1,05; p = 0,005) y la puntuación RALE más alta (OR: 1,22; IC del 95%: 1,06-1,40; p = 0,005). Los pacientes con alteración de la difusión pulmonar mostraron niveles más altos de MMP-7 (11,54 ± 8,96 frente a 6,71 ± 4,25; p = 0,001) y periostina (1,11 ± 0.07 frente a 0,84 ± 0,40; p = 0,001). Se le realizó una TC a 226 pacientes de los cuales 149 (66%) presentaban secuelas radiológicas de la COVID-19. En los pacientes graves, el 68,35% mostraban opacidades en vidrio esmerilado y el 38,46%, bandas parenquimatosas. Los cambios fibróticos tempranos se asociaron a niveles más altos de MMP7 (13,20 ± 9,20 frente a 7,92 ± 6,32; p = 0,001), MMP1 (10,40 ± 8,21 frente a 6,97 ± 8,89; p = 0,023), y periostina (1,36 ± 0,93 frente a 0,87 ± 0,39; p = 0,001). CONCLUSIÓN: Casi la mitad de los pacientes con neumonía moderada o grave por COVID-19 presentaba alteración de la difusión pulmonar 6 meses después del alta. Los pacientes graves mostraban lesiones fibróticas en laTC y un aumento de los biomarcadores séricos relacionados con la fibrosis pulmonar.

Leiomiosarcoma primario vaginal en el embarazo. A propósito de un caso / Primary vaginal leiomyosarcoma in pregnancy. About A case

RESUMEN Los sarcomas primarios de vagina son extremadamente raros especialmente durante la gestación. Se presenta el caso de una gestante de 25+2 semanas que acude a urgencias con clínica de sangrado vaginal objetivándose a la exploración una formación nodular dependiente de pared vaginal derecha. Dada la clínica se reseca en quirófano con el hallazgo histopatológico de leiomiosarcoma. A la gestante se le realiza sin incidencias una cesárea en la semana 34 de gestación, previa maduración pulmonar fetal, completándose en el puerperio inmediato el estudio de extensión sin encontrarse ningún hallazgo relevante. Finalmente, se somete a la paciente a una histerectomía y salpinguectomía bilateral con preservación ovárica. El seguimiento y los controles sucesivos de la gestante en los meses posteriores muestran ausencia de enfermedad.

ABSTRACT Primary sarcomas of the vagina are extremely rare, especially during pregnancy. We report a case of a 25-week-pregnant who came to emergency room complaining of vaginal bleeding. Pelvic examination revealed a globular mass located on the right vaginal wall. Given the persistent bleeding, resection of the mass was performed. The specimen was sent to pathology and confirmed to be a leiomyosarcoma. At 34-weeks of pregnancy after fetal lung maturation a cesarean section is done. It was completed the extension study during immediate postpartum without any relevant finding. Finally, she had a totally hysterectomy and bilateral salpingectomy with ovarian preservation. Clinical follow-up over the following months shows no evidence of disease.

Risk Factors of Poor Outcomes after Admission for a COPD Exacerbation: Multivariate Logistic Predictive Models.

The aim of this study was to identify a multivariate model to predict poor outcomes after admission for exacerbation of chronic obstructive pulmonary disease (COPD).  We performed a multicenter, observational, prospective study. Patients admitted to hospital for COPD were followed up for 3 months. Relevant clinical variables at admission were selected. For each variable, the best cut-offs for the risk of poor outcome were identified using receiver operating characteristic (ROC) curves. Finally, a stepwise logistic regression model was performed. A total of 106 patients with a mean age of 71.1 (9.8) years were included. The mean maximum expiratory volume in the first second (FEV1)(%) was 45.2%, and the mean COPD assessment test (CAT) score at admission was 24.8 (7.1). At 3 months, 39 (36.8%) patients demonstrated poor outcomes: death (2.8%), readmission (20.8%) or new exacerbation (13.2%). Variables included in the logistic model were: previous hospital admission, FEV1 < 45%, Charlson ≥ 3, hemoglobin (Hb)<13 g/L, PCO2 ≥ 46 mmHg, fibrinogen ≥ 554 g/L, C-reactive protein (CRP)≥45 mg/L, leukocyte count < 9810 × 109/L, purulent sputum, long-term oxygen therapy (LTOT) and CAT ≥ 31 at admission. The final model showed that Hb < 13 g/L (OR = 2.46, 95%CI 1.09-6.36), CRP ≥ 45 mg/L (OR = 2.91, 95%CI: 1.11-7.49) and LTOT (3.07, 95%CI: 1.07-8.82) increased the probability of poor outcome up to 82.4%. Adding a CAT ≥ 31 at admission increased the probability to 91.6% (AUC = 0.75; p = 0.001). Up to 36.8% of COPD patients had a poor outcome within 3 months after hospital discharge, with low hemoglobin and high CRP levels being the risk factors for poor outcome. A high CAT at admission increased the predictive value of the model.

The CAT (COPD Assessment Test) questionnaire as a predictor of the evolution of severe COPD exacerbations.

INTRODUCTION: Since exacerbations of chronic obstructive pulmonary disease (COPD) cause both a great impact on the progression of the disease and generate high health expenditures, there is a need to develop tools to evaluate their prognosis. METHOD: Multicenter, observational, prospective study that evaluated the prognostic utility of the COPD Assessment Test (CAT) in severe exacerbations of COPD. Anthropometric and clinical variables were analyzed: smoking, history of exacerbations during the previous year, drug treatment, degree of baseline dyspnea, comorbidities; laboratory variables at admission (complete blood count, arterial blood gas and biochemistry) and CAT scores in the first 24 h of admission, on the third day, at discharge and at 3 months. RESULTS: We evaluated 106 patients (91 males) with a mean age of 71.1 (SD 9.8 years), mean FEV1 45.2% (14.7%) and average CAT score at admission of 24.7 points (7.1). At three months after discharge, treatment failure was observed in 39 (36.8%) patients: 14 (13.2%) presented an exacerbation without the need for hospital admission, 22 were readmitted (20.8%) and 3 (2.8%) died during follow-up. The three factors associated with increased risk of failure were a reduction less than 4 units in the CAT at discharge compared to admission, lower hemoglobin levels and treatment with domiciliary oxygen. CONCLUSIONS: A change of ≤4 points in the CAT score at discharge compared to that obtained at admission due to a severe exacerbation of COPD, helps to predict therapeutic failure such as a new exacerbation, readmission or death in the subsequent three months.

What pulmonologists think about the asthma-COPD overlap syndrome.

BACKGROUND: Some patients with COPD may share characteristics of asthma; this is the so-called asthma-COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. MATERIALS AND METHODS: We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. RESULTS: A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity <0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting ß2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. CONCLUSION: Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting ß2-agonist/inhaled corticosteroids.

Factores asociados a la hospitalización por exacerbación de la enfermedad pulmonar obstructiva crónica / Factors associated with hospital admission for exacerbation of chronic obstructive pulmonary disease

Introducción: Las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) que precisan ingreso hospitalario tienen un gran impacto en la progresión de la enfermedad y generan un alto gasto sanitario. Método: Se trata de un estudio observacional, multicéntrico y transversal, con el objetivo de identificar los factores asociados a las hospitalizaciones por exacerbaciones de la EPOC. Se obtuvieron variables sociodemográficas, antropométricas, de calidad de vida, síntomas respiratorios, presencia de ansiedad y depresión, actividad física y pruebas de función pulmonar. Se analizó su asociación con el ingreso hospitalario mediante análisis multivariante con un modelo de regresión logística. Resultados: Se analizaron 127 pacientes, 50 (39%) de los cuales habían sido hospitalizados. El 93,7% fueron hombres, con una edad media de 67 años (DE=9) y un FEV1 del 41,9% (DE=15,3). En el primer modelo obtenido, la SpO2 basal, el índice BODE y las visitas a urgencias se asociaron con el ingreso, y el área bajo la curva (ABC) ROC fue de 0,809. En un segundo modelo incluimos solo variables de fácil obtención (sin la prueba de la marcha), y solo la SpO2 y las visitas previas a urgencias fueron significativas, con un ABC ROC de 0,783. Conclusiones: El ingreso hospitalario por exacerbación de la EPOC se asocia a peor SpO2, mayor puntuación del índice BODE y un mayor número de visitas al servicio de urgencias. En caso de no disponer de la prueba de caminar 6min, las otras dos variables ofrecen una capacidad discriminativa similar(AU)

Introduction: Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) that require hospital admission have a major impact on the progression of disease and generate high health costs. Method: A multi-center, cross-sectional, observational, study was conducted with the aim to identify factors associated with hospital admission in patients with COPD. We obtained data of socio-demographic and anthropometric characteristics, quality of life, respiratory symptoms, anxiety and depression, physical activity and pulmonary function tests. We analyzed their association with hospital admission with a multivariate analysis using a logistic regression model. Results: We analyzed 127 patients, 50 (39%) of whom had been hospitalized. 93.7% were men, mean age 67 years (SD=9) and a FEV1 of 41.9% (SD=15.3). In the first model obtained, the baseline SpO2, the BODE index and emergency room (ER) visits were associated with hospital admission and the area under the ROC curve (AUC) was 0.809. In a second model we included only variables readily available (without the 6 minutes walking test) and only the SpO2 and previous visits to the ER were significant with an AUC ROC 0.783. Conclusions: hospital admission for exacerbation of COPD is associated with poor SpO2, higher BODE index score and a greater number of visits to the ER. In case you do not have the 6 minutes walking test, the other two variables offer a similar discriminative ability(AU)

Factors associated with hospital admission for exacerbation of chronic obstructive pulmonary disease.

INTRODUCTION: Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) that require hospital admission have a major impact on the progression of disease and generate high health costs. METHOD: A multi-center, cross-sectional, observational, study was conducted with the aim to identify factors associated with hospital admission in patients with COPD. We obtained data of socio-demographic and anthropometric characteristics, quality of life, respiratory symptoms, anxiety and depression, physical activity and pulmonary function tests. We analyzed their association with hospital admission with a multivariate analysis using a logistic regression model. RESULTS: We analyzed 127 patients, 50 (39%) of whom had been hospitalized. 93.7% were men, mean age 67 years (SD=9) and a FEV1 of 41.9% (SD=15.3). In the first model obtained, the baseline SpO(2), the BODE index and emergency room (ER) visits were associated with hospital admission and the area under the ROC curve (AUC) was 0.809. In a second model we included only variables readily available (without the 6 minutes walking test) and only the SpO(2) and previous visits to the ER were significant with an AUC ROC 0.783. CONCLUSIONS: hospital admission for exacerbation of COPD is associated with poor SpO(2), higher BODE index score and a greater number of visits to the ER. In case you do not have the 6 minutes walking test, the other two variables offer a similar discriminative ability.

Respuesta. Síndrome de apnea obstructiva durante el sueño y cortocircuito derecha-izquierda late / Reply. Obstructive sleep apnea syndrome and right-to-left shunt

No disponible

[Factors with influence on sleep apnea/hypopnea syndrome]. / Factores que influyen en el síndrome de apneas-hipopneas durante el sueño.

BACKGROUND AND OBJECTIVE: Evaluate the influence of some variables (gender, age, alcohol intake and obesity) on the apnea/hypopnea index (AHI) in patients with sleep apnea/hypopnea syndrome (SAHS). PATIENTS AND METHOD: We retrospectively reviewed medical records of patients with SAHS in the Hospital General Universitario of Murcia. We assessed demographic variables, alcohol intake, Epworth's scale, obesity and cardiorespiratory polygraphy or polysomnography. A multivariate regression model was used to explain the AHI in relation with other variables. RESULTS: We reviewed 127 medical records of patients with SAHS. Alcohol intake was the most powerful variable influencing the AHI, followed by the numeric value of the Epworth's Scale. No statistical significance was found with regard to the the rest of variables. CONCLUSIONS: In patients with SAHS, the AHI can be related to the alcohol intake and the numeric value of Epworth's Scale.