Documento de consenso sobre asma bronquial en Andalucía / No disponible

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Documento de Consenso de Neurmosur sobre diagnóstico y tratamiento del tabaquismo / No disponible

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Documento de Consenso en Andalucía: enfermedad pulmonar obstructiva crónica / Consensus document in Andalusia: Chronic obstructive pulmonary disease

No disponible

No disponible

Documento de consenso sobre enfermedad pulmonar obstructiva crónica en Andalucía / No disponible

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[Prospective study of 221 community acquired pneumonias followed up in an outpatient clinic. Etiology and clinical-radiological progression]. / Estudio prospectivo de 221 neumonías adquiridas en la comunidad seguidas de forma ambulatoria. Etiología y evolución clinicorradiológica.

BACKGROUND: All the community acquired pneumonia followed up in an outpatient clinic were prospectively studied in order to determine: etiology, clinical-radiological characteristics and its progression with diagnostic and therapeutic protocols. PATIENTS AND METHOD: We arranged clinical evaluation protocols, etiological diagnosis by means of serology (in the first visit and three weeks later); and when necessary, by means of fiberbronchoscopy (protected microbiological brush), as well as clinical and radiological progression (up to three visits) after empirical treatment. RESULTS: Initially, 240 patients were included, of which 221 were fully followed up. Etiological diagnosis was obtained in 86 patients (39%). The bacteria most frequently isolated was Coxiella burnetii (12.2%), followed up Mycoplasma pneumoniae and Legionella pneumophila. Two cases of Strepcococus pneumoniae were diagnosed. The most frequent radiological onset was alveolar infiltrate (86%). The initial empiric treatment were macrolids (71%) or second generation cephalosporines (22%). Most patients presented a favourable clinical and radiological progression. Only 2 patients needed admission to the hospital (< 1%). CONCLUSIONS: In community acquired pneumonias studied in our outpatient clinic we found a high number of "atypical" agents. Treatment with macrolids or second generation cephalosporines are appropriate for these patients.

[School-age smoking in the province of Seville. Epidemiology and influence of personal and social environment (smoking prevention campaign, 1998-1999)]. / Tabaquismo escolar en la provincia de Sevilla. Epidemiología e influencia del entorno personal y social (campaña de prevención del tabaquismo 1998-1999).

OBJECTIVE: To study the prevalence os smoking in school children in Sevilla and the influence of personal and social environment on smoking patterns. METHODS: This study was part of a preventative anti-smoking campaign in schools. Students filled in anonymous questionnaires based on the World Health Organization survey instrument for population attitudes and habits. RESULTS: We surveyed 3385 students between 10 and 19 years of age at 47 schools in Seville and 28 villages in the surrounding province. Current smoking was reported by 19.1% of the students; slightly more girls (19.8%) than boys (18.3%) smoked. Smoking was related to having an older brother or sister who smoked and particularly to having friends who smoked (OR 20.5). The adolescents reported that parents were less permissive than the rest of their environment. Smokers associated tobacco with values such as independence and freedom; they believed that smoking might have an impact on health, although their conviction was less strong than that of non-smokers, regular smokers had high expectations of continuing. CONCLUSIONS: We found a high proportion of smokers among students of both sexes. Starting and continuing to smoke during adolescence is considerably influenced by the social environment of peers and is possibly affected by messages of independence and freedom transmitted through tobacco industry advertising.

Tabaquismo escolar en la provincia de Sevilla. Epidemiología e influencia del entorno personal y social (Campaña de prevención del tabaquismo 1998-1999) / School-age smokers in the province of Seville. Epidemiology and influence of the personal social environment (1998-1999 anti-smoking campaing)

Objetivo: Estudiar la prevalencia del tabaquismo en escolares de Sevilla y la influencia que el entorno personal y social tiene sobre el consumo. Métodos: Este trabajo está incluido en el marco de una campaña de prevención del tabaquismo efectuada en centros de enseñanza. Los alumnos cumplimentaban de forma anónima una encuesta, basada en el cuestionario de la OMS sobre actitudes y hábitos de la población. Resultados: Se evaluaron un total de 3.385 jóvenes de 10 a 19 años de edad, pertenecientes a 47 centros escolares de Sevilla y 28 pueblos de la provincia. El 19,1 por ciento de los jóvenes reconocían ser fumadores activos, con proporción algo mayor en alumnas (19,8 por ciento) que en alumnos (18,3 por ciento). Objetivamos que había conexión del tabaquismo de los jóvenes con el hábito de sus hermanos mayores y sobre todo con el de sus amigos (odds ratio, 20,5). Los adolescentes reconocían baja permisividad por parte de los padres y mayor tolerancia en el resto del entorno. Los fumadores activos vinculan en mayor medida el tabaco con valores como indepedencia y libertad, y creen que puede causar efectos sobre la salud, aunque menos que los no fumadores. Las expectativas de consumo son altas para los fumadores regulares. Conclusiones: Hemos encontrado un elevado porcentaje de fumadores entre los jóvenes escolares de ambos sexos. La adquisición y mantenimiento del tabaquismo en la adolescencia está influido notablemente por el entorno de amigos, pudiendo incidir también mensajes como independencia y libertad transmitidos habitualmente por la industria tabaquera. (AU)

[A randomized comparative study of 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease]. / Estudio comparativo, aleatorio entre 3 días de tratamiento con azitromicina y 10 días de tratamiento con cefuroxima en las exacerbaciones de pacientes con enfermedad pulmonar obstructiva crónica.

BACKGROUND: The aim of this study was to prospectively evaluate the clinical and gasometric evolution and the side effects of two treatment schedules in the exacerbations of patients with chronic obstructive pulmonary disease (COPD): 500 mg/24 h of azithromycin (AZM) for three days versus 500 mg/12 h of acetyl cefuroxime (ACF) for 10 days. PATIENTS AND METHODS: Patients were randomized included into each therapeutic schedule. The patients were seen three times (days 1 and 4, and at 15-21 days) to evaluate clinical symptoms scores. Forced spirometry and arterial gasometry were performed the first and the last time the patients were seen. The number of patients requiring admission during follow up and the secondary effects of each antibiotic were quantified. RESULTS: A total de 50 patients were treated with AZM and 51 with ACF. The evolution of the symptoms was similar although with a trend to greater improvement in those treated with AZM. This improvement was significant for the characteristics of expectoration (p < 0.05). Functional and gasometric evolution was similar in the two schedules. Three patients treated with AZM required hospital admission, as did 5 treated with ACF. A greater number of secondary effects were observed in patients treated with ACF (18%) than in those receiving AZM (10%), with gastrointestinal side effects being the most commonly observed. CONCLUSIONS: Treatment with short schedule of AZM may have the same activity as longer schedule of ACF, with fewer secondary effects thereby suggesting that AZM may be an effective alternative in the treatment of exacerbations in patients with COPD.

[School-age smoking in the province of Seville: results from the first phase of an anti-smoking campaign]. / Tabaquismo escolar en la provincia de Sevilla: resultados de la primera fase de una campaña de prevención del tabaquismo.

OBJECTIVES: To study the prevalence and intensity of smoking among school-age children in Seville by sex, age and type of population, as well as to examine expectations of future smoking. METHODS: This study was part of a school anti-smoking campaign. The students completed an anonymous questionnaire based on the one formulated by the World Health Organization on population attitudes and habits. RESULTS: Of 895 school-age subjects surveyed, 879 questionnaires were valid (428 boys and 451 girls). Ages ranged from 12 to 19 years (mean for boys: 15.4 +/- 1.6 years; for girls 14.6 +/- 1.5 years; p < 0.01). As many as 300 girls (67%) and 278 boys (65%) reported having tried a cigarette at some time. Active smoking was reported by 35% (16% occasionally and 19% daily) with no significant differences between boys and girls. The number of smokers increased with age, coming to represent more than half of subjects over 16 years of age, the proportion being even higher for girls aged 14 years and older. Smoking became well established at age 14 or older for most subjects. More rural than urban or large town dwellers reported smoking. The mean number of cigarettes smoked was higher for boys (8.7 +/- 7.4) than for girls (6.4 +/- 6.2) (p < 0.01). We found differences in boys' and girls' future expectations of smoking, as well as differences between habitual and occasional smokers, the latter group being less certain about whether to continue smoking in the future or not.

[Quality and selection of samples of bronchoalveolar lavage (BAL) in diffuse pneumopathies]. / Estudio de calidad y selección de muestras de lavado broncoalveolar (LBA) en neumopatías difusas.

Bronchoalveolar lavage (BAL) samples used to study immune or inflammatory response in interstitial lung disease must be representative of the lower respiratory tract. Thus, the selection of suitable samples must be part of routine practice. To assess the incidence of unsuitable BAL samples used for cytology and to determine the relation between parameters related to underlying disease and the quality of samples. One hundred sixty-one patients were enrolled. Seventy-two were HIV positive and had diffuse pulmonary infiltrates, 34 had idiopathic pulmonary fibrosis (IPF), 10 had sarcoidosis, 10 had hypersensitivity pneumonitis, 19 had interstitial lung disease and collagen diseases and 2 had pulmonary eosinophilia. Fourteen individuals formed the control group. The quality study was carried out by staining the BAL samples following a modified Wright-Giemsa technique and evaluating the samples by the selection criteria described by Chamberlain and colleagues (1987). We identified unsuitable samples from 53% of the HIV positive patients, from 35% of the IPF patients and from 21% of the interstitial lung disease patients with associated connective tissue disease. In the other groups, all samples were suitable for analysis. Intolerance of BAL with decreasing percentage of fluid recovered was significantly associated with sample quality, particularly in the IPF group. The cytology results that invalidated the samples differed by group. In all groups, unsuitable specimens had low cell counts. The finding or not of evidence of associated infection in HIV-infected patients, on the other hand, did not appear to determine sample quality in and of itself, although it did in samples related to other entities. We can predict that a high rate of unsuitable BAL samples will come mainly from patients with diffuse lung disease associated to HIV infection, IPF and interstitial lung disease with associated connective tissue disease. Tolerance to the technique influences quality of the specimen obtained and, therefore, should be taken into account in interpreting the findings of cytology. The criteria applied by the various teams using BAL should be unified, and it should be determined whether the exclusion of inappropriate samples affects the final composition of study groups.

[An analysis of the prevalence of respiratory symptomatology in the general population]. / Análisis de la prevalencia de sintomatología respiratoria en la población general.

This paper is a report of a cross-sectional epidemiological study that formed part of multicenter European project; the aim was to estimate the prevalence of respiratory symptoms and signs related to asthma over a period of 12 months in the city of Seville. A sample of 4,000 persons of both sexes, aged between 20 and 44 years old, was surveyed first by mail questionnaire and later by telephone interview. We analyzed the response index obtained with the mail survey for the epidemiological study of asthma in the area and for the frequency of respiratory symptoms and their distribution by age and sex. The response index was 53.36% and was similar for men and for women. Forty-nine percent reported at least one respiratory symptom, with nocturnal coughing attacks (27.7%) and wheezing (22.2%) being the most frequent. The frequency of these symptoms was different by sex, however, with the former more often reported by women (p < 0.02) and the latter by men (p < 0.001). We found that 14.9% of the population had rhinitis and that women reported this symptom more often (p < 0.02). Symptoms related to asthma were nocturnal attacks of breathlessness, the use of asthma medication and an asthma attack diagnosed by a physician within the last 12 months. With these criteria the estimated prevalence of asthma was 11.72%, a proportion that held steady for all age groups except the middle-aged and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

[An association of lymphoid interstitial pneumonia, common variable immunodeficiency and non-Hodgkin's lymphoma]. / Asociación de neumonía intersticial linfoide, inmunodeficiencia común variable y linfoma no hodgkiniano.

We describe a woman with lymphoid interstitial pneumonia diagnosed by open lung biopsy following a profile of unproductive cough, weakness and bilateral lung infiltrates. The patient was also diagnosed as having common variable immunodeficiency based on hypogammaglobulinemia, repeated sinusitis and persistent diarrhea. Exfoliative cytology of pleural effusion revealed the development of non-Hodgkin's lymphoma. We review the associations among these processes and consider the suggestion made by other authors that lymphoid interstitial pneumonia be considered a prelymphomatous process.