Recurrence of primary spontaneous pneumothorax: Associated factors.

INTRODUCTION: Determining the risk of recurrence of primary spontaneous pneumothorax is challenging. The objective of this study was to develop a risk assessment model to predict the probability of recurrence in patients with spontaneous pneumothorax. METHODS: A retrospective study was performed of all episodes of pneumothorax diagnosed in the last 12 years in a hospital, in patients not initially submitted to surgery. Logistic regression was used to estimate the probability of recurrence. Based on a set of variables, a predictive model was built with its corresponding ROC curve to determine its discrimination power and diagnostic precision. RESULTS: Of the 253 patients included, 128 (50.6%) experienced recurrence (37% within the first year). Recurrence was detected within 110 days in 25% of patients. The median of time to recurrence for the whole population was 1120 days. The presence of blebs/bullae was found to be a risk factor of recurrence (OR: 5.34; 95% CI: 2.81-10.23; p=0.000), whereas chest drainage exerted protective effect (OR: 0.19; 95% CI: 0.08-0.40; p=0.000). The variables included in the regression model constructed were hemoglobin and leukocyte count in blood, treatment received, and presence of blebs/bullae, with a fair discriminative power to predict recurrence [AUC=0.778 (95% CI: 0.721-0.835)]. CONCLUSION: The overall recurrence rate was high and was associated with the presence of blebs/bullae, failure to perform an active intervention (chest drainage) and low levels of hemoglobin and leukocytes in blood. Recurrence rarely occurs later than three years after the first episode. Once validated, this precision model could be useful to guide therapeutic decisions.

Clinical profile of idiopathic pulmonary fibrosis patients treated with nintedanib in routine clinical practice in Spain: the BROAD Study / Perfil clínico de pacientes con fibrosis pulmonar idiopática tratados con nintedanib en la práctica clínica habitual en españa: estudio broad

Background. Few data are available on the clinical profile of patients diagnosed with idiopathic pulmonary fibrosis (IPF) treated with nintedanib. The primary objective of the study was to describe, based on pulmonary function variables, disease severity in IPF patients who initiated treatment with nintedanib in routine clinical practice. The secondary objectives were to analyze their clinical characteristics and comorbidities. Methods. A multicenter, retrospective study including 173 patients from 32 Spanish hospitals. Patients were stratified by their forced vital capacity (FVC) % predicted and diffusing capacity for carbon monoxide (DLCO) % predicted. These measures were taken as a marker of IPF severity. Results. Mean age ± SD at treatment initiation was 70.1 ± 8.1, and 76.6% of patients were male. Based on FVC, 57% of patients had mild IPF (FVC ≥ 70%), 38.4% moderate IPF (FVC 50%-69%), and 4.7% severe IPF (FVC < 50%). Based on DLCO, 42.5% of patients had mild IPF (DLCO ≥ 50%), 35.5% moderate IPF (DLCO 35%-49%), and 22.2% severe IPF (DLCO < 35%). Eighty-nine percent of patients had at least one comorbid condition. The most prevalent comorbidities were high blood pressure (45.9%), dyslipidemia (42.4%), gastroesophageal reflux (25.6%), diabetes (19.8%), emphysema (15.7%), and cardiovascular diseases (15.7%). Most patients received concomitant treatment (79.7%). Conclusions. The study provides relevant information on the clinical characteristics of IPF patients who initiate nintedanib treatment. Classification of severity depends on the lung function parameter used. The proportion of patients classified as having severe IPF was up to 4 times greater when DLCO, instead of FVC, was used (AU)

Introducción. Se dispone de pocos datos sobre el perfil clínico de los pacientes diagnosticados de fibrosis pulmonar idiopática (FPI) tratados con nintedanib. El objetivo principal del estudio fue describir, basándose en variables de función pulmonar, la gravedad de la enfermedad en pacientes con FPI que iniciaron tratamiento con nintedanib en la práctica clínica habitual. Los objetivos secundarios fueron analizar sus características clínicas y comorbilidades. Métodos. Estudio retrospectivo y multicéntrico que incluyeron a 173 pacientes de 32 hospitales españoles. Los pacientes fueron estratificados por su capacidad vital forzada (CVF) % predicho y por la capacidad de difusión de monóxido de carbono (DLCO) % predicho. Estas variables se consideraron como marcadores de la gravedad de la FPI. Resultados. La edad media ± DE al inicio del tratamiento fue de 70,1 ± 8,1 y el 76,6% de los pacientes eran varones. Según la CVF, el 57% de los pacientes tenían FPI leve (CVF ≥ 70%), el 38,4% FPI moderada (CVF 50%-69%) y el 4,7% FPI grave (CVF < 50%). Según la DLCO, el 42,5% de los pacientes tenían FPI leve (DLCO ≥ 50%), el 35,5% FPI moderada (DLCO 35%-49%) y el 22,2% FPI grave (DLCO < 35%). El 89% de los pacientes tenían al menos una comorbilidad, siendo las más prevalentes la hipertensión arterial (45,9%), dislipidemia (42,4%), reflujo gastroesofágico (25,6%), diabetes (19,8%), enfisema (15,7%) y enfermedades cardiovasculares (15,7%). La mayoría de los pacientes recibieron tratamientos concomitantes (79,7%) (AU)

Recent epidemiological trends in extrapulmonary TB in Galicia, Spain.

OBJECTIVE: To describe the epidemiological trends and characteristics of extrapulmonary tuberculosis (EPTB) in Galicia, Spain, from 2000 to 2019.METHODS: This was a retrospective cohort study based on data from the Galician TB information system.RESULTS: Of the total number of TB cases (n = 15,871), 5,428 (34.2%) had EPTB. The absolute number of cases and incidence of EPTB decreased dramatically (from 480 cases and 17.8 cases/100,000 in 2000, to 172 and 6.4 cases/100,000 in 2019, respectively), with a mean annual decrease of respectively 64% and 4.7% for absolute cases and incidence rates. The risk for EPTB was higher in men than in women (RR 3.86, 95% CI 3.66-4.07). The most frequent age group was 15-44 years (2,234 patients, 41.2%); overall reductions per age group were 82% (0-14 years), 75% (15-44 years), 44% (45-64 years) and 63% (≥65 years), with statistically significant differences. The most frequently locations were the pleura (1,916 cases; 35.3%) and the lymph nodes (1,504; 27.7%).CONCLUSION: The incidence of EPTB in Galicia has decreased significantly in the last 20 years. The epidemiological characteristics have not changed, except for the number of patients with risk factors. This improvement of EPTB epidemiological trends coincides with the implementation of the programme for the prevention and control of TB, which suggests that it has been very effective in the control of the EPTB.

Toracocentesis en Atención Primaria / Thoracentesis in Primary Care

La toracocentesis es una prueba sencilla y con escasas complicaciones que aporta información relevante en el diagnóstico de un derrame pleural, a través de una correcta interpretación del análisis del líquido pleural. Una iniciativa interesante sería incorporar esta técnica a aquellos equipos de Atención Primaria que atienden a pacientes graves y complejos con dificultades para el desplazamiento a centros especializados distantes de sus domicilios. En este contexto, un buen conocimiento de las posibilidades diagnósticas que ofrece el análisis del líquido pleural podría ser de gran utilidad, en manos de personal bien entrenado, para establecer la etiología de un derrame pleural e iniciar, con la mayor celeridad posible, su tratamiento. Este artículo trata de contribuir a ello, trasmitiendo unas pautas de cómo una técnica sencilla puede aportar información relevante para conocer la etiología del derrame pleural y que podría implementarse en un determinado marco de Atención Primaria

Thoracentesis is a simple test with few complications that provides relevant information in the diagnosis of a pleural effusion, through a correct interpretation of the pleural fluid analysis. An interesting initiative would be to incorporate this technique by those Primary Care teams that treat serious and complex patients, with difficulties in moving to specialised centres far from their homes. In this context, a good knowledge of the diagnostic possibilities offered by the pleural fluid analysis could be very useful in the hands of well trained staff to establish the aetiology of a pleural effusion and be able to initiate, as quickly as possible, its treatment. This article aims to contribute to this, by suggesting guidelines on how a simple technique can provide relevant information in order to determine the aetiology of pleural effusion, and which could be implemented within a given Primary Care framework

[Thoracentesis in Primary Care]. / Toracocentesis en Atención Primaria.

Thoracentesis is a simple test with few complications that provides relevant information in the diagnosis of a pleural effusion, through a correct interpretation of the pleural fluid analysis. An interesting initiative would be to incorporate this technique by those Primary Care teams that treat serious and complex patients, with difficulties in moving to specialised centres far from their homes. In this context, a good knowledge of the diagnostic possibilities offered by the pleural fluid analysis could be very useful in the hands of well trained staff to establish the aetiology of a pleural effusion and be able to initiate, as quickly as possible, its treatment. This article aims to contribute to this, by suggesting guidelines on how a simple technique can provide relevant information in order to determine the aetiology of pleural effusion, and which could be implemented within a given Primary Care framework.

Comportamiento de las células nucleadas en los distintos tipos de derrame pleural / Behaviour of nucleated cells in various types of pleural effusion

Introducción. El conocimiento del comportamiento de los componentes celulares del líquido pleural puede ayudar a enfocar el diagnóstico diferencial de un derrame pleural. El objetivo es evaluar su composición en los distintos tipos de derrames y valorar si proporciona información clínica relevante. Pacientes y métodos. Estudio observacional, transversal y retrospectivo en el que se analiza el componente celular de derrames pleurales de diversa etiología. Los derrames se clasificaron como neutrofílicos, linfocíticos (≥50% de cada uno de ellos), eosinofílicos (≥10%) o mesoteliales (>5%) y se agruparon en 6 categorías diagnósticas. Resultados. Se estudiaron 1.467 pacientes (354 insuficiencia cardiaca; 59 otros trasudados; 349 paraneumónicos; 133 tuberculosos; 397 neoplásicos y 175 otros exudados). El predominio celular fue linfocítico en la insuficiencia cardiaca (44,4%), paraneumónicos no complicados (29,2%), tuberculosis (88%) y neoplasias (49,6%); neutrofílico en los paraneumónicos (57%) y neoplásicos (9,6%); eosinofílico en las neoplasias (6,3%) y mesotelial en las tuberculosis (12%). Las etiologías más frecuentes con un recuento linfocitario ≥80% fueron tuberculosis (35,1%) y neoplasias (23,3%). Los parámetros con mayor capacidad discriminante fueron: leucocitos (trasudados: AUC 0,835) y porcentaje de neutrófilos (empiemas: AUC 0,906 y paraneumónicos complicados + empiemas: AUC 0,907). Conclusiones. Los recuentos de células nucleadas ayudan a enfocar la etiología del derrame pleural, ya que cada etiología suele tener un predominio celular característico. El porcentaje de células nucleadas en el líquido pleural no puede descartar tuberculosis si existe un recuento elevado de células mesoteliales, ni un derrame paraneumónico ante un predominio linfocítico, o malignidad con un recuento de linfocitos ≥80% (AU)

Introduction. To know the behavior of cellular components of pleural fluid can help focus the differential diagnosis of a pleural effusion. Our objective was to assess their composition in different types of pleural effusions and assess whether it provides relevant clinical information. Patients and methods. Observational, cross-sectional and retrospective study in which the cellular components of pleural effusions of different etiology were analyzed. Pleural effusions were classified as neutrophilic, lymphocytic (≥50% of each one of them), eosinophilic (≥10%) or mesothelial (>5%) and were grouped into six diagnostic categories. Results. 1.467 patients were studied (354 heart failure; 59 other transudates; 349 paraneumonic; 133 tuberculous; 397 malignant and 175 other exudates). The predominance cell was lymphocytic in heart failure (44,4%), uncomplicated parapneumonic (29,2%), tuberculosis (88%) and malignant (49,6%); neutrophilic in parapneumonic (57%) and malignant (9,6%); eosinophilic in malignant (6,3%) and mesotelial in tuberculosis (12%). The most frequent etiologies with lymphocyte count ≥80% were tuberculosis (35,1%) and malignant (23,3%). Parameters with higher discriminating accuracy were: leukocytes (transudates: AUC 0,835) and percentage of neutrophils (empyemas: AUC 0,906 and complicated parapneumonic+empyemas: AUC 0,907). Conclusions. Nucleated cell counts will help focus the etiology of pleural effusions, since each etiology often have a characteristic cell predominance. The percentage of nucleated cells in pleural fluid not ruled out tuberculosis if there is a high count of mesothelial cells, nor a parapneumonic effusion with lymphocytic predominance, or malignancy with ≥80% lymphocytes (AU)

Behaviour of nucleated cells in various types of pleural effusion. / Comportamiento de las células nucleadas en los distintos tipos de derrame pleural.

INTRODUCTION: To know the behavior of cellular components of pleural fluid can help focus the differential diagnosis of a pleural effusion. Our objective was to assess their composition in different types of pleural effusions and assess whether it provides relevant clinical information. PATIENTS AND METHODS: Observational, cross-sectional and retrospective study in which the cellular components of pleural effusions of different etiology were analyzed. Pleural effusions were classified as neutrophilic, lymphocytic (≥50% of each one of them), eosinophilic (≥10%) or mesothelial (>5%) and were grouped into six diagnostic categories RESULTS: 1.467 patients were studied (354 heart failure; 59 other transudates; 349 paraneumonic; 133 tuberculous; 397 malignant and 175 other exudates). The predominance cell was lymphocytic in heart failure (44,4%), uncomplicated parapneumonic (29,2%), tuberculosis (88%) and malignant (49,6%); neutrophilic in parapneumonic (57%) and malignant (9,6%); eosinophilic in malignant (6,3%) and mesotelial in tuberculosis (12%). The most frequent etiologies with lymphocyte count ≥80% were tuberculosis (35,1%) and malignant (23,3%). Parameters with higher discriminating accuracy were: leukocytes (transudates: AUC 0,835) and percentage of neutrophils (empyemas: AUC 0,906 and complicated parapneumonic+empyemas: AUC 0,907). CONCLUSIONS: Nucleated cell counts will help focus the etiology of pleural effusions, since each etiology often have a characteristic cell predominance. The percentage of nucleated cells in pleural fluid not ruled out tuberculosis if there is a high count of mesothelial cells, nor a parapneumonic effusion with lymphocytic predominance, or malignancy with ≥80% lymphocytes.

Pneumonitis caused by silicone gel following breast implant rupture.

INTRODUCTION: There have been reports of pneumonitis associated with subcutaneous injection of liquid silicone, and of other pulmonary conditions due to cohesive silicone gel prostheses, but we know of no previous cases of pneumonitis associated with silicone gel. MATERIALS AND METHODS: We report the case of a patient with a cohesive silicone gel mammary prosthesis in whom silicone-induced pneumonitis was diagnosed following radiological observation of pulmonary infiltrates and tests including transbronchial biopsy, which revealed the presence of silicone in alveolar histiocytes and small blood vessels. CONCLUSION: Following removal of the ruptured prosthesis and a course of systemic corticoids, the patient progressed favourably.

Diagnóstico precoz del síndrome coronario agudo en los servicios de urgencias. Papel de la h-FABP / Early diagnosis of acute coronary syndrome in the emergency department. The-FABP role

Objetivos: Analizar las características epidemiológicas de los pacientes atendidos en urgencias con sospecha de síndrome coronario agudo (SCA), evaluar los diferentes marcadores empleados en el diagnóstico y determinar la utilidad clínica de un test cualitativo que mide los niveles de la proteína transportadora de ácidos grasos específica del miocardio (h-FABP) en sangre para la identificación precoz del SCA. Métodos: Estudio multicéntrico prospectivo incluyendo pacientes atendidos en el Servicio de Urgencias con dolor torácico sugestivo de síndrome coronario agudo de menos de 180 minutos de duración. Se analizaron variables epidemiológicas incluyendo edad, sexo, duración de dolor y presencia de factores de riesgo vascular. Se compararon los resultados de h-FABP con los de la troponina T. Se consideran positivos los niveles >7 ng/ml de h-FABP. Resultados: Los datos fueron obtenidos de 419 pacientes, con diagnóstico final de SCA en 237 (56 por ciento). La sensibilidad diagnóstica de la proteína transportadora de ácidos grasos específica del miocardio fue del 47 por ciento, significativamente más alta que la de la troponina T (12 por ciento; p<0,05). La especificidad de la troponina T fue mayor aunque no significativamente. Ninguno de los factores de riesgo vascular analizados excepto la presencia de enfermedad cardiovascular periférica fue significativamente más elevado en el grupo de pacientes con diagnóstico final de SCA. Conclusiones: La proteína transportadora de ácidos grasos específica del miocardio puede ser útil en la evaluación de pacientes con sospecha de síndrome coronario agudo en fases precoces (AU)

[Epidemiologic study on tuberculosis in the health area of Santiago de Compostela in 1995, 1996, 1997, and 1998]. / Estudio epidemiológico de la tuberculosis en el Area Sanitaria de Santiago de Compostela durante los años 1995, 1996, 1997 y 1998.

BACKGROUND: We report the epidemiological characteristics of tuberculosis(TB) in the area of Santiago de Compostela (Spain) between 1995 and 1998. METHODS: Inclusion criteria were: 1) microbiological and/or pathological diagnosis of TB in any specimen, and 2) consistent recent medical history of TB with reading > 5 mm to 2 TU PPD tuberculin test 48-72 hours after injection, and adenosine deaminase in pleural effusion > 47 IU/ml. RESULTS: 1,150 patients were included (685 males and 465 females), with mean of age (X) 38.9 years (19.8 SD), range 3 months-88 years. The number of cases was 307 during 1995 and 1996, 302 in 1997 and 213 in 1998. The incidence rate (per 100,000 habitants) was 78.3 in 1995 and 1996, 79.8 in 1997 and 61.9 in 1998. The incidence rate of meningitis was 1.8 in 1995, 1.3 in 1996, 1.05 in 1997 and 0.8 in 1998, with no meningitis in children under 5 years. Cases in association with VIH were 4.2% in 1995, 3.3 in 1996, 5.4 in 1997 and 3.2 in 1998. More of the 50% of cases in both genders were between 15 and 40 years old with another peak over 65 years. The ratio men/woman was 1.8 in 1995 and 1.4 in 1996, 1997 and 1998. CONCLUSIONS: The incidence of tuberculosis has diminished during the last year, but is too early to know the real tendency.

Estudio epidemiológico de la tuberculosis en el Área Sanitaria de Santiago de Compostela durante los años 1995, 1996, 1997 y 1998 / Epidemiological study of tuberculosis in area of Santiago de Compostela (Spain) during 1995,1996,1997 and 1998

Objetivo: Conocer los parámetros epidemiológicos entre 1995 y 1998 de la enfermedad tuberculosa (TB) en el Área Sanitaria de Santiago de Compostela.Método: Búsqueda activa y exhaustiva de los casos que reunían todos o cada uno siguientes criterios: a) hallazgos microbiológicos y/o patológicos diagnósticos de TB, en cualquier espécimen, b) pacientes menores de 35 años con historia clínica reciente compatible con TB con test de Mantoux con una induración >5 mm tras 48-72 horas de la inyec ción intradérmica de 2 TU PPD y adenosina deaminasa (ADA) en líquido pleural >47 IU/mL.Resultados: Hemos estudiado 1.150 pacientes (685 hombres y 465 mujeres), con edad media (X) de 38,9 (19,8 SD) años, con extremos de 3 meses y 88 años. El número de casos fue de 307 en los años 1995 y 1996, de 302 en 1997 y de 213 en 1998. La incidencia de la enfermedad por 100.000 habitantes (X/100.000H) fue de 78,3 en 1995 y 1996, de 79,8 en 1997 y de 61,9 en 1998, con una incidencia de formas contagiosas de 38,3 (X100.000H) en 1995, de 38,9 en 1996, de 37,2 en 1997 y de 21,9 en 1998. La tasa de meningitis tuberculosa fue de 1,8 (X100.000H) en 1995 y de 1,3 en 1996, 1,05 en 1997 y 0,8 en 1998, destacando que en tres últimos años no se declararon casos en niños menores de 5 años. En las formas de asociación con VIH la cifra fue de 4,2 por ciento en 1995, 3,3 por ciento en 1996, 5,4 por ciento en 1997 y de 3,2 por ciento en 1998. Estratificada la muestra por edades hemos objetivado que más del 50 por ciento de los casos en ambos sexos se encontraba entre los 15 y 40 años con otro aumento después de los 65 años.La proporción hombre/mujer (H/M) fue de 1,8 en 1995, de 1,4 en 1996, 1997 y 1998.Conclusiones: La incidencia de tuberculosis ha disminuido en el último año, aunque es demasiado pronto para saber cuál es la tendencia real. (AU)