Adherence to commercial food thickener in patients with oropharyngeal dysphagia.

BACKGROUND: Oropharyngeal dysphagia (OD), a common symptom in the elderly, uses commercial thickener (CT) as part of its treatment. This is often accompanied of dislike and poor compliance. AIM: Describe adherence to CT and possible differences according to dwelling location in an area of influence of approximately 400.0000 inhabitants. METHODS: Cohort prospective observational study. Randomized patients from Nutrition and Dietetic (NDU)-database (4 calls-interviews/year). VARIABLES: Age, diagnostic, gender, dwelling/location: Home (H) / Nursing Home (NH), viscosity (nectar, honey, pudding), days with CT. Adherence measured with a questionnaire, considering implementation of treatment by combining CT use and consumption data, categorised in three groups good, moderate and poor. Change in patterns (improvement, maintenance, worsening) and non-adherence reasons. RESULTS: One hundred sixty-eight patients recruited with indicated viscosity: Nectar 39.7%, honey 29.3% and pudding 30.8%. Average age of 82.6 ± 11.1 years; 57.8% women (46.4% at H vs. 67% at NH, p < 0.01). Dwelling/location: 80 (47.6%) live at H and 88 (52.4%) at NH. Days with CT prior study were 509 ± 475.28. Implementation found in first call: good in 50%, moderate in 20.2% and poor in 29.8%. At first call, adherence parameters were more favourable in NH compared to H. However these parameters were reversed during the study period as there was an improvement at H vs. NH. Also in terms of change in patterns a significant improvement of implementation was found in patients living at H, 31.1% vs. those living at NH, 15.7%, p < 0.05. CT persistence throughout study was 89.7%. CONCLUSIONS: Low adherence to CT found in our community. Telephone follow-up resulted in improved adherence, especially in the H population. Our data provides valuable insights into the variability and changes in CT adherence among patients with OD. Adherence is complex and subject to many factors and dwelling/location is one of them. This study reveals the need to approach CT treatment for OD differently in NH.

Value of estimating pulse wave velocity compared to SCORE in cardiovascular risk stratification in community pharmacies / Valor de la estimación de la velocidad de onda de pulso en comparación con SCORE en la estratificación del riesgo cardiovascular en farmacias comunitarias

Objectives Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies. Methods Observational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness. Results After nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category. Conclusions More than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE (AU)

Objetivos La rigidez arterial es un marcador intermedio con valor pronóstico independiente. Nuestro objetivo es valorar si la estimación de la rigidez arterial puede mejorar la estratificación del riesgo cardiovascular (CV) en comparación con SCORE. Métodos Estudio epidemiológico observacional prospectivo en el que se ofrece a pacientes consecutivos que entran en una farmacia participante la medición voluntaria de la presión arterial y de la velocidad de onda de pulso estimada por oscilometría (AGEDIO, IEM®) para estratificar su riesgo CV según SCORE o según la presencia de rigidez arterial. Resultados Tras 9 meses de reclutamiento, presentamos datos de 923 pacientes (570 mujeres, 353 hombres). Dieciséis/122 (13,1%) pacientes <40años y 72/364 (19,8%) >65años presentaron rigidez arterial patológica y fueron clasificados de alto riesgo, aun hallándose fuera del rango de edad de SCORE. De los 437 (47,3%) pacientes evaluables por SCORE, 42/437 pacientes (9,6%) mostraron rigidez elevada. Los valores de colesterol estaban disponibles en 281 de estos pacientes (64,3%). Entre ellos, según SCORE, solo 6 (2,1%) eran de la categoría de alto riesgo. Conclusiones Más de la mitad de sujetos que entran aleatoriamente en una farmacia comunitaria tenían edades situadas fuera de los rangos de SCORE, imposibilitando el cálculo del riesgo CV con SCORE. En este grupo se constató daño arterial en el 18,1%. En la otra mitad, el 9,6% presentaron daño vascular y, consecuentemente, riesgo elevado, mientras que SCORE solo detectó riesgo elevado en el 2,1%. Por tanto, la estimación de la rigidez arterial en farmacias comunitarias mejora claramente la detección de riesgo CV elevado en comparación con SCORE (AU)

Value of estimating pulse wave velocity compared to SCORE in cardiovascular risk stratification in community pharmacies.

OBJECTIVES: Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV risk stratification compared to SCORE in patients at community pharmacies. METHODS: Observational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness. RESULTS: After nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category. CONCLUSIONS: More than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.

Differences in the use of food textures in oropharyngeal dysphagia according to the place of living.

BACKGROUND&AIMS: Modifying solid/liquid foods is the main treatment in oropharyngeal dysphagia (OD). Commercial Thickener (CT) for treatment is subsidized by health system and is delivered to patient's place of living, once is managed by our hospital Nutrition-Dietetics Unit (NDU). AIM: To describe the patterns of texture for foods/liquids follow in patients with OD who are treated with CT. METHODS: Cohort prospective study. Randomized patients from NDU-database followed throughout 2018 (4 calls-interviews/year). Variables; age, diagnostic, gender, residence type: Home(H)/Nursing Home(NH), thickener manager (patient, family member or caregiver), education, days with commercial thickener (CT), thickener regimen established by Volume/Viscosity test: nectar (N), honey (HY), pudding (P), type of diets; measured by FOIS scale and texture; pureed (PD); soft (SD); mixed (P&S/D); regular (RD), risk foods consumption (RFC), complete diet intake (CI), changes in; diets, intake and RFC. RESULTS: Analysed 204 patients, aged 85 years; (IQR: 78-90), from which 57.8% were women. Residence: 43.6% H/56.4% NH. Days with CT median 380 days (IQR: 153-682). A proper viscosity guideline was indicated in 168 patients: N 37.3%, HY 20.6% and P 24.5%. In 36 patients (17.5%) there were no indications, 75% of them coming from primary care. Despite this, 184 patients (90%) referred a concrete indication; N 35.8%, HY 26% and P 28.4%. The concordance between indicated and referred viscosity was significantly higher at H (Kappa 0.798) compared to NH (Kappa 0.428), p < 0.0001. FOIS: 65.7% followed the total oral diet of a single consistency. Diet textures: PD 66.7%, SD 2.9%, P&S/D 21.1%, RD 9.3%. Difference in PD given in NH 86.1% vs H 41.6%, p < 0.001. Under N viscosity different diet distributions, PD 28.6%H vs 71% NH, p < 0.05. CI in 66.7% with no difference among NH/H. RFC similar but higher consumption of jellies at NH, p < 0.001. CONCLUSIONS: According to this study the place of living determines a better approach to OD treatment. Viscosity and diet texture are more restricted in NH with worse compliance of indicated regimens. Increasing variety in diets and reassessment of OD treatment is desirable.

Farmacia comunitaria, adherencia al tratamiento y COVID-19 / Community pharmacy, treatment adherence and COVID-19

La falta de adherencia es un problema mundial cada vez mayor y es la responsable de que los resultados esperados en salud se alejen de la realidad, aumentando el gasto sanitario. Comprender por qué un paciente no es adherente requiere identificar los factores implicados en su caso concreto y personalizar las estrategias a seguir. Para abordar la no adherencia desde la farmacia comunitaria tenemos el protocolo de la guía ADHe+ de dispensación y uso racional del medicamento, que clasifica a los pacientes no adherentes en tres perfiles (confundido, desconfiado y banalizador), facilitando la tarea de evaluación de sus creencias hacia un medicamento en concreto y en un momento determinado. Siguiendo el protocolo propuesto por la guía, el farmacéutico puede detectar la no adherencia en los medicamentos que el paciente recoge y en los que no e indagar en las causas. Pero el momento actual que estamos viviendo de pandemia por COVID-19 está cambiando el paradigma de la cronicidad. El miedo al contagio, la ralentización de los procesos asistenciales por las nuevas medidas de higiene, la telemedicina, el confinamiento y el desconocimiento de la nueva situación por parte de pacientes y sanitarios puede afectar mucho a la adherencia terapéutica

Non-adherence to treatment is becoming more and more of a global issue and is responsible for the fact that expected health results are getting further away from reality and increasing spending on healthcare. To understand why a patient is not adhering to treatment it is necessary to identify the factors involved in his or her specific case and personalize the strategies to be followed. In order to approach non-adherence to treatment from the community pharmacy perspective, we use the protocol from the ADHe+ guide on the dispensing and rational use of the drug, which classifies non-adhering patients into three profiles (confused, wary and trivializing), facilitating the task of assessing their beliefs with regards to a certain medicine and at a given time. Following the protocol suggested by the guide, pharmacists can detect non-adherence to the medicines the patient collects and does not collect and look into the causes. However, the current times of pandemic that we are experiencing-caused by COVID-19-are changing the pattern of chronicity. Fear of infection, the slowing down of care processes due to the new hygiene measures, telemedicine, quarantine, and the lack of awareness about the new situation by both the patients and healthcare professionals may have a great impact on therapeutic adherence

Prevalence of dysphagia in a regional hospital setting: Acute care hospital and a geriatric sociosanitary care hospital: A cross-sectional study.

RATIONALE: Oropharyngeal Dysphagia (OD) is a symptom commonly found in hospitalized patients and related to a vast array of clinical diagnosis and to high morbidity and mortality that is becoming very important to identify. Our aim was to assess the prevalence of OD in our hospital setting. METHODS: Cross-sectional randomized study to determine the prevalence of dysphagia in an acute care hospital (ACH) and long term care hospital (LTCH). Multiquestionnaire test performed to assess dysphagia with the bedside validated volume-viscosity swallow test (V-VST test), in those with the validated swallowing ability test, eating assessment tool (EAT-10)>3. Variables; sex, age (>65 y), diagnosis, mininutritional assessment (MNA), previous diagnosis of dysphagia (including any recommendations given before), EAT-10, V-VST, presence of dysphagia, type of diet prescribed (basal or therapeutic), use of thickener and diet texture (pureed with liquids allowed, pureed without liquids, soft diet, normal). RESULTS: N = 200 patients (100 in each centre). 49% male; Age = 81.1 [65-101] years; Diagnostics: medical 70%/surgery 30%. Dysphagia analysis: 42% patients showed an EAT-10 > 3 so the V-VST test was done in these patients resulting in global prevalence of 28.5% (95% CI: 22.7-35.1). Among centres no significant differences were observed: ACH 30% (95% CI: 14-34) and LTCH 27% (95% CI: 19-36). Highlighting a greater concentration of dysphagia in Orthogeriatric and Neurological patients in the LTCH than in ACH (Pneumology, Internal Medicine and Cardiology). MNA analysis: 27% normal 44% risk 29% malnutrition. Malnutrition present in 50.9% of patients diagnosed with dysphagia, 44% in those at risc (EAT-10 +) and 27.6% in those without risc or dysphagia (p = 0.020). From the novo patients, 75.4% did not have adequate complete adapted treatment (diet and thickener). Only 13.3% had their thickener prescribed. In those with history of dysphagia 37% had an inappropriate treatment. CONCLUSION: Prevalence of OD matches with what is described in the literature. There is a high proportion of infradiagnostic and overall inadequate treatment, more than a third of patients do not have their diet adapted correctly. It is important to identify this symptom to treat it properly and to raise awareness among sanitary professionals for best adaptation of treatment.

High Prevalence of Liver Fibrosis Among European Adults With Unknown Liver Disease: A Population-Based Study.

BACKGROUND & AIMS: Liver fibrosis is the main determinant of long-term outcome in chronic liver diseases. Little is known about the prevalence of liver fibrosis in the general population. The aim of the study was to investigate the prevalence of liver fibrosis in the general adult population with unknown liver disease. METHODS: This was a population-based, cross-sectional study performed in the Barcelona metropolitan area. Subjects aged 18 to 75 years old were identified randomly from citizens included in the primary health care registry. Of 4866 subjects invited, 3076 participated (63.2%). Liver fibrosis was estimated by measuring liver stiffness (LS) with transient elastography (TE). Liver histology was assessed in 92 subjects with increased LS. RESULTS: Prevalence estimates of increased LS (≥6.8, ≥8.0, and ≥9.0 kPa) were 9.0%, 5.8%, and 3.6%, respectively. The etiology of liver disease was mainly nonalcoholic fatty liver disease (NAFLD), followed by alcohol risk consumption (consumption of ≥21 standard drinking units/wk in men and ≥14 standard drinking units/wk in women). Factors independently associated with increased LS were male sex, abdominal obesity, type 2 diabetes, serum glucose, high-density lipoprotein, and triglyceride levels. Subjects without risk factors for NAFLD or without alcohol risk consumption had a very low prevalence of increased LS. The best cut-off value of LS for significant liver fibrosis (F2-F4) was 9.2 kPa, with high sensitivity and specificity. TE was more accurate than alanine aminotransferase, NAFLD fibrosis score, or Fibrosis 4. An algorithm for screening for liver fibrosis using TE in the community setting is proposed. CONCLUSIONS: These findings show a high prevalence of silent liver disease with advanced fibrosis mainly related to NAFLD in adult European subjects without known liver disease. An LS value less than 9.2 kPa predicts the absence of significant liver fibrosis with high accuracy and could be used for screening purposes.

Evaluación de contenidos de Medicina Natural y Tradicional en Examen Estatal, curso 2013-2014 / Evaluation of contents of Natural and Traditional Medicine in State Exam, course 2013-2014

Se realizó una investigación con el objetivo de describir los resultados de la evaluación de los contenidos de Medicina Natural y Tradicional (MNT) en el examen estatal realizado en el Curso 2013 2014 en la Universidad de Ciencias Médicas de Guantánamo. Para ello se revisaron todos los exámenes estatales realizados en primera convocatoria, donde fue analizada la pregunta relacionada con el tema antes mencionado, la información obtenida se organizó en tablas y gráficos. Se concluyó que el mayor número de estudiantes responden correctamente la planta medicinal a utilizar en el asma bronquial, la mayor dificultad se encuentra en responder correctamente las dos formas de estimulación, un gran número responde una sola forma.

Evaluación de contenidos de Medicina Natural y Tradicional en Examen Estatal, curso 2013-2014 / Evaluation of contents of Natural and Traditional Medicine in State Examination, 2013-2014 course

Se realizó una investigación con el objetivo de describir los resultados de la evaluación de los contenidos de Medicina Natural y Tradicional (MNT) en el examen estatal realizado en el Curso 2013 2014 en la Universidad de Ciencias Médicas de Guantánamo. Para ello se revisaron todos los exámenes estatales realizados en primera convocatoria, donde fue analizada la pregunta relacionada con el tema antes mencionado, la información obtenida se organizó en tablas y gráficos. Se concluyó que el mayor número de estudiantes responden correctamente la planta medicinal a utilizar en el asma bronquial, la mayor dificultad se encuentra en responder correctamente las dos formas de estimulación, un gran número responde una sola forma(AU)

An investigation was carried out with the objective of describing the results of the evaluation of the contents of Natural and Traditional Medicine (MNT) in the state examination conducted in the Course 2013 2014 at the University of Medical Sciences of Guantanamo. To do this, all the state examinations carried out in the first call that were reviewed, the question related to the above mentioned subject was analyzed, the information was obtained and organized in tables and graphs. It was concluded that the largest number of students correctly answer the medicinal plant to be used in bronchial asthma, the greatest difficulty is in correctly answering the two forms of stimulation, a large number responds in a single way

Seudocíclope: una entidad a tener en cuenta después de la cirugía del ligamento cruzado anterior en futbolistas. ¿Predisposición biológica? / Pseudocyclops: An entity to take into consideration after anterior cruciate ligament reconstruction in football players. Biological predisposition?

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Implementación de un sistema de contenidos de Medicina Bioenergética y Natural en la asignatura de Morfofisiología Humana V / Implementation of a system of content about Bioenergetics and Natural Medicine for Human Morphophysiology V

A raíz de las trasformaciones necesarias en el campo de la Educación Médica y con la integración de las ciencias básicas biomédicas surge la disciplina Morfofisiología Humana, que al revisar los documentos metodológicos normativos de la misma no tiene incluido los anexos para integrar la Medicina Bioenergética y Natural (MBN), por la importancia que reviste el dominio de estas temáticas, se realiza este trabajo para diseñar un sistema de contenidos donde se vinculen algunas modalidades de la MBN a la asignatura Morfofisiología Humana V satisfaciendo los requerimientos de perfeccionamiento de profesionales vinculados a la atención comunitaria. Para el logro del objetivo propuesto se llevó a cabo una actualización del tema a través de la revisión de literatura especializada y documental de los diferentes planes de estudios y programas. La constatación de la validez de la propuesta a partir de un cuestionario a especialistas demostró su pertinencia y aplicabilidad (AU)

Following the necessary transformations in the field of Medical Education and the integration of Basic Biomedical Sciences arises Human Morphophysiology as a discipline, that in reviewing regulatory documents and methodology it is no included Bioenergetics and Natural Medicine (MBN) by the importance of mastering these issues, this study is done to design a system of content where some modalities linked to the subject MBN Human Morphophysiology V continue satisfying the requirements of professional linked to community care. To achieve the proposed objective was carried out update the issue through the review of documentary literatures and different curricula and programs. The verification of the validity of the proposal from a questionnaire to specialists demonstrated its relevance and applicability

Neurotransmisores / Neurotransmitters

Se realiza una revisión bibliográfica donde se utiliza la técnica de revisión documental en el Centro de Información Médica de la Universidad Médica de Guantánamo. Se describen las características generales de las sinapsis y de las sustancias consideradas como neurotransmisores. Se describen las características particulares de los neurotransmisores de acuerdo a su división en dos grupos: neurotransmisores de pequeño tamaño molecular (acetilcolina, noradreanalina, adrenalina, dopamina, serotonina, histamina, aminoácidos excitadores e inhibidores, glicina) y péptidos neuroactivos o neuropéptidos (sustancia P y otras taquicininas, péptidos opiodes y otros polipéptidos).(AU)

Algunas realidades del uso de la marihuana / Some realities of the cannabis use

Se destacan aspectos básicos de la marihuana, entre ellos origen, tipos y formas, vías de administración, principales aspectos metabólicos, su eliminación y las actuales hipótesis que se invocan en cuanto a su mecanismo de acción. Se hace referencia, además, a los principales efectos sobre el organismo, así como los principales daños orgánicos. Resaltan los aspectos sobre mediadores que explican las alteraciones neurales. Se señalan algunas características de los adictos de este tipo de droga y el tratamiento en caso de intoxicación aguda(AU)

Enfermedad de Alzheimer: actualización / Alzheimers disease: update

La necesidad de actualización y utilización de la informática médica, así como la posibilidad de contribuir a la formación cultural integral y al desarrollo de habilidades cognoscitivas, constituye una verdad insoslayable de la educación cubana. A esto se suma el incremento del número de estudiantes en nuestras aulas universitarias en las carreras de Medicina y Enfermería y la escasez de literatura que aborde integralmente el tema de la enfermedad de Alzheimer, enfermedad neurodegenerativa que constituye la causa más frecuente de demencia en personas ancianas, cuyos estudios epidémicos indican un aumento en su incidencia en los últimos años. Se exponen aspectos actualizados acerca de su prevención, diagnóstico, factores de riesgo, etapas y tratamiento(AU)

Drogas de diseño: reto del siglo XXI / Design drugs. XXI century challenge

Se destacan aspectos básicos de las drogas de diseño, de manera particular los de la 3,4-Metilendioximetanfetamina (MDMA) o éxtasis, tales como: origen, clasificación general, vías de administración, mecanismo de acción. Se hace referencia, además, a los principales efectos sobre el organismo, efectos adversos, elementos relevantes de la sobredosis y el tratamiento en caso de intoxicación aguda y, de manera precisa, el tratamiento de la hipertermia(AU)

The retrotracheal space: normal anatomic and pathologic appearances.

A variety of diseases can arise from the normal contents of the retrotracheal space or from adjacent structures. Mediastinal diseases in the retrotracheal space typically manifest radiographically as a contour abnormality or an area of increased opacity, although computed tomography (CT) or magnetic resonance (MR) imaging is usually required for diagnosis. The most common aortic arch anomaly, a right subclavian artery that originates from an otherwise normal left-sided aortic arch, appears at posteroanterior chest radiography as an obliquely oriented soft-tissue area of increased opacity that extends superiorly to the right from the superior margin of the aortic arch. CT and MR imaging can reveal associated vascular or mediastinal abnormalities. Aortic aneurysms and pseudoaneurysms can manifest radiographically as fusiform or saccular masslike lesions that protrude into the retrotracheal space. Thoracic MR imaging and spiral CT angiography are the diagnostic procedures of choice for evaluating diverse pathologic conditions of the thoracic aorta. Esophageal diseases can manifest as an abnormality in the retrotracheal space, which may be the initial clue to the diagnosis. At CT, lymphatic malformations in the mediastinum manifest as lobular, multicystic tumors that surround and infiltrate adjacent mediastinal structures. Familiarity with the normal radiologic appearance of the retrotracheal space and with the clinical manifestations of diseases that affect the retrotracheal space and adjacent structures can facilitate detection, diagnosis, and management.

Micosis Pulmonares: Correlación radio-patológica / Thoracic mycosis

Las micosis pulmonares son patologías muy frecuentes, especialmente en pacientes inmunodeprimidos, que pueden causar enfermedad pulmonar severa. El diagnóstico definitivo requiere la demostración histológica del microorganismo, casi siempre mediante biopsia, por lo que el papel de la sospecha clínica y los hallazgos radiológicos es de suma importancia en la instauración de la terapia antifúngica. A continuación describimos algunas de las patologías fúngicas oportunistas y endémicas más frecuentemente encontradas así como ilustraciones de los hallazgos radiológicos y patológicos más relevantes de algunas de ellas

Patron de crazy paving en la TCAR: correlacion radio-patológica / Thoracic mycosis

A pesar de que el patrón de "Crazy paving" fue originalmente descrito en la proteinosis alveolar, la Tomografía de Alta Resolución (TCAR) de tórax ha demostrado que dicho patrón puede evidenciarse en otras entidades patológicas. El objeto de esta publicación es describir varias entidades asociadas con este patrón radiológico, entre otras se incluyen el síndrome de dificultad respiratoria aguda del adulto (SDRA), edema pulmonar tanto de tipo hidrostático como por aumento de la permeabilidad capilar (Idiopático o secundario), hemorragia pulmonar, neumonías eosinófilas aguda y crónica, neumonía lipoidea exógena, neumonitis por hipersensibilidad, bronquiolitis obliterante con neumonía organizada (BOOP), carcinoma bronquioloalveolar, neumonía por Pneumocystis carinii (PCP), pneumonitis postradiación, neumonitis obstructiva, tuberculosis, etc