A home telehealth program for patients with severe COPD: the PROMETE study.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOP) are key events in the natural history of the disease. Patients with more AECOPD have worse prognosis. There is a need of innovative models of care for patients with severe COPD and frequent AECOPD, and Telehealth (TH) is part of these programs. METHODS: In a cluster assignment, controlled trial study design, we recruited 60 patients, 30 in home telehealth (HT) and 30 in conventional care (CC). All participants had a prior diagnosis of COPD with a post-bronchodilator forced expiratory volume (FEV1)% predicted <50%, age ≥ 50 years, were on long-term home oxygen therapy, and non-smokers. Patients in the HT group measured their vital signs on a daily bases, and data were transmitted automatically to a Clinical Monitoring Center for followed-up, and who escalated clinical alerts to a Pneumologist. RESULTS: After 7-month of monitoring and follow-up, there was a significant reduction in ER visits (20 in HT vs. 57 in CC), hospitalizations (12 vs. 33), length of hospital stay in (105 vs. 276 days), and even need for non-invasive mechanical ventilation (0 vs. 8), all p < 0.05. Time to the first severe AECOPD increased from 77 days in CC to 141 days in HT (K-M p < 0.05). There was no study withdrawals associated with technology. All patients showed a high level of satisfaction with the HT program. CONCLUSIONS: We conclude that HT in elderly, severe COPD patients with multiple comorbidities is safe and efficacious in reducing healthcare resources utilization.

[Effectiveness of acupuncture in the treatment of pain from osteoarthritis of the knee]. / Efectividad de la acupuntura en el tratamiento del dolor en la artrosis de rodilla.

AIM: To determine the effectiveness of acupuncture in controlling pain from arthritis of the knee. DESIGN: Systematic review. DATA SOURCES: MedLine, the Cochrane Library. STUDY SELECTION: Of the 9 studies located, only 4 met the inclusion criteria. All were controlled, randomized clinical trials that studied the effect of acupuncture only in the knee joint. DATA EXTRACTION: Primary outcome variables were intensity of pain, overall measure (general improvement, proportion of patients who recovered, subjective improvement in symptoms) and functional status. As secondary outcome measures we used objective physiological measures (range of knee movement, muscle strength, time needed to walk a certain distance, time needed to climb a certain number of stairs), general health status, and other information such as medication needed and side effects. RESULTS: There was moderately strong evidence that acupuncture was more effective in treating knee joint pain than no treatment. The difference can be explained by its marked placebo effect. CONCLUSIONS: There is currently insufficient evidence to recommend acupuncture as a treatment for pain from osteoarthritis of the knee. Additional, better designed studies are needed to determine the actual role of acupuncture in this disease.

Efectividad de la acupuntura en el tratamiento del dolor en la artrosis de rodilla / Effectiveness of acupuncture in the treatment of pain from osteoarthritis of the knee

Objetivo. Determinar la efectividad de la acupuntura en el control del dolor de la artrosis de rodilla. Diseño. Revisión sistemática. Fuentes de datos. MEDLINE, The Cochrane Library. Selección de estudios. De los 9 estudios encontrados, sólo 4 superaron los criterios de selección. Se trata de ensayos clínicos controlados aleatorios que estudian el efecto de la acupuntura únicamente en la articulación de la rodilla. Extracción de datos. Los indicadores de resultado primarios valorados son: intensidad del dolor, medición global (mejoría general, proporción de pacientes recuperados, mejoría subjetiva de los síntomas) y estado funcional. Son considerados indicadores de resultado secundarios: mediciones fisiológicas objetivas (amplitud del movimiento de la rodilla, fuerza muscular, tiempo para caminar una determinada distancia, tiempo para escalar una altura determinada), estado general de salud y otros datos, como la necesidad de utilizar medicación o los efectos secundarios. Resultados. Existe una evidencia moderada sobre la efectividad de la acupuntura en el tratamiento del dolor de la gonartrosis frente al no tratamiento, que puede ser explicada por su fuerte efecto placebo. Conclusiones. En la actualidad no existe suficiente evidencia para recomendar la acupuntura como tratamiento del dolor de la gonartrosis. Son necesarios nuevos estudios, y mejor diseñados, para determinar el verdadero papel de la acupuntura en esta enfermedad (AU)

Metabolic clearance rate of arginine vasopressin in patients with cirrhosis.

Metabolic clearance rate and half-time of arginine vasopressin were measured in 43 cirrhotic patients and 10 control subjects. Synthetic arginine vasopressin was infused intravenously at a rate of 500 pg/min/kg of body weight for 75 min. The metabolic clearance rate was significantly reduced, and the half-time of arginine vasopressin after stopping the infusion was significantly increased in patients with cirrhosis, particularly in those with ascites and in those with moderate or severe liver dysfunction. Changes in metabolic clearance rate and half-time of arginine vasopressin correlated with the score of the liver dysfunction, prothrombin activity and levels of serum albumin and bilirubin but not with parameters of kidney function (serum creatinine levels and clearance of creatinine). We conclude that reduced metabolic clearance rate and prolonged half-time of vasopressin in plasma are frequent findings in cirrhotic patients with poor liver function. This impaired catabolism of antidiuretic hormone may contribute to maintaining elevated plasma levels of this hormone in these patients and may be an additional factor leading to fluid retention and to dilutional hyponatremia.

Antidiuretic hormone and renal function after water loading in patients with cirrhosis of the liver.

Renal function and plasma antidiuretic hormone (ADH) levels were studied basally and after oral water load in four groups of subjects: 15 healthy controls (group I), 15 cirrhotics without ascites (group II), 15 cirrhotics with ascites (group III), and 10 decompensated cirrhotics with hyponatremia (group IV). Renal function and ADH levels were normal in group II. In groups III and IV water diuresis and fractional proximal sodium excretion were significantly decreased, whereas fractional distal sodium resorption and fractional excretion of potassium did not differ from those of controls. Basal ADH was significantly increased only in patients of group IV. In these patients ADH remained abnormally high after water loading. ADH did not correlate with water diuresis, plasma osmolality, mean arterial pressure, and plasma renin activity. We conclude that impaired water excretion in decompensated cirrhotics without hyponatremia cannot be ascribed to high serum levels of ADH. On the contrary, it seems to be related mainly to a reduced delivery of filtrate to the diluting segment of the nephron. In cirrhotic patients with hyponatremia high levels of ADH may play an additional role.

[Sternal osteomyelitis associated with a severe attack of ulcerative colitis with multiple extra-intestinal manifestations]. / Osteomielitis esternal asociada a un brote severo de colitis ulcerosa con múltiples manifestaciones extraintestinales.

A case of ulcerative colitis in which multiple extraintestinal manifestations: erythema nodosum, pyoderma gangrenosum, vesicle pustule lesions, aseptic osteomyelitis and possible local myositis appeared in the course of an acute decompensation is presented. The pathogenesis of these lesions are discussed and the not previously reported association between ulcerative colitis and aseptic osteomyelitis is presented.

[Inferior vena cava syndrome as first manifestation of a non-functioning adrenal carcinoma (author's transl)]. / Síndrome de vena cava inferior como primera manifestación de un carcinoma suprarrenal no functionante.

A case is studied of a non-functioning right adrenal carcinoma which is initiated clinically by a compressive syndrome of the inferior vena cava, without other clinical manifestations to suggest the origin of the tumor. The clinical findings are discussed as well as the roentgenographic images, the computerized axial tomography and surgery, which was followed by the death of the patient, with considerations concerning the possible mechanisms that might explain the death. A bibliographic review is conducted on the most outstanding aspect of non-functioning adrenal tumors and the rarity with which they present themselves in this form, of which we have found only one previous report.