Radiological Structured Report Integrated with Quantitative Imaging Biomarkers and Qualitative Scoring Systems.

The benefits of structured reporting (SR) in radiology are well-known and have been widely described. However, there are limitations that must be overcome. Radiologists may be reluctant to change the conventional way of reporting. Error rates could potentially increase if SR is used improperly. Interruption of the visual search pattern by keeping the eyes focused on the report rather than the images may increase reporting time. Templates that include unnecessary or irrelevant information may undermine the consistency of the report. Last, the lack of support for multiple languages may hamper the adaptation of the report to the target audience. This work aims to mitigate these limitations with a web-based structured reporting system based on templates. By including field validators and logical rules, the system avoids reporting mistakes and allows to automatically calculate values and radiological qualitative scores. The system can manage quantitative information from imaging biomarkers, combining this with qualitative radiological information usually present in the structured report. It manages SR templates as plugins (IHE MRRT compliant and compatible with RSNA's Radreport templates), ensures a seamless integration with PACS/RIS systems, and adapts the report to the target audience by means of natural language extracts generated in multiple languages. We describe a use case of SR template for prostate cancer including PI-RADS 2.1 scoring system and imaging biomarkers. For the time being, the system comprises 24 SR templates and provides service in 37 hospitals and healthcare institutions, endorsing the success of this contribution to mitigate some of the limitations of the SR.

Definition and validation of SNOMED CT subsets using the expression constraint language.

BACKGROUND: SNOMED CT Expression Constraint Language (ECL) is a declarative language developed by SNOMED International for the definition of SNOMED CT Expression Constraints (ECs). ECs are executable expressions that define intensional subsets of clinical meanings by stating constraints over the logic definition of concepts. The execution of an EC on some SNOMED CT substrate yields the intended subset, and it requires an execution engine able to receive an EC as input, execute it, and return the matching concepts. An important issue regarding subsets of clinical concepts is their use in terminology binding between clinical information models and terminologies for defining the set of valid values of codified data. OBJECTIVE: To define and implement methods for the simplification, semantic validation and execution of ECs over a graph-oriented SNOMED CT database, and to provide a method for the visual representation of subsets in order to explore, understand and validate its content, as well as to develop an EC execution platform, called SNQuery, which makes use of these methods. METHODS: Since SNOMED CT is a directed and acyclic graph, we have used a graph-oriented database to represent the content of SNOMED CT, where the schema and instances are represented as graphs and the data manipulation is expressed by graph-oriented operations. For the execution of ECs over the graph database, it is performed a translation process in which ECs are translated into a set of Cypher Query Language queries. We have defined some EC simplification methods that leverage the logic structure underlying SNOMED CT. The purpose of these methods is to reduce the complexity of ECs and, in turn, its execution time, as well as to validate them from a SNOMED CT Concept Model and logical definition points of view. We also have developed a graphic representation based on the circle packing geometrical concept, which allows validating subsets, as well as pre-defined refsets and the terminology itself. RESULTS: We have developed SNQuery, a platform for the definition of intensional subsets of SNOMED CT concepts by means of the execution of ECs over a graph-oriented SNOMED CT database. Additionally, we have incorporated methods for the simplification and semantic validation of ECs, as well as for the visualization of subsets as a mechanism to understand and validate them. SNQuery has been evaluated in terms of EC execution times. CONCLUSION: In this paper, we provide methods to simplify, semantically validate and execute ECs over a graph-oriented database. We also offer a method to visualize the intensional subsets obtained by executing ECs to explore, understand and validate them, as well as refsets and the terminology itself. The definition of intensional subsets is useful to bind content between clinical information models and clinical terminologies, which is a necessary step to achieve semantic interoperability between EHR systems.

[Reconstruction of medial collateral ligament: Description of a new augmentation technique with allograft and interference biocomposite screws]. / Reconstrucción de ligamento colateral medial: descripción de una nueva técnica de aumentación con aloinjerto y tornillos biocompuestos interferenciales.

INTRODUCTION: Medial Collateral Ligament (LCM) instability is associated with multi-ligamentary lesions. There are several procedures for the reconstruction of MCL, we present a percutaneous technique of augmentation. Our goal is to describe a new technique of reconstruction of the LCM by grafting and fixing with biocomposite screws. MATERIAL AND METHODS: We present the technique in a total of 21 consecutive patients with MCL injury operated in the period of December 2011 to October 2014. Reconstruction of MCL was performed with long, tibial or long hallux tendon allografts in 18 patients and only one patient was used autograft. Eighteen of the 20 patients had associated lesions: 5 with medial meniscus injury, 8 with anterior cruciate ligament injury, (ACL), 8 with condral injury and 1 with lateral meniscus injury. CONCLUSION: The surgical technique presented is simple to perform, without damage to other structures and with a strong fixation.

INTRODUCCIÓN: La inestabilidad del ligamento colateral medial (LCM) se asocia con lesiones multiligamentarias. Existen varios procedimientos para la reconstrucción del LCM, presentamos una técnica percutánea de aumentación. Nuestro objetivo es describir una nueva técnica de reconstrucción del LCM mediante injerto y fijación con tornillos biocompuestos. MATERIAL Y MÉTODOS: Presentamos la técnica en un total de 21 pacientes consecutivos con lesión del LCM operados en el período de Diciembre de 2011 a Octubre de 2014. La reconstrucción del LCM se realizó con aloinjertos del tendón del peroneo largo, tibial posterior o flexor largo del Hallux en 18 pacientes y solamente en un paciente se utilizó autoinjerto. De los 20 pacientes, 18 presentaron lesiones asociadas: cinco con lesión de menisco medial, ocho con lesión del ligamento cruzado anterior, (LCA), ocho con lesión condral y uno con lesión del menisco lateral. CONCLUSIÓN: La técnica quirúrgica presentada es sencilla de realizar, sin daño a otras estructuras y con una fijación resistente.

Implementation of an Execution Engine for SNOMED CT Expression Constraint Language.

The need to achieve high levels of semantic interoperability in the health domain is regarded as a crucial issue. Nowadays, one of the weaknesses when working in this direction is the lack of a coordinated use of information and terminological models to define the meaning and content of clinical data. IHTSDO is aware of this problem and has recently developed the SNOMED CT Expression Constraint Language to specify subsets of concepts. In this paper, we describe an implementation of an execution engine of this language. Our final objective is to allow advanced terminological binding between archetypes and SNOMED CT as a fundamental pillar to get semantically interoperable systems. The execution engine is available at http://snquery.veratech.es.

Publication, discovery and interoperability of Clinical Decision Support Systems: A Linked Data approach.

BACKGROUND: The high costs involved in the development of Clinical Decision Support Systems (CDSS) make it necessary to share their functionality across different systems and organizations. Service Oriented Architectures (SOA) have been proposed to allow reusing CDSS by encapsulating them in a Web service. However, strong barriers in sharing CDS functionality are still present as a consequence of lack of expressiveness of services' interfaces. Linked Services are the evolution of the Semantic Web Services paradigm to process Linked Data. They aim to provide semantic descriptions over SOA implementations to overcome the limitations derived from the syntactic nature of Web services technologies. OBJECTIVE: To facilitate the publication, discovery and interoperability of CDS services by evolving them into Linked Services that expose their interfaces as Linked Data. MATERIALS AND METHODS: We developed methods and models to enhance CDS SOA as Linked Services that define a rich semantic layer based on machine interpretable ontologies that powers their interoperability and reuse. These ontologies provided unambiguous descriptions of CDS services properties to expose them to the Web of Data. RESULTS: We developed models compliant with Linked Data principles to create a semantic representation of the components that compose CDS services. To evaluate our approach we implemented a set of CDS Linked Services using a Web service definition ontology. The definitions of Web services were linked to the models developed in order to attach unambiguous semantics to the service components. All models were bound to SNOMED-CT and public ontologies (e.g. Dublin Core) in order to count on a lingua franca to explore them. Discovery and analysis of CDS services based on machine interpretable models was performed reasoning over the ontologies built. DISCUSSION: Linked Services can be used effectively to expose CDS services to the Web of Data by building on current CDS standards. This allows building shared Linked Knowledge Bases to provide machine interpretable semantics to the CDS service description alleviating the challenges on interoperability and reuse. Linked Services allow for building 'digital libraries' of distributed CDS services that can be hosted and maintained in different organizations.

Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.

Computer assisted surgery. Its usefulness in different levels of pre-operative deformities.

OBJECTIVE: To compare the results obtained with computer assisted surgery with conventional techniques and evaluate the influence of navigation at different levels of preoperative deformity. MATERIAL AL METHOD: A retrospective study was conducted on 100 cases with primary total knee arthroplasty performed with conventional or computer assisted surgery. A comparison was made of the post-operative mechanical axis of the lower limb between both groups and in terms of pre-operative deformity. RESULTS: Optimal alignment is most often obtained by using the navigation system (62%) than by a conventional technique (36%). Patients with deformities under 10° varus showed a mean post-operative alignment within the optimal range (0±3° deviation from the neutral mechanical axis), while those with more than 15° of varus show an alignment out of range, regardless of the technique used (p=.002). In those with a deformity of between 10 and 15° of pre-operative varus alignment, values were found closer to the neutral axis in the navigation group (178.7°) than in the conventional technique (175.5°), although these differences are not statistically significant (p=.127). CONCLUSION: Post-operative alignment obtained with navigation is better than with the conventional technique, with a smaller percentage of cases out of range, and greater accuracy in placing implants. A potential benefit was observed in navigation for cases with deformities of between 10 and 15° of varus.

Relación entre asma premenstrual y empeoramiento de síntomas otorrinolaringológicos en mujeres con asma / Relationship between premenstrual asthma and premenstrual worsening of otorhinolaryngological symptoms in women asthma

Objetivo: Analizar si existe empeoramiento de síntomas otorrinolaringológicos (rinorrea, obstrucción nasal y disfonía) en (..) (AU)

Objective: To analyse if there is worsening of several otorhinolaryngological sypmtoms (..) (AU)

Association between modelled traffic-related air pollution and asthma score in the ECRHS.

The aim of our analysis was to study the association between air pollution and asthma among adults. For this goal, a previously developed "asthma score" was used. Persons aged 25-44 yrs were randomly selected (1991-1993) and followed up (2000-2002) within the European Community Respiratory Health Survey (ECRHS I and II, respectively). The asthma score was defined from 0 to 5, based on the positive answers to the following symptoms reported for the last 12 months: wheeze/breathlessness, chest tightness, dyspnoea at rest, dyspnoea after exercise and woken by dyspnoea. Participants' home addresses were linked to outdoor modelled NO2 estimates for 2001. Negative binomial regression was used to model the asthma score. The score from ECRHS II was positively associated with NO2 (ratio of the mean asthma score (RMS) 1.23, 95% CI 1.09-1.38, for an increase of 10 microg x m(-3)). After excluding participants with asthma and symptoms at baseline, the association remained (RMS 1.25, 95% CI 1.05-1.51), and was particularly high among those reporting a high score in ECRHS II. The latter probably reflects incident cases of asthma. Our results suggest that traffic-related pollution causes asthma symptoms and possibly asthma incidence in adults. The asthma score offers an alternative with which to investigate the course and aetiology of asthma in adults.

Evaluación de los valores de la Proteína C Reactiva y su relación con la tensión arterial en una población fumadora y no fumadora / Evaluation of C-Reactive Protein values and their relationship with blood pressure in a smoking and

Introducción: La PCR es un reactante de fase aguda sintetizado en el hígado que se asocia con una disminución de la relajacióndel endotelio vascular, con la incidencia de hipertensión arterial y parece ser predictor de riesgo cardiovascular.Objetivo: Determinar la relación de los valores de proteína C reactiva (PCR) y las cifras de tensión arterial (TA), y observar si están influidos por el hábito tabáquico. Observar si el tabaco ocasiona una respuesta inflamatoria evaluable mediante PCR en suero en la población en estudio, y si ésta se relaciona con las cifras de TA.Material y método: Se evaluaron 228 pilotos aéreos, todos hombres, se recogió la historia de tabquismo, se determinó en suero al PCR y se practicaron tomas de TA. Se analizaron los datos según fueran fumadores (97) o no (131). Se calculó la correlación entre PCR y las cifras de TA sistólica y diastólica mediante la Rho de Sperman y R de Pearson. Seconsideraron diferencias significativas para una p < 0,05.Resultados: Las edades medias fueron de 46,97 años (fumadores) y 46,80 años (no fumadores). Los niveles de PCR fueron 2,55 (± 1,86) mg/l en fumadores y de 1,55 (± 1,14) mg/l en no fumadores (p < 0,001). La cifra de tensión arterial sistólica 124,93 (± 12,71) mm Hg en fumadores y 127,06 (± 13,64) mmHg en no fumadores y de diastólica 76,89 (± 8,30) mmHg en fumadores y 77,52 (± 8,92) mmHg en no fumadores. Se ha encontrado una leve correlación positiva entre la PCR y la TA diastólica sólo en fumadores activos (r = 0,21, p < 0,03).Conclusión: Encontramos una correlación significativa entre los valores de PCR y TA diastólica sólo en fumadores, lo que sugiere una posible influencia del tabaquismo sobre la elevación de la TA mediado por un mecanismo inflamatorio

Introduction: C-reactive protein (CRP) is a synthesized acute phase reactant in the liver associated with a decrease of vascular endothelial and relaxation, with the incidence of arterial hypertension and seems to be a predictor of cardiovascularrisk.Objective: Determine the relationship of the C-reactive protein values and blood pressure (BP) values and observe if they are influenced by the smoking habit. Observe if tobacco causes an evaluable inflammatory response by CRP in serum in the study population, and if it is related with the BP values.Material and methods: A total of 228 airline pilots, all men, were evaluated. Their history of smoking was collected and CRP was measured in serum. Blood pressure was obtained. Data were analyzed according to whether they were smokers (97) or not (131). Correlation was calculated between CRP and systolic and diastolic BP values using Sperman Rho and Pearson's R. Significant differences were considered for a p < 0.05.Results: Mean ages were 46.97 years (smokers) and 46.80 years (non-smokers). CRP levels were 2.55 (± 1.86) mg/l in smokers and 1.55 (± 1.14) mg/l in non-smokers (p < 0.001). Systolic blood pressure value was 124.93 (± 12.71) mm Hg in smokers and 127.06 (± 13.64) mmHg in non-smokers and diastolic 76.89 (± 8.30) mmHg in smokers and 77.52 (± 8.92) mmHg in non-smokers. A mild positive correlation was found between CRP and diastolic BP only in active smokers (r =0.21, p < 0.03). Conclusion: We found a significant correlation between the CRP values and diastolic BP only in smokers. This suggestsa possible influence of smoking on the elevation of BP mediated by an inflammatory mechanismlll_lo (AU)

Influencia del tabaco sobre la Proteína C Reactiva en una población aparentemente sana / Influence of tobacco on C-reactive protein in an apparently healthy population

Introducción: Es nuestro objetivo determinar en qué medida el tabaco induce elevación de Proteína C Reactiva (PCR) en suero y definir el riesgo relativo de enfermedad inflamatoria subyacente en la población fumadora según los valores publicados por The Centers for Diseases Control and Prevention y la American Heart Association.Material y métodos: El presente estudio se ha llevado a cabo en una muestra sana masculina de 544 individuos, formada por personal aeronáutico cuyas edades se sitúan entre los 19 y los 60 años, media de 40 años con desviación típica de 10. De los 544 pilotos, 344 eran no fumadores y 200 fumadores. La PCR se determinó mediante el test ultrasensible.Resultados: La concentración sérica media en individuos no fumadores es de 1,6 mg/l (Intervalo de Confianza 95%: 1,4-1,7), mientras que en fumadores es de 2,09 mg/l (Intervalo de Confianza 95%: 1,9-2,3). El 65,5% de la población fuma-dora obtenía una PCR > 1 mg/l frente al 51,5% de la población no fumadora. Los fumadores tenían 27,3% más riesgo de presentar una PCR sérica superior a 1 mg/l (Riesgo Relativo: 1,273; Intervalo de Confianza 95%: 1,103-1,470) que los no fumadores.Discusión: La PCR es un buen marcador de inflamación, pudiendo utilizarse como factor predictivo de riesgo cardiovascular y de alteración broncopulmonar.Conclusiones: Se puede estimar el valor de 1,2 mg/l para la PCR en suero como referencia en una población masculina adulta sana. La edad y sobrepeso son factores que afectan a la relación entre tabaquismo y PCR sérica, pero es el consumo de tabaco el principal factor determinante de una elevación de la PCR

Introduction: We aim to determine up to what degree tobacco induces and elevation of C-reactive protein (CRP) in serum and define the relative risk of underlying inflammatory disease in the population that smokes according to the values published by the Centers for Diseases Control and Prevention and the American Heart Association.Material and methods: The present study was conducted in a healthy male sample of 544 individuals made up of aeronautic personnel whose ages ranged from 19 to 60 years, with a mean of 40 years and standard deviation of 10. A total of 344 out of the 544 pilots did not smoke and 200 smoked. The CRP was measured with the ultrasensitive test.Results: The means serum concentration in subjects who did not smoke was 1.6 mg/l (95% Confidence Interval: 1.4-1.7) while it was 2.09 mg/l (95 % Confidence Interval: 1.9-2.3) in those who smoked. A total of 65.5% of the population who smoked obtained a CRP > 1 mg/l versus 51.5% of the population who did not smoke. Those who smoked had 27.3% more risk of having a serum CRP value greater than 1 mg/l (Relative Risk: 1.273; 95% Confidence Interval: 1.103-1.470) than those who did not smoke.Discussion: CRP is a good marker of inflammation and can be used as a predictive factor of cardiovascular risk andbronchopulmonary disorder.Conclusions: The value of 1.2 mg/l for CRP in serum can be estimated as reference in a healthy adult masculine population. Age and overweightness are factors that affect the relationship between smoking and serum CRP. However tobacco consumption is the main determining factor of an increase in CRP (AU)

Estudio de la proteína C reactiva como marcador sérico de riesgo cardíaco en varones adultos sanos / No disponible

Objetivo. El objetivo de este estudio es establecer valores de referencia para las concentraciones de proteína C-reactiva (PCR) en suero en adultos sanos y sin hábitos tóxicos, tomando en consideración las repercusiones de la edad. Material y métodos. La muestra incluía a 238 varones sanos que pasaron por estudios clínicos y analíticos y psicotécnicos. Las concentraciones en suero de PCR fueron determinadas usando US de prueba (látex) de PCR de immunoturbidimetric ultrasensible, realizándose un estudio descriptivo y dos estudios analíticos. Resultados. La concentración media de PCR en suero fue de 1,5 mg/L (95% CI; 1,35-1,69miligramos/L). La tendencia de PCR tiende a aumentar con la edad. En nuestra muestra, de los individuos menores de 40 años, el 61,5%, tenían valores inferiores a 1 mg/L, mmientras que un 62,9% de los mayores de 40 años tenían niveles más altos. Cuando los valores de concentración de suero eran superiores a 3 mg/L, no encontramos ninguna relación estadística con la edad. Conclusiones. 1. El riesgo de tener concentraciones de PCR superiores a 1 mg/L después de los 40 años es 2,71 veces superior. 2. El 13,8% de nuestra población de estudio aparentemente sana tenía valores más altos de 3 mg/L, indicando riesgo cardiovascular alto

Obejctive. The aim of this study was to stablish reference values for C-reactive protein (CRP)concentrations in serum in healthy adults with no toxic habits, taking into consideration the repercussions of age. Material and Methods. The sample included 238 healthy males who underwent clinical, a nalytical and psychotechnical studies. Serum concentrations of CRP were determined using the ultra-sensitive immunoturbidimetric CRP test (Latex) US, and a descriptive study and two analytical studies were carried out. Results. Mena serum concentration of CRP was 1.5 mg/L (95% CI; 1,35-1,69 mg/L). CRP tends to increase with age. Inour subjects under the age of 40, 61,5% has values less than 1 mg/L, while 62,9% of those over the age of 40 had higher levels. When the serum concentration values were higher than 3 mg/L, we found no statistical relationship with age. Conclusions. 1. The risk of having CRP concentrations higher than 1 mg/L after the age of 40 was, 2,71 times greater. 2. 13,8% of our apparently healthy study population had values higher than 3 mg/L, indicating high cardiovascular risk

Concentración sérica de proteína C reactiva en varones adultos sanos / No disponible

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[Association between the forced midexpiratory flow/forced vital capacity ratio and bronchial hyperresponsiveness]. / Asociación entre el cociente FEF(25-75%)/FVC y la hiperreactividad bronquial.

OBJECTIVE: A long-standing hypothesis is that a low ratio of airway caliber to lung size is associated with bronchial hyperresponsiveness (BHR). The aim of our study was to measure the association between airway caliber relative to lung size (expressed as the ratio between forced expiratory flow, midexpiratory phase, divided by forced vital capacity [FEF(25%-75%)/FVC]) and BHR measured by a methacholine challenge test, adjusting for age, height, sex, smoking history, geographic area, respiratory symptoms, and baseline forced expiratory volume in 1 second (FEV1). MATERIAL AND METHODS: We carried out a multicenter cross-sectional study of the general Spanish population in 2647 subjects from the European Community Respiratory Health Survey (ECRHS I). The ECRHS questionnaire was administered, total and specific immunoglobulin E were measured, and skin tests, spirometry, and a methacholine challenge test were performed. RESULTS: We show the relationship of the various clinical and sociodemographic variables with the 2 parameters indicative of a positive methacholine test. The lower the FEF(25%-75%)/FVC ratio was, the greater the risk of HRB, after adjustment for variables (odds ratio [OR]=0.09; 95% confidence interval [CI], 0.04-0.018 for the concentration provoking a 20% decrease in FEV1, and OR=0.06; 95% CI, 0.03-0.12 for the dose provoking a 20% decrease in FEV1). CONCLUSIONS: There is a significant association between the FEF(25%-75%)/FVC ratio and BHR after adjustment for age, atopy, smoking, geographic area, respiratory symptoms, and initial FEV1.

Trombosis venosa profunda asociada a neumonía varicelosa y anticuerpos anticardiolipina / Deep vanous thrombosis associated with varicella pneumonia and anticardiolipin antibody

No disponible

Incidence of asthma and its determinants among adults in Spain.

The objective was to measure the incidence of asthma and its determinants in Spain, where the prevalence of asthma is low to medium. A follow-up of subjects participating in the European Community Respiratory Health Survey (ECRHS) was conducted in 1998- 1999 (n = 1,640, 85% of those eligible). Subjects were randomly selected from the general population and were 20 to 44 yr old in 1991-1993. Time of follow-up was on average 6.75 yr (range, 5.3 to 7.9 yr). Asthma was defined as reporting ever having had asthma. The incidence of asthma was 5.53 (95% confidence interval, 4.28- 7.16) per 1,000 person-years (6.88 in females, 4.04 in males). Incidence was highest in subjects who at the baseline survey had bronchial hyperresponsiveness (incidence rate ratio [IRR], 3.85), in those with positive IgE against timothy grass (IRR, 3.16), and in females (IRR, 1.80). These results persisted after adjusting for respiratory symptoms at baseline. There was no significant association (p < 0.2) with high total serum IgE, atopy defined by reactivity to any allergen, smoking, occupational exposure, or maternal asthma. A sensitivity analysis using four definitions of population at risk yielded incidence rates varying from 5.53 to 1.50. In this population of subjects without self-reported asthma or asthma-type symptoms at baseline, bronchial hyperresponsiveness and IgE reactivity to grass appeared as the main determinants of new asthma.

[Factors associated with the development of atopy in young adults]. / Factores asociados al desarrollo de atopia en adultos jóvenes.

BACKGROUND: To determine the risk factors for the development of atopy in Spanish young adults. SUBJECTS AND METHODS: Case-control study over prevalent cases. Carried out in general population between the ages of 20 to 44 years old. Spanish participants of the ECRHS, a random representative sample of Spanish young adults (n = 16,884), and a 20% randomised subsample made by those who answered to a short respiratory questionnaire and had atopy assessed, was studied. Atopy was defined as having serum specific IgE positivity to the following aeroallergnes: cat dander, Cladosporium herbarum, Dermatophagoides pteronyssinus, Parietaria judaica and Phleum pratense. RESULTS: Several factors had a statistically significant effect. In addition to male gender and lower age, maternal allergy (OR = 1.63; 95% CI = 1.11-2.40), having allergic siblings (OR = 1.40; 95% CI = 1.06-1.90) and a higher educational level (OR = 1.69; 95% CI = 1.22-2.34) were associated with the presence of high levels of specific IgE in our sample. Moreover, having had older siblings, especially older brothers appears to be a protective factor to the development of atopy but not in a statistically significant way, while having had pet birds during childhood appears to enhance the risk. CONCLUSIONS: In addition to the familial variables that indicates both environmental and genetic factors, educational level seems to have low degree of association with atopy; this feature shows that variables related with life style are involved in atopy development.

Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD.

STUDY OBJECTIVES: To investigate the possible relationship between functional respiratory impairment measured by FEV1 and isolation of diverse pathogens in the sputum of patients with exacerbations of COPD. DESIGN: Multicenter, cross-sectional, epidemiologic study. SETTING: Pneumology units in six secondary or tertiary hospitals in Spain. PATIENTS: Ninety-one patients with acute exacerbation of COPD were included. INTERVENTIONS: A quantitative sputum culture was performed, and bacterial growth was considered significant only when the germ was isolated at concentrations > 10(6) cfu (> 10(5) for Streptococcus pneumoniae) in samples with < 10 epithelial cells and > 25 leukocytes per low magnification field (x 100). RESULTS: Germs isolated were the following: Haemophilus influenzae (20 cases; 22%), Pseudomonas aeruginosa (14 cases; 15%), S. pneumoniae (9 cases; 10%), Moraxella catarrhalis (8 cases; 9%), other gram-negative bacteria (7 cases; 7%), and non-potentially pathogenic microorganisms (non-PPMs; 33 cases; 36%). P. aeruginosa and H. influenzae were isolated more frequently among the patients with FEV1 < 50% than among those with FEV1 > 50% (p < 0.05). All patients with P. aeruginosa in sputum had FEV1 < 1,700 mL. FEV1 < 50% was associated with a very high risk of P. aeruginosa or H. influenzae isolation: the odds ratios (ORs) are 6.62 (95% confidence interval [CI], 1.2 to 123.6) and 6.85 (95% CI, 1.6 to 52.6), respectively. Furthermore, active tobacco smoking was associated with a high risk of H. influenzae isolation (OR, 8.1; 95% CI, 1.9 to 43.0). CONCLUSIONS: Patients with the greatest degree of functional impairment, as measured by their FEV1, presented a higher probability of having an isolation of P. aeruginosa or H. influenzae in significant concentrations in sputum during an exacerbation. The diagnostic yield of sputum in patients with an FEV1 > 50% was low, with a predominance of non-PPMs. Low FEV1 and active tobacco smoking are data that should be considered when establishing an empiric antibiotic treatment for exacerbated COPD.