Case Series Study of Invasive Pulmonary Aspergillosis.

Diagnosis of invasive pulmonary aspergillosis (IPA) is challenging. The objective of the study was to assess the value of microbiological tests to the diagnosis of IPA in the absence of non-specific radiological data. A retrospective study of 23 patients with suspicion of IPA and positivity of some microbiological diagnostic tests was performed. These tests included conventional microbiological culture, detection of Aspergillus galactomannan (GM) antigen and in some patients (1 â†’ 3)-ß-D-glucan (BDG) and Aspergillus fumigatus DNA using the LightCycler® SeptiFast test. In 10 patients with hematological malignancy, 6 cases were considered 'probable' and 4 'non-classifiable.' In 8 patients with chronic lung disease, 7 cases were classified as 'probable' and 1 as 'proven,' and in 5 patients with prolonged ICU stay (>7 days), there were 2 'proven' cases, 2 'non-classifiable' and 1 putative case. Microbiological culture was positive in 17 cases and 18 Aspergillus spp. were isolated (one mixed culture). A. fumigatus was the most frequent (44.4%) followed by A. tubingensis. The Aspergillus galactomannan (GM) antigen assay was positive in 21 cases (91.3%). The GM antigen and the (1 â†’ 3)-ß-D-glucan (BDG) assays were both performed in 12 cases (52.2%), being positive in 9. The SeptiFast test was performed in 7 patients, being positive in 4. In patients with non-classifiable pulmonary aspergillosis and one or more positive microbiological tests, radiological criteria may not be considered a limiting factor for the diagnosis of IPA.

Derrame pleural eosinofílico secundario a síndrome hipereosinofílico idiopático / Eosinophilic pleural effusion as a manifestation of idiopathic hypereosinophilic syndrome

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Long-term continuous positive airway pressure compliance in females with obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea (OSA), but compliance and variables involved in long-term CPAP adherence in females with OSA are unknown. We performed an observational study including all consecutive females diagnosed with CPAP who started CPAP treatment in two Spanish teaching hospitals between 1999 and 2007 and were followed-up until December 2010. The Kaplan-Meier method was used to calculate the probability of continuing with CPAP treatment and a multivariate Cox regression analysis was used to identify baseline predictors of CPAP dropout. We analysed 708 females, median (interquartile range) age 60 (52-67) years and apnoea-hypopnoea index 43.0 (27.2-66.8). Females were followed for a median of 6.2 (4.2-7.7) years. The probability of still being on CPAP at 5 and 10 years was 82.8% and 79.9%, respectively. The median CPAP use was 6 (interquartile range 4-7) h · day(-1). In the multivariate analysis, independent baseline predictors of CPAP dropout were psychoactive medication (hazard ratio 1.47, 95% CI 1.03-2.08), age (hazard ratio 1.01, 95% CI 1.00-1.03) and CPAP pressure (hazard ratio 0.89, 95% CI 0.81-0.96). Long-term CPAP adherence in females with OSA is good. Psychoactive medication and increasing age were independent predictors of CPAP dropout, whereas higher CPAP was associated with continued treatment.

Características cardiovasculares y clínicas de los pacientes con apneas obstructivas del sueño sin somnolencia diurna excesiva / Clinical Ans Cardiovascular Characteristics of Patients with Obstructive Sleep Apnoeas without Excessive Daytime Sleepiness

ObjetivosInvestigar si los pacientes con apneas obstructivas del sueño (AOS) sin somnolencia diurna excesiva (SDE) presentan problemas cardiovasculares y características clínicas diferentes de los AOS con SDE.MétodosSe compararon retrospectivamente dos grupos de pacientes con AOS, uno de ellos sin SDE (Epworth <11) y otro control con SDE (Epworth>10), ajustados por sexo, edad, índice de masa corporal (IMC) e índice de apneas-hipopneas (IAH). Se analizaron síntomas diurnos y nocturnos de AOS, variables polisomnográficas, prevalencia de hipertensión arterial, diabetes mellitus, hiperlipemia y antecedentes de eventos cardiovasculares previos. Se realizó una regresión logística ajustada por múltiples factores de confusión para identificar variables asociadas al AOS sin SDE.ResultadosSe estudiaron 166 pacientes sin SDE (Epworth 7,2±2,4) y 295 con SDE (Epworth 14,5±2,5). En la regresión logística multiajustada, el AOS sin SDE se asoció de forma independiente con sensación de sueño reparador (IC95% 1,70 a 3,93), menor deterioro intelectual (IC95% 0,30 a 0,95) y menor eficacia del sueño (IC95% 0,96 a 0,99). No se encontraron diferencias en cuanto a prevalencia de comorbilidades cardiovasculares, eventos cardiovasculares previos, estructura de sueño o clínica nocturna de AOS. Cuando se analizaron los pacientes que se encontraban en los cuartiles extremos del Epworth, los resultados obtenidos fueron superponibles a los del total de la serie, desapareciendo únicamente el deterioro intelectual del modelo final.ConclusionesTras ajustar por variables de confusión, el AOS sin SDE tiene una prevalencia similar de comorbilidades cardiovasculares y menor sintomatología diurna que el AOS con SDE(AU)

ObjectivesTo investigate whether patients with obstructive sleep apnoea (OSA) without excessive daytime sleepiness (EDS) have cardiovascular problems and different clinical characteristics from OSA with EDS.MethodsTwo groups of patients were compared retrospectively, one without EDS (Epworth <11) and another control group with EDS (Epworth>10), adjusted for sex, age, body mass index (BMI) and apnoea-hypopnoea index (AHI). The diurnal and nocturnal symptoms of OSA were analysed along with, polysomnography variables, prevalence of hypertension, diabetes mellitus, hyperlipaemia and history of previous cardiovascular events. A logistic regression was performed adjusted for multiple confounding factors to identify the variables associated with OSA without EDS.ResultsA total of 166 patients without EDS were studied (Epworth 7.2±2.4) and 295 with EDS (Epworth 14.5±2.5). In the adjusted multivariate logistic regression, OSA without EDS is independently associated with a feeling of restful sleep (95% CI: 1.70 to 3.93), less intellectual deterioration (95% CI: 0.30 to 0.95) and less effective sleep (95% CI: 0.96 to 0.99). No differences were found as regards prevalence of cardiovascular comorbidity, previous cardiovascular events, sleep structure or nocturnal clinical symptoms of OSA. When the patients who were in the extreme quartiles of the Epworth scale were analysed, the results obtained were equivalent to those of the whole series, with only intellectual deterioration disappearing from the final model.ConclusionsAfter adjusting for confounding variables, OSA without EDS has a similar prevalence of cardiovascular comorbidities and less diurnal symptoms than OSA with EDS(AU)

[Clinical and cardiovascular characteristics of patients with obstructive sleep apnoeas without excessive daytime sleepiness]. / Características cardiovasculares y clínicas de los pacientes con apneas obstructivas del sueño sin somnolencia diurna excesiva.

OBJECTIVES: To investigate whether patients with obstructive sleep apnoea (OSA) without excessive daytime sleepiness (EDS) have cardiovascular problems and different clinical characteristics from OSA with EDS. METHODS: Two groups of patients were compared retrospectively, one without EDS (Epworth <11) and another control group with EDS (Epworth>10), adjusted for sex, age, body mass index (BMI) and apnoea-hypopnoea index (AHI). The diurnal and nocturnal symptoms of OSA were analysed along with, polysomnography variables, prevalence of hypertension, diabetes mellitus, hyperlipaemia and history of previous cardiovascular events. A logistic regression was performed adjusted for multiple confounding factors to identify the variables associated with OSA without EDS. RESULTS: A total of 166 patients without EDS were studied (Epworth 7.2±2.4) and 295 with EDS (Epworth 14.5±2.5). In the adjusted multivariate logistic regression, OSA without EDS is independently associated with a feeling of restful sleep (95% CI: 1.70 to 3.93), less intellectual deterioration (95% CI: 0.30 to 0.95) and less effective sleep (95% CI: 0.96 to 0.99). No differences were found as regards prevalence of cardiovascular comorbidity, previous cardiovascular events, sleep structure or nocturnal clinical symptoms of OSA. When the patients who were in the extreme quartiles of the Epworth scale were analysed, the results obtained were equivalent to those of the whole series, with only intellectual deterioration disappearing from the final model. CONCLUSIONS: After adjusting for confounding variables, OSA without EDS has a similar prevalence of cardiovascular comorbidities and less diurnal symptoms than OSA with EDS.

Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure.

STUDY OBJECTIVES: The aims of this study were to analyze mortality in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) treated with positive airway pressure (PAP) and to know whether PAP compliance affects survival, as well as to investigate the prognostic value of several pretreatment variables. DESIGN AND PATIENTS: A study was made of an historical cohort of 871 patients in whom OSAHS had been diagnosed by sleep study between January 1994 and December 2000 and who had been treated with PAP. Patients were followed up until December 2001. The mean (+/- SD) age of the group was 55.4 +/- 10.6 years, the mean apnea-hypopnea index (AHI) 55.1 +/- 28.7, and 80.9% were men. To assess whether mortality was influenced by PAP therapy compliance, patients were assigned to one of the following compliance categories: < 1 h/d; 1 to 6 h/d; or > 6 h/d. Survival rates were calculated according to the Kaplan-Meier method. Survival curves were compared with the log-rank test and the trend test, when necessary. Univariate and multivariate analyses using a time-dependent Cox model were performed to elicit which variables correlated with mortality. SETTING: Outpatient sleep disorders unit. RESULTS: By the end of the follow-up period (mean duration, 48.5 +/- 22.7 months), 46 patients had died. The 5-year cumulative survival rates were significantly lower in patients who did not use PAP (compliance < 1 h) than in those who used the device for > 6 h/d (85.5% [95% confidence interval (CI), 0.78 to 0.92] vs 96.4% [95% CI, 0.94 to 0.98; p < 0.00005]) and 1 to 6 h/d (85.5% [95% CI, 0.78 to 0.92] vs 91.3% [ 95% CI, 0.88 to 0.94; p = 0.01]), respectively. A trend in survival rates across the groups was identified (p = 0.0004). The main cause of death in 19 cases was cardiovascular disease (CVD). Variables that independently correlated with mortality in the multivariate analysis were the following PAP use categories: compliance for > 6 h/d (odds ratio [OR], 0.10; 95% CI, 0.04 to 0.29); compliance for 1 to 6 h/d (OR, 0.28; 95% CI, 0.11 to 0.69); arterial hypertension (AHT) [OR, 3.25; 95% CI, 1.24 to 8.54]; age (OR, 1.06; 95% CI, 1.01 to 1.10); and FEV1 percent predicted (OR, 0.96; 95% CI, 0.94 to 0.98). CONCLUSION: Mortality rates in OSAHS patients who did not receive PAP therapy were higher compared with those treated with PAP and were moderately or highly compliant with therapy. A trend in survival across compliance categories was found. Patients died mainly from CVD. Categories of PAP compliance, AHT, age, and FEV1 percent predicted were the variables that independently predicted mortality.