Valoración ecográfica de la dinámica diafragmática en pacientes con enfermedad pulmonar obstructiva crónica tras tratamiento con indacaterol/glicopirronio / Ultrasound assessment of diaphragmatic dynamics in patients with chronic obstructive pulmonary disease after treatment with indacaterol/glycopyrronium

Introduction Air trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to a change in the normal diaphragmatic configuration with associated functional impairment. Said deterioration improves with bronchodilator therapy. Chest ultrasound (CU) has been used to assess changes in diaphragmatic motility after short-acting bronchodilator therapy, but there are no previous studies on these changes after long-acting bronchodilator treatment. Material and methods Interventional prospective study. Patients with COPD and moderate to very severe ventilatory obstruction were included in the study. Diaphragm motion and thickness were assessed by CU before and after 3 months of treatment with indacaterol/glycopirronium 85/43 mcg. Results Thirty patients were included (56.6% men, mean age: 69.4 ± 6.2 years). Pre- and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9 ± 7.1 mm and 26.4 ± 8.7 mm (p < 0.0001); 42.5 ± 14.1 mm and 64.5 ± 25.9 mm (p < 0.0001); and 36.5 ± 17.4 mm and 46.7 ± 18.5 mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). Conclusions Treatment with indacaterol/glycopyrronium 85/43 mcg every 24 hours for 3 months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients (AU)

Introducción El atrapamiento aéreo en la enfermedad pulmonar obstructiva crónica (EPOC) es uno de los principales responsables de la disnea en estos enfermos. Su incremento conlleva que el diafragma pierda su configuración habitual y se afecte así su funcionalidad, la cual parece mejorar tras la administración de terapia broncodilatadora. La ecografía torácica (ET) se ha utilizado para evaluar estos cambios tras el uso de broncodilatadores de acción corta, pero no hay estudios que valoren estas variaciones con el empleo de broncodilatadores de acción larga. Material y métodos Estudio prospectivo intervencionista de 3 meses de seguimiento donde se valoró el movimiento/grosor diafragmático con ET antes y después del inicio del tratamiento con indacaterol/glicopirronio 85/43 mcg en pacientes EPOC con obstrucción moderada-muy grave al flujo aéreo. Resultados Treinta pacientes fueron incluidos (56,6% hombres, edad media: 69,4 ± 6,2 años). La movilidad diafragmática pre y postratamiento en respiración a volumen corriente, profunda y sniff nasal fue de 19,9 ± 7,1 mm y 26,4 ± 8,7 mm (p < 0,0001), 42,5 ± 14,1 mm y 64,5 ± 25,9 mm (p < 0,0001) y 36,5 ± 17,4 mm y 46,7 ± 18,5 mm (p = 0,012), respectivamente. También existió una mejora significativa en el grosor diafragmático mínimo y máximo (p < 0,05) pero no en la fracción de engrosamiento diafragmático tras tratamiento (p = 0,341). Conclusione El tratamiento con indacaterol/glicopirronio 85/43 mcg cada 24 horas durante 3 meses mejoró la movilidad diafragmática en paciente con EPOC con obstrucción moderada-muy grave al flujo aéreo. La ET puede ser útil en la valoración de la repuesta al tratamiento de estos pacientes (AU)

Ultrasound assessment of diaphragmatic dynamics in patients with chronic obstructive pulmonary disease after treatment with indacaterol/glycopyrronium.

INTRODUCTION: Air trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to a change in the normal diaphragmatic configuration with associated functional impairment. Said deterioration improves with bronchodilator therapy. Chest ultrasound (CU) has been used to assess changes in diaphragmatic motility after short-acting bronchodilator therapy, but there are no previous studies on these changes after long-acting bronchodilator treatment. MATERIAL AND METHODS: Interventional prospective study. Patients with COPD and moderate to very severe ventilatory obstruction were included in the study. Diaphragm motion and thickness were assessed by CU before and after 3 months of treatment with indacaterol/glycopirronium 85/43 mcg. RESULTS: Thirty patients were included (56.6% men, mean age: 69.4 ± 6.2 years). Pre- and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9 ± 7.1 mm and 26.4 ± 8.7 mm (p < 0.0001); 42.5 ± 14.1 mm and 64.5 ± 25.9 mm (p < 0.0001); and 36.5 ± 17.4 mm and 46.7 ± 18.5 mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). CONCLUSIONS: Treatment with indacaterol/glycopyrronium 85/43 mcg every 24 hours for 3 months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients.

Prognostic value of lung ultrasound and its link with inflammatory biomarkers in patients with SARS-CoV-2 infection.

BACKGROUND: Lung ultrasound (LUS) has shown to correlate well with the findings obtained by chest computed tomography (CT) in acute-phase COVID-19. Although there is a significant correlation between blood biomarkers and CT radiological findings, a potential correlation between biochemical parameters and LUS images is still unknown. Our purpose was to evaluate whether mortality can be predicted from either of two lung ultrasound scoring systems (LUSS) as well as the potential association between lung lesions visualised by LUS and blood biomarkers. METHODS: We performed a retrospective observational study on 45 patients aged>70 years with SARS-CoV-2 infection who required hospitalisation. LUS was carried out at admission and on day 7, when the clinical course was favourable or earlier in case of worsening. Disease severity was scored by means of LUSS in 8 (LUSS8) and in 12 (LUSS12) quadrants. LUS and blood draw for inflammatory marker analysis were performed at the same time. RESULTS: LUSS8 vs LUSS12 predicted mortality in 93.3% vs 91.1% of the cases; their associated odds ratios (OR) were 1.67 (95% CI 1.20-2.31) and 1.57 (95% CI 1.10-2.23), respectively. The association between biochemical parameters and LUSS scores was significant for ferritin; the OR for LUSS12 was 1.005 (95% CI 1.001-1.009) and for LUSS8 1.005 (95% CI 1.0-1.1), using thresholds for both of them. CONCLUSIONS: The prognostic capacity of LUSS12 does not surpass that of LUSS8. There is a correlation between ferritin levels and LUSS.

Utilización de los servicios de urgencias en zonas rurales y urbanas / Use of emergency departments in rural and urban areas in Spain

Objetivos: Describir la utilización de los servicios de urgencias (SU) y analizar las diferencias entre zonas rurales y urbanas. Material y métodos: Con la Encuesta Nacional de Salud de los años 2006 y 2011 se describen los perfiles de los pacientes que tienen visitas al SU según tamaño del municipio de residencia y se identifican las variables asociadas con tener una visita a los SU para determinar el efecto del tamaño del municipio de residencia. Resultados: En ambos años, la mayor utilización de SU se observa en las personas que utilizan más Atención Primaria u hospitales, que tienen peor salud autopercibida y estado funcional, con más enfermedades crónicas, de clases sociales más bajas, y de menor edad. Ajustando por el resto de las variables, los residentes en municipios de más habitantes o capitales de provincia tienen una mayor frecuentación de SU que los residentes en municipios más pequeños, que tienen una mayor utilización de SU públicos y no hospitalarios, que los residentes en zonas urbanas. Discusión: Existe una utilización más elevada de los SU por los habitantes de zonas urbanas que no puede justificarse por su peor estado de salud, lo que indicaría no una infrautilización en zonas rurales, sino sobreutilización en zonas urbanas (AU)

Objectives: Describe the use of emergency departments (ED), and analyse the differences in use between residents in rural and urban areas. Material and methods: Using data from the National Health Survey of 2006 and 2011, the profiles of patients with ED visits by population size of place of residence were obtained. The variables associated with making one visit to the ED were also evaluated, in order to determine the effect of the population size of place of residence. Results: A higher use of ED is observed in persons with a higher frequency of use of Primary Care and hospital admissions, and increases with worse self-perceived health and functional status, with more chronic diseases, in people from lower social classes, and younger ages. Adjusting for the other variables, residents in larger cities have a higher use of ED than residents in rural areas, who show a higher use of public and non-hospital based ED, than residents in urban areas. Discussion: There is a higher use of ED by inhabitants of urban areas that cannot be justified by a worst health status of that population. This tends to indicate that the use of ED is not under-used in rural areas, but overused in urban areas (AU)

[Use of emergency departments in rural and urban areas in Spain]. / Utilización de los servicios de urgencias en zonas rurales y urbanas.

OBJECTIVES: Describe the use of emergency departments (ED), and analyse the differences in use between residents in rural and urban areas. MATERIAL AND METHODS: Using data from the National Health Survey of 2006 and 2011, the profiles of patients with ED visits by population size of place of residence were obtained. The variables associated with making one visit to the ED were also evaluated, in order to determine the effect of the population size of place of residence. RESULTS: A higher use of ED is observed in persons with a higher frequency of use of Primary Care and hospital admissions, and increases with worse self-perceived health and functional status, with more chronic diseases, in people from lower social classes, and younger ages. Adjusting for the other variables, residents in larger cities have a higher use of ED than residents in rural areas, who show a higher use of public and non-hospital based ED, than residents in urban areas. DISCUSSION: There is a higher use of ED by inhabitants of urban areas that cannot be justified by a worst health status of that population. This tends to indicate that the use of ED is not under-used in rural areas, but overused in urban areas.

Development and validation of a computer-aided diagnostic tool to screen for age-related macular degeneration by optical coherence tomography.

BACKGROUND: To develop and assess the technical validity of new computer-aided diagnostic software (CAD) for automated analyses of optical coherence tomography (OCT) images for the purpose of screening for neovascular age-related macular degeneration. METHODS: Artificial visual techniques were used to develop the CAD in two steps: normalisation and feature vector extraction from OCT images; and training and classification by means of decision trees. Technical validation was performed by a retrospective study design based on OCT images randomly extracted from clinical charts. Images were classified as normal or abnormal to serve for screening purposes. Sensitivity, specificity, positive predictive values and negative predictive values were obtained. RESULTS: The CAD was able to quantify image information by working in the perceptually uniform hue-saturation-value colour space. Particle swarm optimisation with Haar-like features is suitable to reveal structural features in normal and abnormal OCT images. Decision trees were useful to characterise normal and abnormal images using feature vectors obtained from descriptive statistics of detected structures. The sensitivity of the CAD was 96% and the specificity 92%. CONCLUSIONS: This new CAD for automated analysis of OCT images offers adequate sensitivity and specificity to distinguish normal OCT images from those showing potential neovascular age-related macular degeneration. These results will enable its clinical validation and a subsequent cost-effectiveness assessment to be made before recommendations are made for population-screening purposes.

[Comparison of the effectiveness of two different pharmacologic approaches to prevent intraoperative floppy iris syndrome]. / Comparación de la efectividad de dos estrategias farmacológicas para la prevención del síndrome de iris flácido intraquirúrgico.

OBJECTIVE: To compare the effectiveness of two strategies to prevent the appearance of intraoperative floppy iris syndrome (IFIS) in patients exposed to a-blockers. METHODS: We compared retrospectively the presence and severity of the appearance of IFIS in 29 patients subjected to cataract surgery, establishing two groups of 12 patients (22 eyes) and 17 patients (33 eyes). The strategy applied to group one consisted of suspending the exposure to a-blockers for at least one week prior to the intervention, the topical application of 1% atropine three times a day for two days before the intervention and the use of intracameral lidocaine. The strategy for group two consisted of suspending use of the drug for at least one week before the intervention and the intracameral application at the beginning of surgery of a solution of physiological serum, adrenaline and lidocaine. RESULTS: Six patients from group one showed no evidence of IFIS, 2 exhibited bilateral mild symptoms, 2 bilateral moderate and 2 unilateral severe symptoms of IFIS. In total, 45.5% eyes suffered from IFIS. In group two, only 3 eyes (9.1%) from 2 patients exhibited mild symptoms. Statistical analysis showed a significant difference between both groups (p=0.002). If only those exhibiting moderate and severe symptoms are taken into account the result was highly statistically significant (p=0.0002). CONCLUSION: The study shows a greater statistical effectiveness of the strategy applied to group two compared to the strategy applied to group one (Arch Soc Esp Oftalmol 2009; 84: 549-556).

Obesity and health related quality of life in the general adult population of the Canary Islands.

PURPOSE: To explore the relationship between excess weight and health related quality of life (HRQL) in the general population by means of the EuroQol-5D questionnaire. METHODS: The relationship between excess weight and HRQL was explored by the 2004 Canary Islands Health Survey. Survey participants from 16 years of age and older were classified according to their body mass index (BMI). The relationship between excess weight and the dichotomized EuroQol-5D was examined by multiple logistic regression analysis, adjusting by socio-demographic variables, smoking status, alcohol consumption, and self-reported disease status. RESULTS: People with excess weight were older, less educated, and had more associated diseases than the population without excess weight. Excess weight and HRQL are inversely correlated. Severely obese participants showed EuroQol-5D index scores significantly lower than those of normal weight participants (0.65 vs. 0.87). The adjusted odds ratio for the lower HRQL is 3.17 for severely obese people compared to normal weight people. CONCLUSIONS: Excess weight has a negative impact on HRQL, even for people without chronic diseases. A better understanding of the relationships between excess weight, its associated comorbidities, and HRQL may have important implications for the design and assessment of prevention and treatment strategies.