Caracterización de adultos mayores con diagnóstico de asma bronquial / Description of senior citizens with a diagnosis of bronchial asthma

Fundamento: el asma en el anciano es difícil de diagnosticar, debido a la mala percepción de la limitación al flujo aéreo, la aceptación de la disnea como algo común a una edad avanzada, forma y actividad física disminuida, además de la presencia de comorbilidades con otras enfermedades o factores de riesgo asociados. Objetivo: caracterizar pacientes adultos mayores con diagnóstico de asma bronquial, atendidos en el hospital clínico quirúrgico provincial Amalia Simoni, de Camagüey, durante el año 2016. Métodos: se realizó un estudio descriptivo transversal de una muestra de 62 gerontes de entre 60 y 79 años, con diagnóstico clínico y espirométrico de asma bronquial, que acudieron a las consultas de neumología y medicina interna del hospital y durante el período de tiempo antes declarados. Resultados: prevalecieron los adultos mayores entre 60 y 69 años (67,7 por ciento); el sexo femenino (61,3 por ciento); elevado índice de alteraciones radiológicas, electrocardiográficas y ecocardiográficas, coincidente con la frecuencia de otras enfermedades con el asma bronquial, en este grupo poblacional. Las comorbilidades que predominaron fueron el tabaquismo (93,5 por ciento), la enfermedad pulmonar obstructiva crónica (74,2 por ciento), la insuficiencia cardiaca (72,6 por ciento), hipertensión arterial (61,3 por ciento) y diabetes mellitus (56 por ciento). Conclusiones: se caracterizó la muestra de adultos mayores con diagnóstico de asma bronquial incluidos en el estudio(AU)

Background: asthma in the elderly is difficult to be diagnosed, due to the poor perception of air flow limitation, the acceptance of dyspnea as something common at an advanced age, diminished shape and physical activity, as well as the presence of comorbidities with other diseases or associated risk factors. Objective: to describe the elderly patients with a diagnosis of bronchial asthma, attended to at the Amalia Simoni Provincial Medico-Chirurgical Hospital of Camagüey, during 2016. Methods: a cross-sectional descriptive study was carried out with a sample of 62 senior citizens of the 60 to 79 age group, with a clinical and spirometric diagnosis of bronchial asthma, who visited the pulmonology and internal medicine departments of the aforementioned hospital and during the period herein declared. Results: there was a prevalence of elderly patients of 60-69 years old (67,7 percent) and of the female sex (61,3 percent). There was a high index of radiological, electrocardiographic and echocardiographic alterations, coinciding with the frequency of other diseases with bronchial asthma in this population group. The comorbidities that predominated were smoking (93,5 percent), chronic obstructive pulmonary disease (74,2 percent), heart failure (72,6 percent), hypertension (61,3 percent) and diabetes mellitus (56 percent). Conclusions: the study described the sample of senior citizens diagnosed with bronchial asthma(AU)

Adulto con hipoplasia pulmonar / Anadultwithpulmonary hipoplasia

La hipoplasia pulmonar es una enfermedad bronco-pulmonar rara, que es diagnosticada en la infancia. Estos pacientes suelen presentar una amplia gama de síntomas, desde frecuentes infecciones respiratorias hasta dolor y disnea intensa. Sus causas están relacionadas a la invasión del espacio intra-torácico o a las anomalías del tracto urinario. Se hace presentación de un paciente en la edad adulta, con antecedentes de hipertensión arterial y asma bronquial, historia de bronquitis a repetición hasta los 3 años y varias neumonías. Acude a consulta por presentar disnea. A la auscultación se detecta una abolición del murmullo vesicular en la base del pulmón derecho. Se indican complementarios, radiografía de tórax, broncoscopia y tomografía axial computarizada, hasta definir un diagnóstico de hipoplasia pulmonar(AU)

Pulmonary hypoplasia is an uncommon bronchopulmonary disease that is diagnosed during childhood. Patients with this condition usually present with a wide variety of symptoms, ranging from frequent respiratory infections to pain and respiratory dyspnea. Its causes are related to the invasion of the intrathoracic cavity or to anomalies of the urinary tract. This study presents the case of an adult patient with a past medical history of arterial hypertension and bronchial asthma, as well as repeated bronchitis until the age of 3 years and several pneumonias. He presents to the doctors office complaining of dyspnea. On auscultation an abolition of the vesicular breath sound at the base of the right lung is found. Investigations are ordered including chest X-ray, bronchoscopy and CT scan, which confirmed a diagnosis of pulmonary hypoplasia(AU)

Quilotórax bilateral y linfoma simultáneo en dos varones: presentación de dos casos / Bilateral chylothorax and simultaneous lymphoma in two male patients: report of two cases

El quilotórax es una enfermedad grave, más aún si es bilateral y de causa maligna, pero tiene tratamiento y el enfermo puede estabilizarse.Objetivo: presentar dos pacientes de interés médico y demostrar que puede esperarse buena respuesta al tratamiento.Casos Clínicos: se presentaron dos enfermos portadores de quilotórax bilateral y linfoma, ambos varones, atendidos en el hospital de forma simultánea; se realizaron los exámenes complementarios diagnósticos. El diagnóstico en ambos resultó linfoma no Hodgkin y Hodgkin respectivamente, fueron tratados con dieta, se restringieron las grasas; tratamiento oncoespecÍfico y toracocentésis repetidas en ambos hemitórax. El primero, mejorado del derrame bilateral y síntomas inicialmente, fallece a los 11 meses por no control de su enfermedad base. El segundo, estable de ambas afecciones a los 18 meses, en ambos casos el quilotórax se compensó y no fue necesario repetir drenaje. Se hacen análisis comparativo con otros reportes sobre todo cuando el linfoma es la causa etiológica, la conducta adoptada concuerda con otros estudios actuales.Conclusiones: los enfermos mejoraron del quilotórax bilateral, uno no estabilizó su enfermedad de base y murió, mientras el otro está asintomático. Puede obtenerse buena respuesta terapéutica...

Chylothorax is a serious disease, even more if it is bilateral and of a malignant cause; but it has treatment and the patient’s condition may be stable.Objective: to present two patients of medical interest and prove that a good response from the treatment may be expected.Clinical cases: two male patients with bilateral chylothorax and lymphoma were simultaneously attended at the hospital. Complementary diagnostic tests were made. The diagnosis of both patients turned out to be non-Hodgkin’s and Hodgkin’s lymphomas respectively. They were put on a diet in which fat was cut; the oncospecific treatment and repeated thoracocentesis were applied in both hemithoraxes. The first patient, after getting better from the bilateral effusion and initial symptoms, passed away 11 months later for not controlling the base disease. The second patient presented a stable condition of both complaints 18 months later. In both cases chylotorax was eased and it was not necessary to repeat the drainage. Analyses compared to other reports are made mainly when the lymphoma is the etiological cause; the adopted conduct coincides with other current studies.Conclusions: the patients got better from bilateral chylothorax; one of them did not get a stable condition of his base disease and died and the second one is asymptomatic. A good therapeutic response may be obtained...

Adjuvant interferon gamma in patients with pulmonary atypical Mycobacteriosis: a randomized, double-blind, placebo-controlled study.

BACKGROUND: High antibiotic resistance is described in atypical Mycobacteriosis, mainly by Mycobacterium avium complex (MAC). METHODS: A randomized, double-blind, placebo-controlled clinical trial was carried out in two hospitals to evaluate the effect of interferon (IFN) gamma as immunoadjuvant to chemotherapy on patients with atypical mycobacteria lung disease. Patients received placebo or 1 x 106 IU recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to daily oral azithromycin, ciprofloxacin, ethambutol and rifampin. Sputum samples collection for direct smear observation and culture as well as clinical and thorax radiography assessments were done during treatment and one year after. Cytokines and oxidative stress determinations were carried out in peripheral blood before and after treatment. RESULTS: Eighteen patients were included in the IFN group and 14 received placebo. Groups were homogeneous at entry; average age was 60 years, 75% men, 84% white; MAC infection prevailed (94%). At the end of treatment, 72% of patients treated with IFN gamma were evaluated as complete responders, but only 36% in the placebo group. The difference was maintained during follow-up. A more rapid complete response was obtained in the IFN group (5 months before), with a significantly earlier improvement in respiratory symptoms and pulmonary lesions reduction. Disease-related deaths were 35.7% of the patients in the placebo group and only 11.1% in the IFN group. Three patients in the IFN group normalized their globular sedimentation rate values. Although differences in bacteriology were not significant during the treatment period, some patients in the placebo group converted again to positive during follow-up. Significant increments in serum TGF-beta and advanced oxidation protein products were observed in the placebo group but not among IFN receiving patients. Treatments were well tolerated. Flu-like symptoms predominated in the IFN gamma group. No severe events were recorded. CONCLUSION: These data suggest that IFN gamma is useful and well tolerated as adjuvant therapy in patients with pulmonary atypical Mycobacteriosis, predominantly MAC. Further wider clinical trials are encouraged. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70900209.

Adjuvant interferon gamma in patients with pulmonary atypical Mycobacteriosis: a randomized, double-blind, placebo-controlled study

Background High antibiotic resistance is described in atypical Mycobacteriosis, mainly by Mycobacterium avium complex (MAC). MethodsA randomized, double-blind, placebo-controlled clinical trial was carried out in two hospitals to evaluate the effect of interferon (IFN) gamma as immunoadjuvant to chemotherapy on patients with atypical mycobacteria lung disease. Patients received placebo or 1 × 106 IU recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to daily oral azithromycin, ciprofloxacin, ethambutol and rifampin. Sputum samples collection for direct smear observation and culture as well as clinical and thorax radiography assessments were done during treatment and one year after. Cytokines and oxidative stress determinations were carried out in peripheral blood before and after treatment. Results Eighteen patients were included in the IFN group and 14 received placebo. Groups were homogeneous at entry; average age was 60 years, 75 percent men, 84 percent white; MAC infection prevailed (94 percent). At the end of treatment, 72 percent of patients treated with IFN gamma were evaluated as complete responders, but only 36 percent in the placebo group. The difference was maintained during follow-up. A more rapid complete response was obtained in the IFN group (5 months before), with a significantly earlier improvement in respiratory symptoms and pulmonary lesions reduction. Disease-related deaths were 35.7 percent of the patients in the placebo group and only 11.1 percent in the IFN group. Three patients in the IFN group normalized their globular sedimentation rate values. Although differences in bacteriology were not significant during the treatment period, some patients in the placebo group converted again to positive during follow-up. Significant increments in serum TGF-beta and advanced oxidation protein products were observed in the placebo group but not among IFN... (AU)

Importancia de aa broncoscopia en el diagnóstico de la endometriosis pulmonar / Importance of the bronchoscopy in the pulmonary endometriosis diagnosis

Se presenta un caso de endometriosis pulmonar en una paciente de 21 años de edad, con diagnóstico presuntivo de una valvulopatía mitral. La presentación clínica consistió en hemoptisis coincidente con la menstruación, con un marcado empeoramiento progresivo. El tratamiento empleado fue el Danazol, 400mg diarios, la evolución clínica fue favorable. Después de diez meses se mantiene libre de hemoptisis recurrentes. Debido a la rareza de la endometriosis en esta localización, se comenta el caso y se analizan los aspectos etiopatogénicos, clínicos, diagnósticos y terapéuticos. Se resalta la importancia de la broncoscopia en el diagnóstico de esta enfermedad.

A case of pulmonary endometriosis in a 21-year-old patient is presented, with presumptive diagnostic of a mitral valvulopathy. The clinical presentation consisted of hemoptysis that happen at the same time with the menstruation, with a marked progressive deterioration. The employed treatment was the Danazol, 400mg daily, the clinical course was favorable. After ten months kept free of recurrent hemoptysis. Due to the peculiarity of the endometriosis in this localization, the case is commented and the etiopathogenic, clinical, diagnostic and therapeutic aspects are analyzed. The importance of the bronchoscopy in the diagnosis of this illness stands out.

Rehabilitación respiratoria en la enfermedad pulmonar obstructiva crónica / Respiratory rehabilitation in chronic obstructive pulmonary disease

Se realizó un estudio observacional descriptivo a un grupo de pacientes con enfermedad pulmonar obstructiva crónica, en el Hospital Clínico Quirúrgico “Amalia Simoni” de Camagüey, desde el 1ro de diciembre de 2001 al 1ro de diciembre de 2002, para evaluar la tolerancia al ejercicio físico después de una rehabilitación respiratoria El universo estuvo formado por 30pacientes, a los que se les realizaron ejercicios respiratorios como desbloqueo diafragmático, refuerzo de la prensa abdominal y respiración con los labios fruncidos. Los datos se completaron mediante una encuesta, la cual se convirtió en el registro primariodefinitivo. Se encontró predominio del grupo etáreo de 50 a 59 años (53.33 por ciento) y del sexo masculino (56.66 por ciento) respectivamente; predominaron los pacientes trabajadores (46.66 por ciento) y los que fumaron más de 20 años (53.33 por ciento), los cuales no presentaronmejoría después de los ejercicios. La dificultad para cargar peso y subir escaleras fueron las principales limitaciones antes de los ejercicios. Se evidenció una mejoría después de los mismos, el 73.33 por ciento pudo subir escaleras, y el 66.6 por ciento cargar peso

Rehabilitación respiratoria en la enfermedad pulmonar obstructiva crónica / Respiratory rehabilitation in chronic obstructive pulmonary disease

Se realizó un estudio observacional descriptivo a un grupo de pacientes con enfermedad pulmonar obstructiva crónica, en el Hospital Clínico Quirúrgico “Amalia Simoni” de Camagüey, desde el 1ro de diciembre de 2001 al 1ro de diciembre de 2002, para evaluar la tolerancia al ejercicio físico después de una rehabilitación respiratoria El universo estuvo formado por 30pacientes, a los que se les realizaron ejercicios respiratorios como desbloqueo diafragmático, refuerzo de la prensa abdominal y respiración con los labios fruncidos. Los datos se completaron mediante una encuesta, la cual se convirtió en el registro primariodefinitivo. Se encontró predominio del grupo etáreo de 50 a 59 años (53.33 por ciento) y del sexo masculino (56.66 por ciento) respectivamente; predominaron los pacientes trabajadores (46.66 por ciento) y los que fumaron más de 20 años (53.33 por ciento), los cuales no presentaronmejoría después de los ejercicios. La dificultad para cargar peso y subir escaleras fueron las principales limitaciones antes de los ejercicios. Se evidenció una mejoría después de los mismos, el 73.33 por ciento pudo subir escaleras, y el 66.6 por ciento cargar peso(AU)