Depression and anxiety symptoms in Spanish adult patients with cystic fibrosis: associations with health-related quality of life.

BACKGROUND: Cystic fibrosis (CF) is a chronic disease with an impact on the quality of life. Self-reported symptoms of depression and anxiety were assessed in the Spanish cohort of the International Epidemiological Study on Depression and Anxiety in patients with CF (International Depression-Anxiety Epidemiological Study) and their relationship with health status and health-related quality of life (HRQoL) was evaluated. METHODS: This cross-sectional study recruited adult patients with CF at 10 Spanish centers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Revised Cystic Fibrosis Questionnaire. Demographic and health data were recorded from medical charts. Logistic regression was used to determine the predictors of elevated symptoms of depression and anxiety (HADS≥8). RESULTS: Of the 336 participants recruited (mean age, 28.1years; 48.2% women), 41 (12.2%) had elevated depression-related scores, and 100 (29.7%) had elevated anxiety-related scores (HADS≥8). After adjusting for confounders, only less education, intravenous antibiotics, psychiatric medications and psychotherapy were significantly associated with elevated psychological symptoms. Specifically, regardless of lung function, patients who were depressed or anxious reported worse HRQoL. CONCLUSIONS: The prevalence of elevated symptoms of depression and anxiety was high in Spanish adult patients with CF, and these symptoms were associated with a decreased HRQoL.

Previous outpatient antibiotic use in patients admitted to hospital for COPD exacerbations: room for improvement.

PURPOSE: Several studies have analyzed factors associated to hospitalization in chronic obstructive pulmonary disease (COPD) patients. However, data are lacking on the quality of treatment received by patients prior to hospital admission. The present study analyzed how often patients requiring hospitalization for a COPD exacerbation had received previous treatment for the exacerbation, particularly antibiotics. METHODS: This was a multicenter, cross-sectional, observational study conducted in 30 Spanish hospitals among COPD patients aged >40 years who were hospitalized for an acute exacerbation. Patients were grouped according to whether or not they had received treatment prior to admission and, subsequently, according to whether or not they had received antibiotics. Patient eligibility for antibiotic therapy was assessed using both national and European guidelines. RESULTS: The study population consisted of 298 patients, of which 277 (93 %) were men, with a mean [standard deviation (SD)] age of 69.1 (9.5) years. One hundred and thirty-three patients (45 %) had received treatment prior to admission; among these, 76/133 (57 %) had received antibiotic therapy. However, 81-91 % of these patients fulfilled criteria for this therapy. Antibiotic use was significantly associated with yellow or green-yellow sputum prior to the exacerbation, a higher number of exacerbations in the previous year, more visits to emergency departments, and bronchiectasis. On the other hand, 10-20 % of patients who did receive antibiotics were not eligible for this therapy according to guidelines. CONCLUSIONS: This study demonstrates a low rate of previous outpatient treatment and antibiotic use among patients with a COPD exacerbation requiring hospital admission.

Normativa del diagnóstico y el tratamiento de la afección respiratoria en la fibrosis quística / Guidelines for diagnosing and treating respiratory involvement in cystic fibrosis

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Fibrosis quística: consenso sobre el tratamiento del neumotórax y de la hemoptisis masiva y sobre las indicaciones del trasplante pulmonar / Cystic fibrosis: consensus on the treatment of pneumothorax and massive hemoptysis and on indications for lung transplantation

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HLA class II and susceptibility and resistance to insulin-dependent diabetes mellitus in a population from the northwest of Spain.

The role of HLA class II alleles in genetic predisposition to insulin-dependent diabetes mellitus (IDDM) was examined using Polymerase Chain Reaction/oligonucleotide probe typing (PCR/SSOs) of eight HLA class II loci in 58 IDDM patients and 50 healthy controls from the Northwest of Spain (Asturias). We compared the distribution of HLA class II alleles, haplotypes and genotypes between IDDM patients and controls, and tested three recently proposed HLA-IDDM susceptibility theories. By using the aetiologic fraction (delta) as an almost absolute measure of the strongest linkage of disequilibrium of a HLA marker to the putative Type I susceptibility locus, it has been found that the strength of association of the HLA markers may be quantified as follows: DQA1*03-DQB1*0302 or DQA1*0501-DQB1*0201 > DR3 or DR4; presence of more than one dimer DQ alpha beta of the six proposed by Rønningen > non-Asp57 DQ beta and Arg52 DQ alpha > Arg52 DQ alpha > non-Asp57 DQ beta/non-Asp57 DQ beta > DRB1*0301; DQA1*0501-DQB1*0201 > DQA1*03-DQB1*0302; DQB1*0302. The presence of at least one Asp57 DQ beta allele was the best protection HLA marker to IDDM in our population. Therefore, the above data confirm that IDDM susceptibility to HLA locus is linked more to DQ than DR.

Q fever pneumonia: a review of 164 community-acquired cases in the Basque country.

One hundred and sixty four cases of Q fever pneumonia are reviewed. Coxiella burnetti is responsible for 18.8% of pneumonias acquired in the community in our region with an extremely high seasonal variation. 91% of the cases occur between January and June. 88.5% of the patients are less than 40 yrs of age and 77% are male. The most common clinical symptoms are high fever, cough, cephalalgia and myalgias. 46.5% of the patients have no respiratory symptoms although 34% of the cases report pleural pain. The radiological signs are nonspecific. With regard to laboratory data, it is often observed that the white blood cell count (WBC) is normal and the liver enzymes are abnormal (45%). Treatment with doxycycline reduces the fever more quickly than erythromycin.