Asociación de trasplante de progenitores hematopoyéticos y síndrome de Parsonage-Turner: ¿coincidencia o relación causa-efecto? / Association between hematopoietic stem cell transplantation and Parsonage Turner syndrome: coincidence or cause-effect relationship?

El síndrome de Parsonage-Turner o plexopatía braquial idiopática es una inflamación total o parcial del plexo braquial cuya presentación típica es una omalgia intensa y súbita, seguida de debilidad braquial y amiotrofia precoz. La etiología es desconocida, aunque se propone un mecanismo inmunomediado.El trasplante de progenitores hematopoyéticos es un tratamiento bien establecido de las neoplasias hematológicas y tiene un papel creciente en el tratamiento de enfermedades autoinmunes. Los efectos adversos neurológicos son probablemente infradiagnosticados.La asociación del síndrome de Parsonage-Turner y el trasplante de progenitores hematopoyéticos es muy poco conocida. Describimos dos casos clínicos de plexopatía braquial idiopática tras trasplante de células stem (progenitores) hematopoyéticas (TPH).La reconstitución del sistema inmune tras un trasplante de progenitores hematopoyéticos puede ser un desencadenante de plexopatía braquial, aunque se necesitan más estudios para entender la fisiopatología de esta entidad y establecer su relación causal con el trasplante. (AU)

Parsonage-Turner syndrome or idiopathic brachial neuritis is a total or partial inflammation of the brachial plexus, with a typical presentation as a sudden and very intense pain in the shoulder, followed by weakness and early amyotrophy. The etiology is still unknown, although an immune mediated mechanism is thought to be involved.Hematopoietic stem cell transplantation is a well-established treatment for hematological malignancies, but with a growing implication in the treatment of autoimmune diseases. The neurological side effects are probably underdiagnosed.The association of the Parsonage-Turner syndrome and the hematopoietic stem cell transplantation is scarce. We describe two clinical cases of idiopathic brachial plexopathy after hematopoietic stem cell transplantation.The reconstruction of the immune system after a transplant may be the trigger of a brachial plexopathy, but more studies are necessary for the etiology of this disease to be understood and to establish a cause-effect relation with the transplant. (AU)

[Association between hematopoietic stem cell transplantation and Parsonage Turner syndrome: coincidence or cause-effect relationship?] / Asociación de trasplante de progenitores hematopoyéticos y síndrome de Parsonage-Turner: ¿coincidencia o relación causa-efecto?

Parsonage-Turner syndrome or idiopathic brachial neuritis is a total or partial inflammation of the brachial plexus, with a typical presentation as a sudden and very intense pain in the shoulder, followed by weakness and early amyotrophy. The etiology is still unknown, although an immune mediated mechanism is thought to be involved. Hematopoietic stem cell transplantation is a well-established treatment for hematological malignancies, but with a growing implication in the treatment of autoimmune diseases. The neurological side effects are probably underdiagnosed. The association of the Parsonage-Turner syndrome and the hematopoietic stem cell transplantation is scarce. We describe two clinical cases of idiopathic brachial plexopathy after hematopoietic stem cell transplantation. The reconstruction of the immune system after a transplant may be the trigger of a brachial plexopathy, but more studies are necessary for the etiology of this disease to be understood and to establish a cause-effect relation with the transplant.

Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

BACKGROUND: Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. AIMS: The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. MATERIALS AND METHODS: COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. RESULTS: Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P=0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P=0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (ß coefficient -0.785, P=0.014, and R2=0.219). CONCLUSION: A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

Recomendaciones sobre programas de rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica de la Sociedad de Rehabilitación Cardiorrespiratoria / Recommendations of the Spanish Society of Cardiorespiratory Rehabilitation on pulmonary rehabilitation programmes in patients with chronic obstructive pulmonary disease

Introducción. La rehabilitación respiratoria (RR) es un componente primordial en el manejo de pacientes con enfermedades respiratorias crónicas. El objetivo de este documento de recomendaciones es proporcionar al equipo de rehabilitación una puesta al día de las principales intervenciones a realizar dentro de un programa de RR, haciendo especial énfasis en las evaluaciones previas al inicio del programa. Una valoración adecuada permitirá seleccionar las intervenciones según las necesidades individuales de cada paciente y mejorar la eficiencia de la RR. Métodos. Un comité de expertos que incluía a médicos y fisioterapeutas de la Sociedad de Rehabilitación Cardiorrespiratoria, y un reumatólogo especialista en osteoporosis de la Sociedad Española de Reumatología actualizaron la evidencia disponible en RR a partir de estudios de calidad (revisiones, metaanálisis y ensayos clínicos), incorporando nuevas estrategias e intervenciones complementarias al ejercicio físico. El resultado final del documento fue acordado por todos sus miembros. Resultados. Se proporciona información necesaria para realizar un abordaje multidisciplinario del paciente con enfermedad pulmonar obstructiva crónica que permita hacer una adecuada valoración individualizada y seleccionar las intervenciones a realizar dentro del programa de RR. Conclusiones. El entrenamiento físico sigue siendo la piedra angular de la RR. No obstante, existen diferentes intervenciones que pueden implementarse dentro de los programas de RR, de acuerdo con una valoración y selección adecuada de los pacientes (AU)

Introduction. Pulmonary rehabilitation (PR) is one of the key components in the management of patients with chronic respiratory disease. The goal of this guidance document is to provide rehabilitation team members with an update on the main interventions to be carried out within a PR programme, with special emphasis on the assessments that precede the start of the programme. An appropriate assessment will allow the interventions to be tailored to the patient's individual needs and will improve the overall efficiency of PR. Methods. An expert committee, which included physicians and physiotherapists of the Spanish Society of Cardio-Respiratory Rehabilitation, as well as a rheumatologist specialised in osteoporosis from the Spanish Society of Rheumatology updated the available evidence on PR based on high-quality studies (reviews, meta-analyses and clinical trials), incorporating new strategies and interventions that complemented physical exercise. The final draft of the document was agreed on by all of the members. Results. The document provides all the appropriate information to enable a multidisciplinary approach to the treatment of patients with chronic obstructive pulmonary disease, allowing appropriate individualised assessment and selection of interventions to be carried out within the PR programme. Conclusions. Exercise training remains the cornerstone of PR. Nevertheless, different interventions may be implemented within PR programmes, based on appropriate assessment and adequate patient selection (AU)

Estado actual de la educación para la salud en los programas de rehabilitación respiratoria / Current status of health education in the respiratory rehabilitation programs

Objetivo. La educación para la salud debe ser un componente básico de los programas de rehabilitación pulmonar (PRP). Sin embargo, un gran número de programas no contemplan su inclusión. Por otro lado, cuando la educación está presente, su estructura no es homogénea. Por este motivo, el objetivo de esta revisión es conocer cuál es el estado actual de la educación para la salud en pacientes afectos de enfermedades respiratorias. Resultados. En los últimos años, se han introducido cambios sustanciales en la estructura de los programas educativos para pacientes neumológicos. Dichos cambios han contemplado la aplicación de programas educativos basados en el autocuidado. Estas intervenciones van dirigidas a que el paciente aprenda las necesidades para cumplir con las pautas médicas e introducir comportamientos para controlar la enfermedad y el estado general. Aunque la contribución específica de la educación no se conoce con exactitud, diversos estudios muestran una tendencia a la reducción de los días de hospitalización y a un menor uso de los recursos sanitarios(AU)

Objective. Health education should be a core component of pulmonary rehabilitation programs (PRP). However, many programs do not consider the inclusion of education. On the other hand, when education is present, its structure is not homogeneous. The objective of this review is to know what the current status of education is for patients with respiratory diseases. Results. In recent years, substantial changes have been made in the structure of educational programs for patients with pulmonary diseases. These changes have seen the implementation of educational programs based on self-care. These interventions are aimed at having the patient learn what needs must be complied with including the medical guidelines and to introduce behaviors to control the disease and general condition. Although the specific contribution of education is not precisely known, several studies show a tendency to reduction in days of hospitalization and less use of the health resources(AU)