Effects of a Surgical Mask on Functional Capacity Measured Using the 6-min Walk Test in Patients with Cardiorespiratory Disease

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Heart Failure with Reduced Ejection Fraction and Prognostic Scales: The Impact of Exercise Modality in Cardiopulmonary Exercise Tests.

The cardiopulmonary exercise (CPET) test is an essential tool to determine the severity, prognosis, and need for invasive treatments in heart failure with reduced ejection fraction (HFrEF) but disregards the exercise modality. The present study aimed at analyzing the differences between treadmill and cycle-ergometer exercises. This was a prospective study, involving 65 patients with HfrEF who performed treadmill exercise followed by cycle-ergometer exercise 72 h later. We enrolled 65 patients, aged 58 ± 9 years, with an ejection fraction of 29 ± 9%. Peak VO2 was 20% greater (95% CI: 18−21%; p < 0.000) on the treadmill, and the ventilatory efficiency estimated by the VE/VCO2 slope (32 ± 8 vs. 34 ± 9; p < 0.05). The ventilatory response was greater on the treadmill: maximum ventilation (55 ± 16 vs. 46 ± 11 L/min; p < 0.000) and ventilatory reserve at the maximum effort (28 ± 17 vs. 41 ± 15%; p < 0.000). These values led to a change in the functional class of 23 (51%) patients and ventilatory class of 28 (47%) patients. Differences in the main parameters, including peak VO2 and VE/VCO2, impact prognostic scales and possible advanced treatments; therefore, the results should be interpreted in accordance with the exercise modality.

PCR en esputo para el diagnóstico de COVID-19 en un caso con patrón radiológico infrecuente / PCR in Sputum for the Diagnosis of COVID-19 in a Case with Infrequent Radiological Pattern

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Influenza, SARS-CoV-2 y aspergilosis pulmonar invasora / Influenza, SARS-CoV-2 and Invasive Pulmonary Aspergillosis

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Assessment of risk scores in Covid-19.

OBJECTIVE: To analyse the accuracy of commonly used risk scores (PSI and CURB-65) in predicting mortality and need for ICU admission in Covid-19. MATERIAL AND METHODS: Prospective study of patients diagnosed with Covid-19 pneumonia. Patients were followed until home discharge or death. PSI, CURB-65, SMART-COP and MuLBSTA severity scores were assessed on admission. Risk scores were related to mortality and ICU admission. RESULTS: About 249 patients, 143 males (57.4%) were included. The mean age was 65.6 + 16.1 years. Factors associates with mortality in the multivariate analysis were age > 80 years (OR: 13.9; 95% CI 3.8-51.1) (P = .000), lymphocytes < 800 (OR: 2.9; CI 95% 1.1-7-9) (P = .040), confusion (OR: 6.3; 95% CI 1.6-24.7) (P = .008) and NT-proBNP > 500 pg/mL (OR: 10.1; 95% CI 1.1-63.1) (P = .039). In predicting mortality, the PSI score: AUC 0.874 (95% CI 0.808-0.939) and the CURB-65 score: AUC 0.852 (95% CI 0.794-0.909) were the ones that obtained the best results. In the need for ICU admission, the SMART-COP score: AUC 0.749 (95% CI 0.695-0.820) and the MuLBSTA score: AUC 0.777 (95% CI 0.713-0.840) were the ones that obtained better results, with significant differences with PSI and CURB-65. The scores with the lowest value for ICU admission prediction were PSI with AUC of 0.620 (95% CI 0.549-0.690) and CURB-65 with AUC of 0.604 (95% CI 0.528-0.680). CONCLUSIONS: Prognosis scores routinely used for CAP (PSI and CURB-65) were good predictors for mortality in patients with Covid-19 CAP but not for need of hospitalisation or ICU admission. In the evaluation of Covid-19 pneumonia, we need scores that allow to decide the appropriate level of care.

Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva / Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation

INTRODUCCIÓN: El síndrome de obesidad-hipoventilación (SOH) es un factor de riesgo para presentar insuficiencia cardiaca (IC). Algunos estudios relacionan el uso de ventilación no invasiva (VNI) con la alteración de parámetros hemodinámicos. Nuestro objetivo fue describir la situación hemodinámica de un grupo de pacientes con SOH y estudiar el efecto de la VNI. PACIENTES Y MÉTODOS: Con un diseño transversal de mediciones repetidas, se incluyó a pacientes con SOH tratados con VNI en situación estable. Se estudió su hemodinámica con bioimpedancia: 30 min basales y otros 30 con VNI. Se midieron el gasto cardiaco (GC), el índice cardiaco y el volumen sistólico. Se tomó como referencia el GC calculado para cada paciente expresado como porcentaje sobre su límite inferior de normalidad (LIN) y se establecieron 2 grupos: sin IC con GC conservado (≥ 100% sobre LIN) y con IC y GC bajo (< 100% del LIN). Se utilizaron la U de Mann-Whitney para comparación de variables independientes y el test de Wilcoxon para variables apareadas, se consideró significativo p < 0,05. RESULTADOS: La muestra final fue de 36 casos, de 66 (8) años, 19 (52%) varones. En 17 (46%) detectamos IC con GC de 3,7 l/min (66%) frente al grupo sin IC con 7 l/min (107%). Tras VNI, los pacientes en IC mejoraron su GC (4,5 l/min [77%] p = 0,009) y no lo modificó el grupo sin IC: 6,8 l/min (104%), p = 0,2. CONCLUSIÓN: Un 46% de pacientes con SOH estable presenta IC. La VNI mejora su hemodinámica y no influye en los pacientes con GC conservado

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P < .05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P = .009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P = .2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO

Aspergilosis invasora como complicación de infección por virus influenza H3N2 / Invasive Aspergillosis as a Complication of Influenza Virus H3N2 Infection

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Severe asthma and bronchiectasis.

Objective: The aim of our study was to determine the tomographic findings and prevalence of bronchiectasis in our population of patients with severe asthma, and to identify factors associated with the presence of bronchiectasis in these patients. Materials and methods: We retrospectively collected data from the medical histories of patients referred to the asthma unit of our hospital, with a diagnosis of severe asthma between 2015 and 2017. Patients with ABPA, cystic fibrosis, immunodeficiency or systemic disease were excluded. High-resolution thorax-computed tomodensitography (HRCT) was performed in all patients. A standardized protocol was applied in data collection. Results: A total of 108 patients comprising 50 men (46%) and 58 women (54%) were included in the study. Of the 108 patients, 59 (55%) had at least one abnormality detected by HRCT, the most commonly reported abnormalities being bronchiectasis (35%), bronchial wall thickening (33%), emphysema (7%), atelectasis area (6%), mosaic attenuation due to air trapping (4%), and "tree in bud" image (2%). Subjects with bronchiectasis were older (p = 0.001), had a longer asthma history (p = 0.048), had poorer pulmonary function tests with lower FVC (p = 0.031), had more severe bronchial obstruction with lower FEV1 (p = 0.008) and had lower FEV1/FVC (p = 0.003). They also experienced more frequent hospitalizations in the previous year (p = 0.019) and received treatment with omalizumab more frequently (p = 0.049). Plasma eosinophil count and IgE levels were comparable in both groups. In the multivariate analysis, the presence of bronchiectasis was associated with ages older than 40 (OR: 8.3; 95% CI: 1.7-41.2) and chronic airflow obstruction (OR: 5.4; 95% CI: 1.9-15.3). Conclusions: We found that in patients with severe asthma, the prevalence of bronchiectasis is high and that bronchiectasis is associated with a longer asthma history, greater severity and, more importantly, chronic airflow obstruction. These findings are still insufficient evidence to considere features of asthma-bronchiectasis overlap syndrome, a distinct phenotype of severe asthma, but bronchiectasis is a frequent phenomenon leading to a more severe disease with frequent exacerbations. The performance of thorax HRCT on patients with severe asthma can help to evaluate management strategies for the disease in order to improve treatment and prognosis.

Obesity-Hypoventilation Syndrome: Baseline Hemodynamic Status and Impact of non-Invasive Ventilation. / Síndrome de obesidad-hipoventilación: situación hemodinámica basal e impacto de la ventilación no invasiva.

INTRODUCTION: Obesity-hypoventilation syndrome (OHS) is a risk factor for heart failure (HF). Some studies associate the use of non-invasive ventilation (NIV) with changes in hemodynamic parameters. Our objective was to describe the hemodynamic status of a group of patients with OHS and to study the effect of NIV. PATIENTS AND METHODS: Patients with stable OHS treated with NIV were included in this cross-sectional repeated measurements study. Hemodynamics were measured by bioimpedance: 30minutes at baseline and another 30minutes on NIV. Cardiac output (CO), cardiac index, and systolic volume were measured. The CO calculated for each patient expressed as a percentage of the lower limit of normal (LLN) was taken as reference, and 2 groups were formed: patients without HF and normal CO (≥ 100% of LLN) and patients with HF and low CO (< 100% of LLN). The Mann-Whitney U test was used to compare independent variables and the Wilcoxon test was used for paired variables, with significance set at P<.05. RESULTS: The final sample comprised 36 patients, aged 66 (± 8) years, 19 (52%) men. In 17 (46%) patients, HF was detected with a CO of 3.7 l/min (66%) compared to the group without HF, whose CO was 7 l/min (107%). After NIV, patients with HF showed improvement in CO (4.5 l/min (77%), P=.009, while the non-HF group remained unchanged, with CO 6.8 l/min (104%), P=.2. CONCLUSION: A total of 46% of patients with stable OHS present HF; NIV improves hemodynamics and does not affect patients with normal CO.

Objective and Subjective Sleep Efficiency in Adult Patients with Cystic Fibrosis and Impact on Quality of Life.

INTRODUCTION: Poor sleep quality and excessive daytime sleepiness are common in patients with cystic fibrosis (CF), and both are negatively correlated with health-related quality of life (HRQoL). The objective of our study was to evaluate subjective and objective sleep quality in adult CF patients and its effect on HRQoL. MATERIALS AND METHODS: This was a descriptive, prospective, cross-sectional study of CF patients > 18 years of age. Patients underwent nocturnal polysomnography (PSG) and were administered the Pittsburgh Sleep Quality Index questionnaire (PSQI) and the Cystic Fibrosis Quality of Life Questionnaire (CFQR 14 + Spain). RESULTS: The study included 23 patients, 14 women (61%). The mean age of the participants was 32 + 18 years. The mean PSQI score was 5.57 + 3.55; 13 (56.5%) of the patients were poor sleepers, and 13% reported poor sleep quality; seven (30%) had sleep latency > 30 min, 10 (43.5%) had sleep efficiency < 85%. Nineteen underwent polysomnography. According to PSG measurements, sleep efficiency was less than 90% in 61% of the patients. Pathological values were found for the following parameters: intra-sleep wakefulness in 12 patients (63%); microarousal index in 12 patients (63%); and apnea-hypopnea index (AHI) in 2 patients. The desaturation time with SpO2 < 90% (T90) was > 30% in 3 patients. We observed a significant correlation between PSQI and all dimensions of CFQR 14. CONCLUSIONS: Subjective and objective sleep efficiency decreases in adult CF patients. Sleep quality has an impact on HRQoL. The PSQI questionnaire was able to discriminate sleep quality.

Respuesta a la hipercapnia en pacientes con síndrome obesidad-hipoventilación en tratamiento con ventilación no invasiva en domicilio / Hypercapnia Response in Patients with Obesity-Hypoventilation Syndrome Treated with Non-Invasive Ventilation at Home

Introducción: En la patogenia del síndrome de obesidad-hipoventilación (SOH) se ha postulado una disfunción del centro respiratorio, que muchas veces precisa la utilización de ventilación no invasiva (VNI) en domicilio para el tratamiento. Nuestro objetivo fue medir el efecto de la VNI en la función del CR en pacientes con SOH y los factores que lo determinan. Métodos: Con un diseño prospectivo de mediciones repetidas se estudió la respuesta a la hipercapnia (RHC) midiendo la pendiente de la relación p01/pEtCO2 en situación basal y tras 6meses de tratamiento con VNI en un grupo de pacientes con SOH. Previamente en un grupo control se estableció un umbral en 0,22cmH2O/mmHg para diferenciar la respuesta óptima (RO) de la respuesta subóptima (RSO) del CR. Resultados: Se incluyeron 36 casos, 19 varones (52%), de 65 (DE: 9) años de edad; un 63% de ellos tenían un p01/pEtCO2 por debajo del valor de referencia. El valor basal de p01/pEtCO2 fue de 0,17 (DE: 0,14) cmH2O/mmHg y tras 6meses de VNI fue de 0,30 (DE: 0,22) cmH2O/mmHg (p=0,011). Tras 6meses de tratamiento con VNI, 12 casos (33%) mantienen una función deprimida de su CR. Conclusión: Un 63% de los pacientes con SOH mostraron disfunción de su CR. La aplicación de VNI mejora la función del CR, aunque no en todos los casos

Introduction: Respiratory center (RC) dysfunction has been implicated in the pathogenesis of obesity-hypoventilation syndrome (OHS), and often requires treatment with home non-invasive ventilation (NIV). Our objective was to measure the effect of NIV on RC function in patients with OHS, and the factors that determine such an effect. Methods: We performed a prospective, repeated measures study to evaluate hypercapnia response (HR) by determining the p01/pEtCO2 ratio slope at baseline and after 6months of treatment with NIV in a group of OHS patients. A threshold of 0.22cmH2O/mmHg had previously been established in a control group, in order to differentiate optimal RC response from suboptimal RC response. Results: A total of 36 cases were included, 19 men (52%) aged 65 (SD 9) years, 63% of whom had p01/pEtCO2 below the reference value. Baseline p01/pEtCO2 was 0.17 (SD: 0.14) cmH2O/mmHg and, after 6 months of NIV, 0.30 (SD: 0.22) cmH2O/mmHg (p=0.011). After 6months of treatment with NIV, depressed RC function persisted in 12 cases (33%). Conclusion: In total, 63% of OHS patients had RC dysfunction. The application of NIV improves RC function but not in all cases

Hypercapnia Response in Patients with Obesity-Hypoventilation Syndrome Treated with Non-Invasive Ventilation at Home. / Respuesta a la hipercapnia en pacientes con síndrome obesidad-hipoventilación en tratamiento con ventilación no invasiva en domicilio.

INTRODUCTION: Respiratory center (RC) dysfunction has been implicated in the pathogenesis of obesity-hypoventilation syndrome (OHS), and often requires treatment with home non-invasive ventilation (NIV). Our objective was to measure the effect of NIV on RC function in patients with OHS, and the factors that determine such an effect. METHODS: We performed a prospective, repeated measures study to evaluate hypercapnia response (HR) by determining the p01/pEtCO2 ratio slope at baseline and after 6months of treatment with NIV in a group of OHS patients. A threshold of 0.22cmH2O/mmHg had previously been established in a control group, in order to differentiate optimal RC response from suboptimal RC response. RESULTS: A total of 36 cases were included, 19 men (52%) aged 65 (SD 9) years, 63% of whom had p01/pEtCO2 below the reference value. Baseline p01/pEtCO2 was 0.17 (SD: 0.14) cmH2O/mmHg and, after 6 months of NIV, 0.30 (SD: 0.22) cmH2O/mmHg (p=0.011). After 6months of treatment with NIV, depressed RC function persisted in 12 cases (33%). CONCLUSION: In total, 63% of OHS patients had RC dysfunction. The application of NIV improves RC function but not in all cases.

Snoring as a Determinant Factor of Oxidative Stress in the Airway of Patients with Obstructive Sleep Apnea.

PURPOSE: In obstructive sleep apnea-hypopnea syndrome (OSAS), airway collapses and vibrations cause local and systemic inflammatory response and oxidative stress (OS). Our objective was to determine the presence of OS in the airway of patients with OSAS compared with controls without OSAS and determine its relation to treatment with CPAP and other clinical variables. METHOD: We performed a prospective observational case-control study with repeated measures. We recruited consecutive patients with SAHS diagnosed using complete polysomnography, and a parallel control group. We collected a sample of exhaled breath condensate (EBC) prior to nasal continuous positive airway pressure (CPAP) treatment and again after 4 months. The marker of OS used was 8-isoprostane (8-IPN). The variables analyzed were age, sex, anthropometric variables, apnea-hypopnea index (AHI), snoring, oxygenation, and polysomnographic variables. RESULTS: The study included 20 patients and 10 controls. In cases, the initial value of 8-IPN was 6.8 (1.9), and after nasal CPAP, it was 5.3 (1.2) pg/ml (p = 0.02). In controls, the value of 8-IPN was 5.6 (1.1) pg/ml (p = 0.04 compared to initial values). 8-IPN showed significant correlation with snoring, AHI, BMI, nocturnal desaturation index, and non-REM sleep. On multivariate analysis, only snoring was a significant predictor of 8-IPN. CONCLUSIONS: Snoring, and not OSAS severity, could be the phenomenon underlying the presence of local OS measured in the airway of patients with OSAS.