Utilidad del lavado broncoalveolar para la detección microbiológica, y factores asociados, en receptores de trasplante de precursores hematopoyéticos: estudio de cohorte retrospectivo

Introducción: Las opacidades pulmonares en receptores de trasplante de precursores hematopoyéticos (TPH) representan un desafío diagnóstico y son una causa de morbimortalidad. Existen grandes discrepancias con respecto a la sensibilidad diagnóstica del lavado broncoalveolar (LBA), sus complicaciones, y los factores asociados a la identificación microbiológica. Objetivo: Conocer la utilidad del estudio microbiológico del LBA en el diagnóstico, modificación de la conducta médica y estimar las complicaciones y mortalidad asociada al procedimiento, en receptores de TPH con opacidades pulmonares. Pacientes y Métodos: Estudio de cohorte, retrospectivo, en adultos receptores de TPH a los que se les realizó una broncoscopía con LBA por presentar opacidades pulmonares, en el Hospital Italiano de Buenos Aires entre el 01/01/2011 y el 31/12/2020. Resultados: De los 189 procedimientos analizados, en 79 se logró un hallazgo microbiológico (41,8%) y 122 permitieron modificar la conducta médica (64,6%). En 11 casos se observaron complicaciones graves dentro de las 12 horas (5,8%) de efectuado el LBA. La mortalidad intrahospitalaria fue de 16,8% (N = 21/125). El valor de neutrófilos en sangre previo al LBA (p = 0,037) y la presencia de nódulos pulmonares como lesión tomográfica predominante (p = 0,029) se asociaron independientemente al hallazgo microbiològico global. Conclusiones: Nuestra investigación apoya la realización del LBA como herramienta diagnóstica en pacientes que reciben un TPH y presentan opacidades pulmonares.

Background: Lung opacities are a cause of morbimortality in bone marrow transplant patients, and represent a diagnostic challenge. There are large discrepancies regarding the diagnostic sensitivity of bronchoalveolar lavage (BAL), its complications, and the factors associated with microbiological detection. Aim: To know the usefulness of the microbiological study of BAL in the diagnosis, in the modification in medical behavior and to estimate the complications and associated mortality of this diagnostic procedure in patients transplanted with hematopoietic progenitor cells with pulmonary opacities. Methods: Retrospective cohort study in bone marrow transplant adult patients who underwent bronchoscopy with BAL due to lung opacities at Hospital Italiano de Buenos Aires between 01/01/2011 and 12/31/2020. Results: Of the 189 BAL analyzed, 79 presented a microbiological detection (41.8%) and 122 allowed to modify the medical behavior (64.6%). Severe complications were observed within 12 hours after the procedure in11 cases (5.8%). In-hospital mortality was 16,8% (N = 21/125). The value of blood neutrophils prior to bronchoalveolar lavage (p = 0.037) and the presence of pulmonary nodules as the predominant tomographic lesion (p = 0.029) were independently associated with global microbiological detection. Conclusion: Our research supports the performance of BAL as a diagnostic tool in bone marrow transplant patients with lung opacities.

[Hypoxemia, pleural and pericardial effusion after splanchnic neurolysis. A case report.] / Hipoxemia, derrame pleural y pericárdico en neurolisis de nervios esplácnicos. Reporte de caso

Introduction: Alcohol neurolysis of splanchnic nerves is a valuable tool for treating visceral intractable pain from the upper abdomen in cancer patients. It is a safe and effective procedure, yet not risk free. It's most common adverse effects are mild and self-limited. Materials: We present a case of a 72-year old woman suffering from pancreatic cancer with intractable pain despite opioid use. Alcohol neurolysis of splanchnic nerves was indicated after hospital admission. Results: After the procedure pain was subdued, yet hypoxemia, pleural and pericardial effusion developed. Frequent causes for these events were ruled out. The patient was discharged 24 hours after with adequate pain control. Conclusions: Hypoxemia, pleural and pericardial effusion after alcohol neurolysis of splanchnic nerves is infrequent. These findings are likely to be linked to the effect of alcohol.

Introducción: La neurolisis o alcoholización de los nervios esplácnicos es una valiosa herramienta para el tratamiento del dolor visceral del abdomen superior de origen neoplásico en pacientes con mala respuesta a tratamiento por vía oral. Es un procedimiento seguro y efectivo, aunque no exento de riesgos. Sus efectos adversos más frecuentes son leves y autolimitados. Materiales: Presentamos el caso de una mujer de 72 años con cáncer de páncreas y mal manejo del dolor pese al consumo de opioides. Se le indico neurolisis de los nervios esplácnicos bajo internación. Resultados: Post procedimiento presentó buen manejo del dolor, sin embargo evolucionó con hipoxemia, derrame pleural bilateral y pericárdico. Se descartaron causas frecuentes de estos eventos. La paciente fue dada de alta a las 24 hs con buen manejo del dolor. Conclusiones: El desarrollo de hipoxemia, derrame pleural bilateral y pericárdico posterior a la neurolisis de los nervios esplácnicos es una complicación infrecuente. Estos hallazgos probablemente se encuentren vinculados al efecto del alcohol.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome.

Background and aim: Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome. Methods: A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis. Results: A total of 200 patients (mean age 48.8 ± 14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8 ± 8.1 mL/min/kg vs. 28.8 ± 9.6 mL/min/kg, p = 0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p < 0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p = 0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders. Conclusion: Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.

Antecedentes y objetivo: Varios informes han demostrado la persistencia de síntomas a largo plazo luego de la infección inicial por COVID-19 (síndrome post-COVID-19). El objetivo de este estudio fue analizar las características de la prueba de esfuerzo cardiopulmonar (PECP) realizada en pacientes con antecedentes de infección por COVID-19, comparando sujetos según la presencia de síndrome post-COVID-19. Métodos: se realizó un estudio transversal. Se incluyeron pacientes consecutivos >18 años con antecedentes de infección por SARS-CoV-2 confirmada por la prueba de reacción en cadena de la polimerasa y una PECP realizada entre 45 y 120 días luego del episodio viral. Se evaluó la asociación entre variables relacionadas con la PECP y síndrome post-COVID-19 mediante análisis univariante y multivariado. Resultados: Se incluyeron 200 pacientes (edad media 48,8 ± 14,3 años, 51% hombres). Los pacientes con síndrome post-COVID-19 mostraron un VO2 pico significativamente menor (25,8 ± 8,1 mL/min/kg frente a 28,8 ± 9,6 mL/min/kg, p = 0,017) en comparación con los sujetos asintomáticos. Además, los pacientes con síndrome post-COVID-19 desarrollaron síntomas con mayor frecuencia durante la PECP (52,7% vs. 13,7%, p < 0,001) y tenían menos probabilidades de alcanzar el umbral anaeróbico (50,9% vs. 72,7%, p = 0,002) en comparación con sujetos asintomáticos. Estos hallazgos no se modificaron al ajustar por factores de confusión. Conclusión: Nuestros datos sugieren que el síndrome post-COVID-19 se asoció con un menor VO2 pico, una menor probabilidad de alcanzar el umbral anaeróbico y una mayor probabilidad de presentar síntomas durante la PECP. Se necesitan estudios futuros para determinar si estas anomalías durante la PECP tendrían valor pronóstico.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome

Background and aimSeveral reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome.MethodsA cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis.ResultsA total of 200 patients (mean age 48.8±14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8±8.1mL/min/kg vs. 28.8±9.6mL/min/kg, p=0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p<0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p=0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders.ConclusionOur data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value. (AU)

Antecedentes y objetivoVarios informes han demostrado la persistencia de síntomas a largo plazo luego de la infección inicial por COVID-19 (síndrome post-COVID-19). El objetivo de este estudio fue analizar las características de la prueba de esfuerzo cardiopulmonar (PECP) realizada en pacientes con antecedentes de infección por COVID-19, comparando sujetos según la presencia de síndrome post-COVID-19.Métodosse realizó un estudio transversal. Se incluyeron pacientes consecutivos >18 años con antecedentes de infección por SARS-CoV-2 confirmada por la prueba de reacción en cadena de la polimerasa y una PECP realizada entre 45 y 120 días luego del episodio viral. Se evaluó la asociación entre variables relacionadas con la PECP y síndrome post-COVID-19 mediante análisis univariante y multivariado.ResultadosSe incluyeron 200 pacientes (edad media 48,8±14,3 años, 51% hombres). Los pacientes con síndrome post-COVID-19 mostraron un VO2 pico significativamente menor (25,8±8,1mL/min/kg frente a 28,8±9,6mL/min/kg, p=0,017) en comparación con los sujetos asintomáticos. Además, los pacientes con síndrome post-COVID-19 desarrollaron síntomas con mayor frecuencia durante la PECP (52,7% vs. 13,7%, p<0,001) y tenían menos probabilidades de alcanzar el umbral anaeróbico (50,9% vs. 72,7%, p=0,002) en comparación con sujetos asintomáticos. Estos hallazgos no se modificaron al ajustar por factores de confusión.ConclusiónNuestros datos sugieren que el síndrome post-COVID-19 se asoció con un menor VO2 pico, una menor probabilidad de alcanzar el umbral anaeróbico y una mayor probabilidad de presentar síntomas durante la PECP. Se necesitan estudios futuros para determinar si estas anomalías durante la PECP tendrían valor pronóstico. (AU)

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome.

BACKGROUND AND AIM: Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome. METHODS: A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis. RESULTS: A total of 200 patients (mean age 48.8±14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8±8.1mL/min/kg vs. 28.8±9.6mL/min/kg, p=0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p<0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p=0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders. CONCLUSION: Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.

Síndrome pos-COVID-19: solo sabemos que sabemos poco / Pos-COVID-19 syndrome: we only know how little we know

La COVID-19 puede producir síntomas persistentes luego de la infección inicial. En cuadros más graves, pueden corresponder a la evolución propia de una patología crítica o a secuelas inflamatorias/fibróticas pulmonares, entre otras. Esto puede confirmarse por estudios respiratorios e imagenológicos. En el caso de la COVID-19 no grave, el denominado síndrome pos-COVID-19, se trata de síntomas persistentes luego de al menos 28 días sin una secuela orgánica clara. Los síntomas más comunes en este caso son fatiga, cefalea y disnea, que pueden persistir meses luego de la infección inicial. Su curso puede ser oscilante e incluso aumentar progresivamente. El espectro de síntomas es muy amplio y requiere una adecuada evaluación del paciente. Se cree que tiene su origen en la desregulación inmunológica luego de la infección inicial. Su evaluación y seguimiento requieren un adecuado manejo sintomático y acompañamiento por el profesional a cargo. (AU)

Patients who underwent COVID-19 can develop persisting symptoms and sequelae. Severe cases may exhibit systemic complications of critical care and/or inflammatory/fibrotic lung injury. Imaging and respiratory function tests can assist in the evaluation of both. Nonsevere cases can also develop persisting symptoms for more than 28 days, which has been defined as the post COVID-19 syndrome. The most common symptoms in said syndrome are fatigue, headache and dyspnea, which can last for months. Its course can be oscillating or even increase progressively within the first months. The considerable range of symptoms requires proper patient assessment. Post-infectious immune disregulation is believed to be the source of this syndrome. Proper assessment and followup warrant measured symptom management and emphatic care by the attending physician. (AU)

Cost-Effectiveness and Budget Impact Analysis of Primary Screening With Human Papillomavirus Test With Genotyping in Argentina.

OBJECTIVES: Cervical cancer (ICC) is the fourth leading cause of mortality in women in Argentina and primary screening with conventional cytology (Papanicolaou smear) is the most widely used strategy despite its limitations. Strategies based on human papillomavirus (HPV) testing have the potential to improve detection and reduce mortality. The objective of this study is to evaluate the cost-effectiveness and budgetary impact of a strategy based on HPV testing with genotyping. METHODS: We used a decision model to compare the ICC screening strategies. The population consisted of 30- to 65-year-old females suitable for screening in Argentina. Inputs comprised epidemiologic, diagnostic performance, and costs data. The clinical impact was represented by the number of ICC detected and ICC-related mortality. Incremental cost-effectiveness ratio, estimated in terms of Argentinean pesos per life-year gained, and the budgetary impact were calculated at 5, 10, and 20 years. Univariate and probabilistic sensitivity analyses were performed. RESULTS: Primary screening with HPV testing would prevent 1853 ICC deaths and reduce mortality by 13% at year 10 compared with Papanicolaou smear. With an incremental cost-effectiveness ratio of AR$329 042 in the base case, it would be cost-effective for a cost-effectiveness threshold of 1 gross domestic product per capita. It would imply an additional expense in the first 5 years and probably savings in the subsequent ones. Sensitivity analyses confirm the robustness of the findings. CONCLUSIONS: The primary screening strategy based on HPV testing with genotyping compared with conventional cytology is most likely a cost-effective strategy in Argentina.

Características clínicas de la enfermedad por Coronavirus 2019 en un centro de Argentina. Cohorte retrospective / Clinical characteristics of Coronavirus Disease 2019 in a single center of Argentina. Retrospective cohort

Resumen La enfermedad por coronavirus (COVID-19) es un problema prioritario de salud. El objetivo del trabajo fue evaluar las características clínicas, evolución y gravedad de COVID-19 en un centro hospitalario de tercer nivel de la provincia de Buenos Aires, Argentina. Se realizó un estudio de cohorte retrospectiva de pacientes con COVID-19, entre el 3 de marzo y 21 de junio de 2020. Se evaluaron las características en función de la presencia o ausencia de neumonía y de la gravedad de la enfermedad. Se incluyeron 101 pacientes, la mediana de edad fue de 42 años y el 53% mujeres. Los síntomas más frecuentes fueron: fiebre 66% y tos 57%. La disnea y la fiebre se asociaron a la presencia de neumonía. Las comorbilidades más prevalentes fueron: hipertensión 22%, obesidad 18%, enfermedad cardiovascular 7% y enfermedad respiratoria crónica 7%. Los hallazgos de laboratorio más comunes fueron: linfopenia 55%, dímero-D elevado 38% y plaquetopenia 20%. El 26% presentó neumonía y el 24% fue personal de salud. En el 24% de los casos se necesitó más de una muestra de RT-PCR para el diagnóstico. Un valor moderado-alto del Índice de severidad de neumonía (PSI) fue más frecuente en la neumonía grave que en la leve (63 contra 17%, p 0.032). Se registró una mortalidad del 5%. Las características clínicas, la gravedad y evolución fueron similares a las descritas a nivel mundial. Destacamos la proporción elevada del personal de salud infectado, la tasa de falsos negativos de la RT-PCR y la utilidad del PSI para discriminar la gravedad de la neumonía.

Abstract Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. The patients were divided according to the presence or absence of pneumonia and the severity of the disease. The median age was 42 years and 53% were women. The most common symptoms were fever 66% and cough 57%. Dyspnea and fever were associated with the presence of pneumonia. The most prevalent comorbidities were: hypertension 22%, obesity 18%, cardiovascular disease 7% and chronic respiratory disease 7%. The presence of any comorbidity and hypertension were more common in severe cases. The most frequent laboratory findings were: lymphopenia 55%, elevated D-dimer 38%, and thrombocytopenia 20%. In severe diseases, the level of C-reactive protein and D-dimer were higher. Twenty six patients had pneumonia and 24% were healthcare workers. For diagnosis, more than one reverse transcriptase polymerase chain reaction (RT-PCR) sample was needed in 24% of cases. A moderate-high value of the Pneumonia Severity Index (PSI) was more prevalent in severe than mild pneumonia (63% vs. 17%, p 0.032). A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.

[Cryobiopsy in interstitial lung disease: a real-life experience from a single center in Argentina]. / Criobiopsia en enfermedades pulmonares intersticiales difusas. Experiencia en un Centro de Argentina.

Cryobiopsy in interstitial lung disease: a real-life experience from a single center in Argentina. Transbronchial lung cryobiopsy (TBLC) has been recently introduced for the histological assessment of interstitial lung diseases. The objectives were to assess the diagnostic yield and safety of TBLC for interstitial lung diseases in our setting. A retrospective review of subjects who underwent TBLC in a tertiary care center from September 2016 to November 2019 was performed. Data regarding subject and procedure characteristics, complications, histopathological and multidisciplinary diagnosis was recorded. Logistic regression was used to analyze potential factors associated to diagnosis and complications. A total of 52 subjects were included. Mean number of samples was 5.7 (SD 1.7) with a median sample diameter of 6 mm (interquartile range 6-8). Pneumothorax developed in 13 (25%) participants, and no cases of severe bleeding or death were registered. A 73.1% and 84.5% diagnostic yield was recorded through histology and added multidisciplinary evaluation respectively. The number of samples was associated to the diagnostic yield in a multivariate analysis (OR 2.15 - CI95% 1.16- 3.99). TBLC appears to be safe and effective for the assessment of interstitial lung diseases in a real life setting when applied in a center with access to multidisciplinary evaluation.

La criobiopsia transbronquial pulmonar (CBTB) ha sido introducida recientemente para el diagnóstico histológico de las enfermedades pulmonares intersticiales difusas (EPID). Nuestro objetivo fue evaluar el rédito diagnóstico y la seguridad de la CBTB para EPID en un centro de tercer nivel, en Buenos Aires, Argentina. Se efectuó una revisión retrospectiva de sujetos a los que se les realizó una CBTB en este centro desde septiembre de 2016 a noviembre de 2019. Se registró la información referida al paciente, el procedimiento y sus complicaciones, el diagnóstico histológico y multidisciplinario. Se analizaron potenciales factores asociados a diagnóstico y complicaciones por regresión logística. Se incluyeron 52 pacientes. La media de muestras fue 5.7 (DE 1.7) con una mediana de diámetro de 6 mm (rango intercuartil 6-8). Trece (25%) enfermos desarrollaron neumotórax sin encontrarse casos de sangrado grave o muerte. El rédito diagnóstico fue de 73.1% y 84.5% para la histología y la evaluación multidisciplinaria respectivamente. El número de muestras se asoció al rédito diagnóstico en el análisis multivariado (OR 2.15 ­ IC95% 1.16-3.99). La CBTB parece ser segura y efectiva para la evaluación de las EPID en la práctica al aplicarse en un centro con acceso a evaluación multidisciplinaria.

Hallazgos por imágenes en COVID-19: actualización y guía práctica / Imaging findings in COVID-19: update and practical guide

El cuadro clínico de la enfermedad conocida como COVID-19, causada por el nuevo coronavirus SARS-CoV-2 puede variar desde síntomas respiratorios leves hasta una insuficiencia respiratoria severa. Sus efectos en el organismo, especialmente la afección pulmonar, pueden ser visualizados a través de los estudios por imágenes. Si bien el diagnóstico de certeza se confirma mediante la reacción en cadena de la polimerasa con transcriptasa reversa (RT-PCR), los estudios por imágenes, especialmente la radiografía y la tomografía computarizada (TC) de tórax, desempeñan un papel fundamental en el manejo clínico de estos pacientes. Conocer su utilidad, casos de uso y hallazgos esperables brinda herramientas para el equipo de salud, temas que serán abordados en esta actualización y guía práctica. (AU)

The clinical pattern of the disease known as COVID-19, caused by the new coronavirus SARS-Cov-2 can range from mild respiratory symptoms to severe respiratory failure. Its effects on the body, especially the lung condition, can be visualized through imaging studies. While the diagnosis of certainty is confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR), imaging studies, especially chest xray and computed tomography (CT), play a critical role in the clinical management of these patients. Knowing their usefulness, use cases, and expected findings provides tools for the health care team, topics that will be addressed in this update, and practical guide. (AU)

Diagnosis of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease: A cross-sectional study.

INTRODUCTION: Pulmonary embolism (PE) remains a frequent complication in patients with chronic obstructive pulmonary disease (COPD). It is unclear that the extent to which the traditional risk stratifying scores for PE are accurate in this population. METHODS: Cross-sectional study of adult patients with COPD and suspected PE included in an Institutional Registry of Thromboembolic Disease at a tertiary teaching hospital in the city of Buenos Aires, Argentina. We estimated the area under the receiver operating characteristic curves (AU-ROC), sensitivity and specificity of the Wells and Geneva scores using a positive computed tomography angiography as the gold standard for PE. We also estimated the sensitivity and specificity for the presence of isolated worsening of dyspnea at presentation, without other cardinal symptoms of acute exacerbation of COPD. RESULTS: A total of 168 patients were included, of which 22% had confirmed PE. The AUC was 0.66 (95% CI 0.56-0.76) and 0.56 (95% CI 0.45-0.67) for the Wells and Geneva, respectively. Considering the most widely used cutoff points, the sensitivity and specificity were 24% and 90% for the Wells and 59% and 43% for the Geneva score, respectively. Isolated worsening of dyspnea on presentation had a sensitivity of 92% and specificity of 37%. CONCLUSIONS: Both Wells and Geneva scores exhibit poor diagnostic accuracy for the diagnosis of PE in patients with COPD. The presence of isolated worsening of dyspnea on presentation could be an easy to identify criteria for the initial triage in this population. Further validation of our findings remains warranted.

[Clinical characteristics of coronavirus disease 2019 in a single center of Argentina. Retrospective cohort]. / Características clínicas de la enfermedad por coronavirus 2019 en un centro de Argentina. Cohorte retrospectiva.

Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. The patients were divided according to the presence or absence of pneumonia and the severity of the disease. The median age was 42 years and 53% were women. The most common symptoms were fever 66% and cough 57%. Dyspnea and fever were associated with the presence of pneumonia. The most prevalent comorbidities were: hypertension 22%, obesity 18%, cardiovascular disease 7% and chronic respiratory disease 7%. The presence of any comorbidity and hypertension were more common in severe cases. The most frequent laboratory findings were: lymphopenia 55%, elevated D-dimer 38%, and thrombocytopenia 20%. In severe diseases, the level of C-reactive protein and D-dimer were higher. Twenty six patients had pneumonia and 24% were healthcare workers. For diagnosis, more than one reverse transcriptase polymerase chain reaction (RT-PCR) sample was needed in 24% of cases. A moderate-high value of the Pneumonia Severity Index (PSI) was more prevalent in severe than mild pneumonia (63% vs. 17%, p 0.032). A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.

La enfermedad por coronavirus (COVID-19) es un problema prioritario de salud. El objetivo del trabajo fue evaluar las características clínicas, evolución y gravedad de COVID-19 en un centro hospitalario de tercer nivel de la provincia de Buenos Aires, Argentina. Se realizó un estudio de cohorte retrospectiva de pacientes con COVID-19, entre el 3 de marzo y 21 de junio de 2020. Se evaluaron las características en función de la presencia o ausencia de neumonía y de la gravedad de la enfermedad. Se incluyeron 101 pacientes, la mediana de edad fue de 42 años y el 53% mujeres. Los síntomas más frecuentes fueron: fiebre 66% y tos 57%. La disnea y la fiebre se asociaron a la presencia de neumonía. Las comorbilidades más prevalentes fueron: hipertensión 22%, obesidad 18%, enfermedad cardiovascular 7% y enfermedad respiratoria crónica 7%. Los hallazgos de laboratorio más comunes fueron: linfopenia 55%, dímero-D elevado 38% y plaquetopenia 20%. El 26% presentó neumonía y el 24% fue personal de salud. En el 24% de los casos se necesitó más de una muestra de RT-PCR para el diagnóstico. Un valor moderado-alto del Índice de severidad de neumonía (PSI) fue más frecuente en la neumonía grave que en la leve (63 contra 17%, p 0.032). Se registró una mortalidad del 5%. Las características clínicas, la gravedad y evolución fueron similares a las descritas a nivel mundial. Destacamos la proporción elevada del personal de salud infectado, la tasa de falsos negativos de la RT-PCR y la utilidad del PSI para discriminar la gravedad de la neumonía.

Abordaje diagnóstico de la neumonitis por hipersensibilidad / Diagnostic approach to pneumonitis due to hypersensitivity

Leímos con interés el artículo publicado en el tercer número del año 2018 de la Revista Americana de Medicina Respiratoria sobre "Neumonitis por hipersensibilidad: Reporte de dos casos clínicos" y felicitamos a los autores por su iniciativa. Sin embargo, nos gustaría hacer notar que a nuestro entender el trabajo envía algunos mensajes incorrectos en relación al diagnóstico y tratamiento de la neumonitis por hipersensibilidad

Métodos de análisis gráfico de obstrucción espirométrica: ¿una imagen vale más que mil palabras? / Graphical Analysis Methods in Obstructive Spirometry: Does a Picture Speak More Than a Thousand Words?

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Neumonitis por radiación secundaria a radioembolización hepática con itrio-90 / Radiation pneumonitis following hepatic yttrium-90 radioembolization

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Effect of angiotensin 2 receptor blockers on chronic obstructive lung disease mortality: A retrospective cohort study.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is the fifth cause of mortality worldwide. Systemic inflammation is a crucial element in its physiopathology. As Renin-Angiotensin System is one of the main components of this inflammatory neurohumoral cascade, Angiotensin Receptor Blockers (ARBs) might have an effect on mortality in COPD patients. GOAL: To evaluate the association between ARBs treatment and mortality in COPD patients. METHODS: Retrospective cohort of patients with diagnosis of COPD from 2003 to 2013. COPD cases were detected according to the diagnosis by treating physicians in any field of the electronic clinical health records by controlled vocabulary in patients older than 18 years affiliated to the Hospital Italiano de Buenos Aires (HIBA) Health Plan. Patients were classified in two groups depending on their use of ARBs according to the hospital pharmacy records. The mortality registry of the HIBA was used to obtain the event of death. The 8 year survival experience was described using Kaplan Meier estimator and survival curve comparisons were calculated with the Cox Mantel test. Hazard Ratios (HR) were estimated using a Cox proportional risk model. A propensity score (PS) was developed for the use of ARBs. RESULTS: 1140 deaths were detected, 1063 in the no exposure group and 77 in the ARBs exposure group. The 8 year survival was 71% (CI 95% 69-72%). The survival in the non exposed group was 71% (CI 95% 69-73%) and 76% (CI 95% 0,69-0,81) in the ARBs exposed group. The unadjusted HR for mortality was 0.85 (CI 95% 0.67-1.07, p = 0.17) and the adjusted HR by PS was 0.63 (CI 95% 0.50-0.80, p < 0.001). DISCUSSION: ARBs use seems to be associated to a lower mortality in patients with COPD. Additional studies are needed to corroborate this finding.