Descripción y análisis de mortalidad a corto y medio plazo en una unidad de cuidados respiratorios intermedios: nuestra experiencia / Pdescription and analysis of short and medium-term mortality in an intermediate respiratory care unit: our experience

Objetivo: Describir y analizar la mortalidad de los pacientes que ingresan en nuestra UCRI, tanto durante el ingreso en dicha UCRI, como a lo largo de toda la estancia hospitalaria, y a los 3 y 6 meses del alta hospitalaria. Metodología: Estudio prospectivo de 380 pacientes, no Covid, ingresados en nuestra UCRI, destinada al tratamiento del fallo respiratorio agudo con VMNI, a lo largo de año y medio de actividad. Se recogieron datos demográficos, índice de Charlson modificado (m), tipo de fallo respiratorio, servicio de pertenencia, días de estancia en UCRI y la mortalidad tanto en UCRI como hospitalaria, y a los 3 y 6 meses del alta del hospital. Resultados: El 55% eran varones con una edad media de 71 años y un índice de Charlson (m) de 6,4. La mortalidad en UCRI fue del 16.4% y la intrahospitalaria del 27%, relacionándose ambas con la edad, el índice de Chalson (m), el servicio de pertenencia y el fallo respiratorio hipoxémico. Tras el alta hospitalaria, la supervivencia a los tres meses fue del 83,6% y a los 6 meses del 75,5% relacionándose ambas con la edad y el índice de Charlson (m). Conclusiones: Las UCRIs son útiles en el tratamiento del fallo respiratorio agudo en pacientes con alta carga de comorbilidad, permitiendo a tales pacientes tener una elevada supervivencia a medio plazo tras el alta hospitalaria. (AU)

Objective: describe and analyze the mortality of patients admitted to our IRCU, both during admission to said IRCU, and throughout the entire hospital stay, and 3 and 6 months after hospital discharge. Methodology: prospective study of 380 non-Covid patients admitted to our IRCU, intended for the treatment of acute respiratory failure with NIV, over a year and a half of activity. Demographic data, modified Charlson index (m), type of respiratory failure, service affiliation, days of stay in the IRCU, and mortality both in the IRCU and in hospital, and at 3 and 6 months after hospital discharge were collected. Results: 55% were men with a mean age of 71 years and a Charlson index (m) of 6.4. Mortality in the IRCU was 16.4% and in-hospital mortality was 27%, both being related to age, the Chalson index (m), the service to which they belong, and hypoxemic respiratory failure. After hospital discharge, survival at three months was 83.6% and at 6 months was 75.5%, both related to age and the Charlson index (m). Conclusions: IRCU are useful in the treatment of acute respiratory failure in patients with a high burden of comorbidity, allowing such patients to have a high medium-term survival after hospital discharge. (AU)

Sarcoidosis-like reactions in cancer patients treated with immune checkpoint inhibitors: experience in a Spanish hospital

Background Immune checkpoint inhibitors (ICI) have been associated with several immune-related adverse events, including sarcoidosis-like reactions (SLR). SLR, which has a low prevalence but an increasing incidence, is similar to sarcoidosis in terms of histology, and clinical and radiological manifestations. The most commonly affected organs are hilar and mediastinal lymph nodes and skin. SLR is an exclusion diagnosis, so a lymph node biopsy can be useful to distinguish between tumor progression and SLR, particularly in tumors in which nodal involvement is very common. Patients and methods We performed a retrospective analysis of SLR in all cancer patients receiving ICIs in our institution between January 2016 and June 2020. Results Among the 1063 treated patients, seven experienced SLR, four of whom were symptomatic (cough, skin lesions, arthralgia), with time to onset ranging from 1.5 to 6.7 months after ICI initiation. All seven patients had bilateral hilar lymphadenopathy, and granulomatous reactions in five of the six patients with lymph node biopsies. SLR improved in all patients, including four patients who continued with ICI. Three patients received corticosteroids and/or stopped ICI therapy. Four of these patients had partial responses at the time SLR was identified. Conclusion Management of SLR lacks a consensus recommendation, although corticosteroids and/or stopping the ICI are generally implemented. The potential consequences of stopping anticancer treatment should be taken into consideration, particularly in the absence of clear management recommendations (AU)

Sarcoidosis-like reactions in cancer patients treated with immune checkpoint inhibitors: experience in a Spanish hospital.

BACKGROUND: Immune checkpoint inhibitors (ICI) have been associated with several immune-related adverse events, including sarcoidosis-like reactions (SLR). SLR, which has a low prevalence but an increasing incidence, is similar to sarcoidosis in terms of histology, and clinical and radiological manifestations. The most commonly affected organs are hilar and mediastinal lymph nodes and skin. SLR is an exclusion diagnosis, so a lymph node biopsy can be useful to distinguish between tumor progression and SLR, particularly in tumors in which nodal involvement is very common. PATIENTS AND METHODS: We performed a retrospective analysis of SLR in all cancer patients receiving ICIs in our institution between January 2016 and June 2020. RESULTS: Among the 1063 treated patients, seven experienced SLR, four of whom were symptomatic (cough, skin lesions, arthralgia), with time to onset ranging from 1.5 to 6.7 months after ICI initiation. All seven patients had bilateral hilar lymphadenopathy, and granulomatous reactions in five of the six patients with lymph node biopsies. SLR improved in all patients, including four patients who continued with ICI. Three patients received corticosteroids and/or stopped ICI therapy. Four of these patients had partial responses at the time SLR was identified. CONCLUSION: Management of SLR lacks a consensus recommendation, although corticosteroids and/or stopping the ICI are generally implemented. The potential consequences of stopping anticancer treatment should be taken into consideration, particularly in the absence of clear management recommendations.

Embarazo en paciente con miopatía congénita y severa afectación respiratoria / No disponible

No disponible

[Variations in the prevalence and patient profile of white-coat syndrome, according to its definition using self-measurement of blood pressure at home]. / Variaciones de la prevalencia y el perfil del paciente con fenómeno de bata blanca, según su definición con automedida de presión arterial domiciliaria (AMPA).

OBJECTIVE: To calculate the prevalence of white-coat syndrome (WCS) in patients with hypertension, comparing the two most common definitions and their effect on the profile of the patient with WCS. DESIGN: Cross-sectional, descriptive study.Setting. Urban health centre.Patients. Hypertense patients selected by simple randomised sampling from among those included in the hypertension programme. MEASUREMENTS: Clinical blood pressure (CBP) from the previous year was collected. Home blood pressure (HBP) was measured by the patient with an electronic sphygmomanometer. Age, sex, further tests (analysis and electrocardiogram) and other clinical features were also recorded. WCS was defined as when CBP was above/equal to 140/90 mmHg and HBP was under 135/85 mmHg or when the difference between CBP and HBP was more than/equal to 20 mmHg systolic and/or 10 mmHg diastolic pressure. RESULTS: In 154 hypertense patients (60.4% women) between 38 and 92 years old, mean CBP (141.1/85.3) was higher than mean HBP (136.8/79.8). WCS prevalence varied (p = 0.001), depending on the definition used (20.1% and 36.4%). The systolic and diastolic mean CBP of the last year were higher in those patients with WCS (p < 0.001 for diastolic pressure). The profile of hypertense patients with WCS varied according to the definition used. CONCLUSIONS: WCS is common in hypertense patients treated in Primary Care and may condition an inadequate assessment of the degree of blood pressure monitoring. As the way of defining WCS conditions its prevalence, its profile and clinical decision-taking, it is essential to agree a uniform definition for practical use.

Variaciones de la prevalencia y el perfil del paciente con fenómeno de bata blanca, según su definición con automedida de presión arterial domiciliaria (ampa) / Variations in the prevalence and patient profile of white-coat syndrome, according to its definition using self-measurement of blood pressure at home

Objetivo. Estimar la prevalencia del fenómeno de bata blanca (FBB) en hipertensos tratados, comparando las dos definiciones más empleadas y su influencia en el perfil del paciente con FBB. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud urbano. Pacientes. Hipertensos seleccionados mediante muestreo aleatorio simple entre los incluidos en el programa de hipertensión arterial. Mediciones. Se recogieron las tensiones arteriales en la clínica (TAC) del último año y se midieron por el paciente las tensiones arteriales domiciliarias (TADo) con esfigmomanómetro electrónico, además de edad, sexo, pruebas complementarias (analítica y electrocardiograma) y otras características clínicas. Se definió FBB cuando la TAC era 140/90 mmHg y la TADo < 135/85 mmHg o cuando la diferencia entre TAC y TADo era 20 mmHg de sistólica y/o 10 mmHg de diastólica. Resultados. En 154 pacientes hipertensos (60,4 por ciento mujeres) de 38-92 años, la TAC media (141,1/85,3) fue superior a la TADo media (136,8/79,8). La prevalencia de FBB fue diferente (p = 0,001) según la definición empleada (20,1 por ciento y 36,4 por ciento). Las TAC sistólicas y diastólicas medias del último año fueron superiores en los pacientes que presentaban FBB (p < 0,001 para la diastólica). El perfil del hipertenso con FBB variaba según la definición empleada. Conclusiones. El FBB es frecuente en hipertensos tratados en atención primaria y puede condicionar una inadecuada valoración del grado de control de la TA. La manera de definirlo condiciona su prevalencia, perfil y toma de decisiones clínicas, por lo que consensuar una definición uniforme parece imprescindible para su aplicación práctica (AU)