A real life cohort of Mepolizumab treatment in severe eosinophilic asthma.

Summary: Background. Mepolizumab, a monoclonal antibody that interacts with IL-5, was the first anti-IL-5 approved for uncontrolled severe eosinophilic asthma. In several randomised, placebo-controlled trials, treatment with mepolizumab has shown a significant improvement in asthma symptoms and the need to use of oral corticosteroids (OCS). Several studies have correlated blood levels of eosinophil cationic protein (ECP) with the degree of eosinophilic inflammation, which could make it an indirect marker of eosinophilic activity. Methods. This was a single-centre retrospective study that included all patients diagnosed with severe eosinophilic asthma under treatment with mepolizumab. We recorded the number of exacerbations, daily prednisone intake, asthma control test scores and forced expiratory volume in the first second. Results. We followed 22 patients, 14 of whom were OCS-dependent with a mean daily dose of 15.85 ± 15.62 mg prednisone. After 12 months, only five continued taking OCS and the mean daily dose was reduced by up to 2.50 ± 3.84 mg (p less than 0.007). The exacerbation rate at baseline was 2.91 ± 2.27 and decreased to 0.82 ± 1.14 in the following year (p less than 0.001). ACT scores increased significantly from 16.00 ± 5.85 to 20.71 ± 4.45 after six months (p = 0.003). We also observed a decrease in ECP from 81.46 ± 43.99 µg/L to 19.12 ± 18.80 µg/L (p > 0.001). Conclusions. These real-life results are consistent with previous clinical trials demonstrating the efficacy and safety of mepolizumab in routine clinical practice for severe uncontrolled eosinophilic asthma. We observed a significant decrease in blood eosinophil counts and in ECP levels, suggesting a reduction in eosinophil activity following mepolizumab treatment.

Liderazgo de la mujer en la investigación clínica: estudio observacional retrospectivo durante dos décadas en España / Women's leadership in clinical research: A retrospective observational study over two decades in Spain

Antecedentes y objetivo Los datos disponibles avalan las diferencias por género en el liderazgo de las investigaciones clínicas (IC). Este estudio analiza en qué medida las mujeres lideran estas investigaciones. Materiales y métodos Estudio observacional retrospectivo en un hospital universitario terciario asociado a uno de los institutos de investigación sanitaria más importantes de España. Analizamos los investigadores principales (IP) por género (2001-2020). Variable principal: proporción de IC lideradas por mujeres durante el período de estudio. Variables secundarias: diferencias de IP por género según el tipo de estudio: ensayos clínicos (EC) o estudios de no-intervención (ENI) y según la financiación. Fuentes de datos: registros del Comité de Ética en Investigación con medicamentos (CEIm) y del Departamento de Recursos Humanos. Resultados Durante el estudio, el CEIm aprobó 8.466 protocolos; el 52% (4.408/8.466) fueron EC y el resto, ENI. Las mujeres lideraron un 39,7% (3.360/8.466) del total. La brecha de género se observó principalmente en EC: las mujeres fueron IP de un 31,5% de ellos (1.391/4.408) y de un 48,5% (1.969/4.058) de los ENI. Ello a pesar de la tendencia creciente del número de facultativas. Los estudios de financiación privada fueron más comúnmente liderados por hombres. Conclusiones Nuestros resultados demuestran que existe una infrarrepresentación de las mujeres en puestos de liderazgo en la investigación, principalmente en aquellos con financiación privada. Este estudio refuerza la idea de que todavía queda un largo camino por recorrer en este campo. Se necesitan más estudios para la identificación de diferencias existentes que permitan implantar cambios a nivel institucional y cultural que promuevan la igualdad de género en el ámbito de la investigación clínica (AU)

Background and objective Available data support differences by gender in the leadership of clinical investigations (CI). This study analyzes to what extent women lead these investigations. Materials and method Observational-retrospective study in a tertiary university hospital associated with one of the most important health research institutes in Spain. We analyzed the principal investigators (PI) by gender from 2001 to 2020. Main outcome: proportion of CI led by female doctors (FD) during the study period. Secondary outcomes: differences in PI by gender according to the type of study: clinical trials (CT) or non-interventional-researches (NIR) and according to type of funding. Data sources: Research Ethics Committee (REC) and Human Resources Department registries. Result During the study, the REC approved 8,466 protocols, 52% (4,408/8,466) were EC, the rest were NIR. Women led 39.7% (3,360/8,466) of the total. The gender gap was observed mainly in EC: FD were IP of 31.5% of them (1,391/4,408) and 48.5% (1,969/4,058) of NIR. This despite the increasing trend in the number of FD staff. By type of funding, when the studies were supported by private sector there was a wider gap markedly unfavorable for women. Conclusions Our results show that there is underrepresentation of women in research leadership, mainly those with private financing. This study reinforces the idea that there is still a long way to go in this field. More studies are necessary to identify the existing differences that allow the implementation of actions at the institutional and cultural level that promote gender equality in the field of clinical research (AU)

Women's leadership in clinical research: A retrospective observational study over two decades in Spain.

BACKGROUND AND OBJECTIVE: Available data support differences by gender in the leadership of clinical investigations (CI). This study analyzes to what extent women lead these investigations. MATERIALS AND METHODS: Observational-retrospective study in a tertiary university hospital associated with one of the most important health research institutes in Spain. We analyzed the principal investigators (PI) by gender from 2001 to 2020. MAIN OUTCOME: proportion of CI led by female doctors (FD) during the study period. SECONDARY OUTCOMES: differences in PI by gender according to the type of study: clinical trials (CT) or non-interventional-researches (NIR) and according to type of funding. DATA SOURCES: Research Ethics Committee (REC) and Human Resources Department registries. RESULTS: During the study, the REC approved 8466 protocols, 52% (4408/8466) were EC, the rest were NIR. Women led 39.7% (3360/8466) of the total. The gender gap was observed mainly in EC: FD were IP of 31.5% of them (1391/4408) and 48.5% (1969/4058) of NIR. This despite the increasing trend in the number of FD staff. By type of funding, when the studies were supported by private sector there was a wider gap markedly unfavorable for women. CONCLUSIONS: Our results show that there is underrepresentation of women in research leadership, mainly those with private financing. This study reinforces the idea that there is still a long way to go in this field. More studies are necessary to identify the existing differences that allow the implementation of actions at the institutional and cultural level that promote gender equality in the field of clinical research.

Multidisciplinary severe asthma management: the role of hospital pharmacists in accredited specialized adult asthma units in Spain

No disponible

How are the ancient cystic fibrosis patients? Cystic fibrosis diagnosed over 60 years-old.

BACKGROUND AND AIMS: To specify the prevalence of patients diagnosed with CF at age of ≥60 year-old and to analyze their characteristics. PATIENTS AND METHODS: Observational study of CF patients which were diagnosed at age ≥60 year-old. The analyzed variables were: age, sex, nationality, lung function parameters, conditions present at diagnosis, microbiological characteristics and genetic findings. RESULTS: eight patients were included. 7 patients were female (87.5%) with a mean age of 70.6 years (median 71.5 years, range 60-78 years). The most important findings were: sweat test >60 mEq/l; heterozygotes F508del; bronchiectasis in CT; methicillin-sensitive Staphylococcus aureus (50%) in sputum. The most patients presented a normal or mild obstructive lung function. CONCLUSIONS: CF must also be considered a disease diagnosed in adulthood, incorporating the sweat test within the usual techniques of differential diagnosis in patients with different diseases associated with CF, because genetic counselling is esencial.

Juego de patentes. Sobre medicamentos genéricos y biosimilares / The patents game. Generic and biosimilar drugs

La protección mediante patentes a los medicamentos es limitada y, al expirar estos títulos de propiedad intelectual, entran en el mercado otros medicamentos copiados que compiten con los innovadores. Inicialmente estos fueron idénticos a los originales, los llamados medicamentos genéricos, pero, en los últimos años, a raíz de la irrupción de las terapias biológicas y la expiración de muchas de sus patentes han aparecido también los medicamentos biosimilares. Aunque no son copias exactas del original, al igual que los medicamentos genéricos, los medicamentos biosimilares tienen que demostrar equivalencia en calidad seguridad y eficacia respecto a los originales. A pesar de su importancia y su contribución a la sostenibilidad del sistema sanitario, a veces hay desconocimiento sobre las diferencias entre medicamentos genéricos y medicamentos biosimilares y qué implica su utilización en términos clínicos y económicos. Con esta revisión pretendemos aclarar aspectos que a menudo se desconocen a pesar del uso cada vez mayor de estos fármacos (AU)

The protection provided by patents on medicines has a limited duration. The expiry of patents expiration allows copies of the drugs to be released, competing with original. At first, they were identical to the original, known as generic drugs, but in recent years, due to the marketing of biological therapies and the expiry of many of their patents, biosimilar drugs have also emerged. These are not exact copies of the original, but, like generic drugs, biosimilar drugs have to demonstrate equivalence to the reference drugs in quality, safety and efficacy. Nevertheless, despite their importance and contribution to sustainability of health system, doctors are sometimes unaware of differences between them, and their impact in terms of clinical and economic effects. An attempt is made to review and clarify certain aspects often unknown by physicians, despite their involvement in their use (AU)

Nocardiosis pulmonar en una paciente tratada con corticoides / No disponible

En general, la nocardiosis pulmonar es una infección poco frecuente con una morbilidad aumentada cuando el diagnostico no se hace de forma precoz. En poblaciones inmunodeprimidas su prevalencia llega a ser más alta que en la población general. De esta forma, el tratamiento con corticoides sistémicos utilizado en algunas enfermedades respiratorias, tal como es la fibrosis pulmonar, favorecen el desarrollo de esta infección oportunista. Es por esta razón que se debe tener en cuenta la posibilidad de nocardiosis pulmonar dentro del diagnóstico diferencial de una neumonía de tórpida evolución en pacientes con alteración de la inmunidad

Pulmonary infection caused by Nocardia is not common but is associated with a high mortality rate whether it is not diagnosed at an early stage. However, in immunocompromised patients the prevalence of this infection is higher as well as its related complications. So, the use of systemic corticosteroid drugs in different respiratory diseases, as pulmonary fibrosis, might result in the developing of this opportunist infection. So, pulmonary nocardiosis should be considered among the differential diagnosis of a nonresolving pneumonia in immunocompromised patients

[The patents game. Generic and biosimilar drugs]. / Juego de patentes. Sobre medicamentos genéricos y biosimilares.

The protection provided by patents on medicines has a limited duration. The expiry of patents expiration allows copies of the drugs to be released, competing with original. At first, they were identical to the original, known as generic drugs, but in recent years, due to the marketing of biological therapies and the expiry of many of their patents, biosimilar drugs have also emerged. These are not exact copies of the original, but, like generic drugs, biosimilar drugs have to demonstrate equivalence to the reference drugs in quality, safety and efficacy. Nevertheless, despite their importance and contribution to sustainability of health system, doctors are sometimes unaware of differences between them, and their impact in terms of clinical and economic effects. An attempt is made to review and clarify certain aspects often unknown by physicians, despite their involvement in their use.

Déficit de alfa-1-antitripsina en asma grave mal controlada / No disponible

En la mayoría de pacientes remitidos a consultas especializadas por mal control de su asma, esta circunstancia se produce por causas ajenas a la propia enfermedad o por mal cumplimiento del tratamiento por parte del paciente. Una causa poco común que puede contribuir a un mal control del asma es el déficit de alfa-1-antitripisina, enfermedad con un alto porcentaje de infradiagnóstico, cuyo diagnóstico precoz y tratamiento sustitutivo podrían frenar la caída de la función pulmonar y mejorar el control del asma en estos pacientes

In most of patients who attend to a specialized doctor’s appointment due to an unsatisfactory asthma control, this fact is due to reasons unrelated with the breathing disorder itself or due to the noncompliance of the treatment by the patient. In the same way, there are diseases like the alpha-1-antitrypsin deficiency with a high percentage of incorrect diagnosis, whose early diagnosis and replacement therapy can slow down the reduction of the pulmonary function and achieve a correct asthma control leading to an enhancement of the patients’ quality of life

Eradication of Burkholderia cepacia Using Inhaled Aztreonam Lysine in Two Patients with Bronchiectasis.

There are not many articles about the chronic bronchial infection/colonization in patients with underlying lung disease other than cystic fibrosis (CF), especially with non-CF bronchiectasis (NCFBQ). The prevalence of B. cepacia complex is not well known in NCFBQ. The vast majority of published clinical data on Burkholderia infection in individuals with CF is comprised of uncontrolled, anecdotal, and/or single center experiences, and no consensus has emerged regarding treatment. We present two cases diagnosed with bronchiectasis (BQ) of different etiology, with early pulmonary infection by B. cepacia complex, which was eradicated with inhaled aztreonam lysine.

Fibrosis quística diagnosticada en edad adulta / Cystic fibrosis in adult age

Objetivo. Precisar la prevalencia de enfermos con fibrosis quística (FQ) diagnosticados en edades superiores a los 18 años y analizar sus características clínicas, genéticas y microbiológicas. Pacientes y métodos. Estudio observacional, transversal y descriptivo de todos los pacientes diagnosticados de FQ a edad igual o superior a los 18 años. Las variables analizadas fueron: edad actual, edad al diagnóstico, sexo, nacionalidad, parámetros de función pulmonar, patologías presentes al momento del diagnóstico, características microbiológicas y hallazgos genéticos. Resultados. Se incluyeron 89 pacientes (14,8%, del total de 600 pacientes en seguimiento en las unidades participantes), 45 mujeres (50,6%) y 44 varones (49,4%), con una edad media al diagnóstico de 36,4 años. Ochenta y un pacientes (91%) eran de nacionalidad española. La prueba del sudor fue diagnóstica en 77 de los 89 estudiados (86,5%). Las mutaciones detectadas con mayor frecuencia fueron la F508del/otra y la G542X/otra y los hallazgos clínicos más frecuentes en el momento del diagnóstico fueron las bronquiectasias en 33 pacientes (37,1%) y la esterilidad en 12 (13,5%). Los microorganismos colonizadores más frecuentes fueron Staphylococcus aureus (S.aureus) sensible a meticilina (23,6%) y Pseudomonas aeruginosa (P. aeruginosa) (13,5%). La mayoría de los pacientes presentaban una alteración ventilatoria obstructiva leve y no tenía afectación pancreática. La prueba del sudor con frecuencia ofreció resultados no concluyentes. Conclusiones. La FQ es también una enfermedad de diagnóstico en la edad adulta. Los pacientes diagnosticados en edad adulta presentan una función pulmonar levemente alterada y una baja incidencia de afectación pancreática, por lo que su pronóstico tiende a ser favorable (AU)

Aim. To know the prevalence of the patients diagnosed of cystic fibrosis (CF) older than 18 years old of five specific Spanish Units and to analyze their clinical, genetic and microbiological characteristics. Patients and methods. Observational, cross-sectional, descriptive study of patients diagnosed with CF at age or older than 18 years. The variables analyzed were: current age, age at diagnosis, sex, nationality, lung function parameters, pathologies presented at diagnosis, microbiological features and genetic findings. Results. Eigthy nine patients (14.8% of the total of 600 CF patients followed at the participating units), of which 45 patients were female (50.6%) and 44 were males (49.4%), were included with a mean age at diagnosis of 36.4 years. Eigthy one patients (91%) were Spaniards. The sweat test was diagnostic in 77 (86.5%) of the patients studied. The sweat test was diagnostic in 77 of the 89 patients studied (86.5%). The most frequently detected mutations were F508del/other and G542X/other, and the most frequent clinical findings at diagnosis were the presence of bronchiectasis in 33 patients (37.1%) followed by sterility in 12 patients (13.5%). The most common colonizing organisms were meticillin-sensitive Staphylococcus aureus (S.aureus) (23.6%) and Pseudomonas aeruginosa (P. aeruginosa) (13.5%). Most patients presented a mild obstructive ventilatory defect and had no pancreatic involvement. The sweat test used to be indeterminate. Conclusions. CF is also a disease which diagnosis can be in adulthood. CF patients diagnosed in adulthood have a mild lung function and lower incidence of pancreatic involvement, so their prognosis tends to be favorable (AU)

Cystic fibrosis in adult age. / Fibrosis quística diagnosticada en edad adulta.

AIM: To know the prevalence of the patients diagnosed of cystic fibrosis (CF) older than 18 years old of five specific Spanish Units and to analyze their clinical, genetic and microbiological characteristics. PATIENTS AND METHODS: Observational, cross-sectional, descriptive study of patients diagnosed with CF at age or older than 18 years. The variables analyzed were: current age, age at diagnosis, sex, nationality, lung function parameters, pathologies presented at diagnosis, microbiological features and genetic findings. RESULTS: Eigthy nine patients (14.8% of the total of 600 CF patients followed at the participating units), of which 45 patients were female (50.6%) and 44 were males (49.4%), were included with a mean age at diagnosis of 36.4 years. Eigthy one patients (91%) were Spaniards. The sweat test was diagnostic in 77 (86.5%) of the patients studied. The sweat test was diagnostic in 77 of the 89 patients studied (86.5%). The most frequently detected mutations were F508del/other and G542X/other, and the most frequent clinical findings at diagnosis were the presence of bronchiectasis in 33 patients (37.1%) followed by sterility in 12 patients (13.5%). The most common colonizing organisms were meticillin-sensitive Staphylococcus aureus (S.aureus) (23.6%) and Pseudomonas aeruginosa (P. aeruginosa) (13.5%). Most patients presented a mild obstructive ventilatory defect and had no pancreatic involvement. The sweat test used to be indeterminate. CONCLUSIONS: CF is also a disease which diagnosis can be in adulthood. CF patients diagnosed in adulthood have a mild lung function and lower incidence of pancreatic involvement, so their prognosis tends to be favorable.

Análisis de las preferencias de los profesionales sanitarios respecto a la prescripción electrónica de tratamientos farmacológicos en pacientes hospitalizados / Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients

Objetivo. Evaluar preferencias de profesionales sanitarios acerca de la prescripción electrónica (PE) sobre las condiciones de trabajo, riesgo de errores de medicación y utilidad de ventajas aportadas por este sistema. Material y métodos. Estudio transversal mediante entrevista a una muestra de usuarios de PE en un hospital terciario. El cuestionario se estructuró en 3 categorías para valorar: su repercusión en la carga de trabajo, en el riesgo de errores de medicación y sus ventajas teóricas, inconvenientes y sugerencias. Resultados. Participaron 76 profesionales (58 médicos, 9 farmacéuticos y 9 DUE). Sobre su repercusión en la rutina lo mejor valorado fue la reducción de la carga de trabajo y el tiempo empleado (bueno o muy bueno para el 85,5%; IC 95%: 75,5-92,5). Opinaron que la reducción de errores se debía principalmente a soportes de ayuda predefinidos. Las ventajas mejor valoradas fueron: legibilidad y alertas (las consideraron positivamente un 98,7% [IC 95%: 92,9-99,9] y 97,4% [IC 95%:90,81-99,68]). Estimaron como principales inconvenientes los tecnológicos: excesiva dependencia, falta de equipos y fallos informáticos, así como la falta de continuidad farmacoterapéutica entre las distintas unidades de hospitalización durante el ingreso. La necesidad de unificación entre aplicaciones informáticas del hospital fue la sugerencia de mejora más repetida. Conclusión. Los profesionales sanitarios manifestaron un alto grado de satisfacción sobre la PE, a la que consideraron eficaz y segura. Como principal inconveniente destacaron la dependencia de la tecnología y falta de infraestructura. También opinaron que sería deseable una mayor integración entre las distintas aplicaciones informáticas (AU)

Objective: to evaluate health personnel perceptions about medical order entry systems concerning the effect on workflow, medication errors risk and assessment of its potential advantages. Material and methods: A cross-section opinion interview was conducted in a tertiary care hospital. Questionnaire consisted of three sections: perception of its effect on workflow, influence on medication error risk and assessment of potential advantages. We also asked them to assess drawbacks and provide suggestions about this prescription system. Results: 76 health professionals were interviewed (58 physicians, 9 pharmacists and 9 nurses). They were satisfied mainly due to decrease the workload (85.5%; IC 95%: 75.58-92.55). They thought that the main characteristics that contribute to reduce medication errors are clinical decision supports related to predefined aspects which the program provided by default. Among potential benefits of medical order entry systems, legibility and warnings triggered by the program (98.7%; IC 95%: 92.90-99.97 and 97,4%; IC 95%: 90.81-99.68 respectively) were the most valuable. High technology dependence, IT failures and lack of infrastructure and medication therapy discontinuities at times of transition between different hospitals’ units were the main drawbacks considered. The most repeated suggestion was related to the improvement of links between other health informatics applications used in the hospital. Conclusion: health personnel were highly satisfied with the CPOE system, which is considered to be effective and safe. Technology dependence and IT failures were the main disadvantages reported. According to them, a greater coordination and unification of all software applications available in the hospital would be desirable (AU)

[Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients]. / Análisis de las preferencias de los profesionales sanitarios respecto a la prescripción electrónica de tratamientos farmacológicos en pacientes hospitalizados.

OBJECTIVE: to evaluate health personnel perceptions about medical order entry systems concerning the effect on workflow, medication errors risk and assessment of its potential advantages. MATERIAL AND METHODS: A cross-section opinion interview was conducted in a tertiary care hospital. Questionnaire consisted of three sections: perception of its effect on workflow, influence on medication error risk and assessment of potential advantages. We also asked them to assess drawbacks and provide suggestions about this prescription system. RESULTS: 76 health professionals were interviewed (58 physicians, 9 pharmacists and 9 nurses). They were satisfied mainly due to decrease the workload (85.5%; IC 95%: 75.58-92.55). They thought that the main characteristics that contribute to reduce medication errors are clinical decision supports related to predefined aspects which the program provided by default. Among potential benefits of medical order entry systems, legibility and warnings triggered by the program (98.7%; IC 95%: 92.90-99.97 and 97,4%; IC 95%: 90.81-99.68 respectively) were the most valuable. High technology dependence, IT failures and lack of infrastructure and medication therapy discontinuities at times of transition between different hospitals' units were the main drawbacks considered. The most repeated suggestion was related to the improvement of links between other health informatics applications used in the hospital. CONCLUSION: health personnel were highly satisfied with the CPOE system, which is considered to be effective and safe. Technology dependence and IT failures were the main disadvantages reported. According to them, a greater coordination and unification of all software applications available in the hospital would be desirable.

Infección por micobacterias no tuberculosas en pacientes con bronquiectasias no causadas por fibrosis quística / Non-tuberculous mycobacterial infection in patients with non-cystic fibrosis bronchiectasias

Objetivo. Conocer la prevalencia y características de la infección por micobacterias no tuberculosas en enfermos con bronquiectasias no relacionadas con la fibrosis quística. Pacientes y métodos. Estudio descriptivo retrospectivo de pacientes adultos con bronquiectasias no relacionadas con la fibrosis quística con un seguimiento de al menos dos años. Resultados. Se incluyeron 68 pacientes, 50 mujeres (73,5%), con una edad media de 63,31±16,2 años. La etiología más frecuente fue la enfermedad pulmonar obstructiva crónica (28 pacientes, 41,2%) con una afectación leve-moderada y colonización por Pseudomonas aeruginosa (P. aeruginosa) (70,6%). Siete pacientes (10,3%) presentaron infección por micobacterias no tuberculosas, tratándose de Mycobacterium avium complex en 6 ocasiones (7,35%). Cuatro (57,14%) pacientes recibieron tratamiento antimicrobiano específico. En los enfermos infectados fue menor la frecuencia de P. aeruginosa y el uso de corticoides inhalados. No hubo diferencias espirométricas significativas entre los pacientes infectados por micobacterias no tuberculosas y los no infectados. Conclusiones. Las bronquiectasias no relacionadas con la fibrosis quística podrían considerarse un factor de riesgo para la infección por micobacterias no tuberculosas(AU)

Aims. To know the characteristics and prevalence of non-tuberculous mycobacterial infection infection in patients with non-cystic fibrosis bronchiectasis. Patients and methods. A retrospective descriptive study of NCFB adult patients whose disease had been followed-up for at least two years was performed. Results. A total of 68 subjects were included, 50 females (73.5%), with mean age of 63.31± 16.2 years. The most frequent etiology of the non-cystic fibrosis bronchiectasis was COPD in 28 cases (41.2%) with a light-moderate pulmonary involvement and Pseudomonas aeruginosa (P. aeruginosa) colonization (70.6%). Seven patients (10.3%) had MNT infection, six of whom had Mycobacterium avium complex (7.35%). Four patients (57.14%) were treated. In the infected patients, P. aeruginosa and the use of inhaled steroids were observed with less frequency. There were no significant differences between the infected and non-infected patients in relation to spirometric values. Conclusions. The non-cystic fibrosis bronchiectasis could be considered a risk factor for non-tuberculous mycobacterial infection(AU)

Comportamiento de la actividad física cotidiana en pacientes con hipertensión arterial pulmonar en tratamiento con antagonistas de los receptores de la endotelina / Daily physical activity in patients diagnosed of pulmonary arterial hypertension and treated with endothelin receptor antagonists

Introducción: Se ha visto que la evaluación de la actividad física cotidiana (AFC) es importante porque ayuda a la prevención y al tratamiento de algunas enfermedades. Objetivos: Evaluar la AFC mediante el uso de acelerómetros triaxiales en pacientes con hipertensión arterial pulmonar y en tratamiento con antagonistas de los receptores de la endotelina. Material y métodos: Se incluyeron seis pacientes diagnosticados de hipertensión arterial pulmonar mediante cateterismo cardíaco derecho. Se evaluaron la clase funcional de la Organización Mundial de la Salud, el test de la marcha en 6 minutos y la actividad física medida con la escala London Chest Activity of Daily Living y con acelerómetros RT3. Se hicieron las evaluaciones en dos ocasiones, antes y después del tratamiento con antagonistas no selectivos de los receptores de la endotelina. Resultados: Los valores medios de la escala London Chest Activity of Daily Living, antes y después del tratamiento, fueron: 35,0 (26,8-43,5) [mediana y rango intercuartílico] y 22,0 (16,5-28,3), respectivamente (p = 0,068). La AFC medida con acelerómetros se asoció con la saturación mínima de oxígeno durante el test de la marcha en 6 minutos (r = 0,825, p = 0,043). El tiempo total de registro de actividades físicas de baja intensidad se asoció con las resistencias vasculares pulmonares (r = 0,989; p = 0,001) y el tiempo total de actividades físicas de alta intensidad con las resistencias vasculares sistémicas (r = 0,0890; p = 0,043). Conclusión: La AFC de los pacientes con hipertensión arterial pulmonar podría evaluarse con acelerómetros. En este sentido, la actividad física se asocia con la tolerancia al ejercicio y con los registros hemodinámicos (AU)

Introduction: The assessment of daily physical activity is important to prevent and treat many diseases more effectively. Objectives: to evaluate daily physical activity using Tri-axial accelerometers in patients with pulmonary arterial hypertension and treated with endothelin receptor antagonists. Material and methods: Six patients with pulmonary arterial hypertension diagnosed by right heart catheterization were included. World Health Organization functional class, 6-minute walking test, daily physical activity evaluated with the London Chest Activity of Daily Living Scale and with RT3 accelerometers devices were assessed in two opportunities, before and after three months of treatment with nonselective endothelin receptor antagonist drugs. Results: Mean scores of the London Chest Activity of Daily Living Scale scale before and after three months treatment were 35.0 (26.8-43.5) [median and interquartilic range] and 22.0 (16.5-28.3), respectively (p=0.068). Daily physical activity measured by accelerometer was associated with the minimum oxygen saturation during the 6-minute walking test (r=0.825, p=0.043). The total period of low intensity physical activity registered was associated with pulmonary vascular resistances (r=0.989; p=0.001) and the total period of heavy intensity physical activity registered with the systemic vascular resistances (r=0.0890; p=0.043). Conclusion: Daily physical activity of patients with pulmonary arterial hypertension could be evaluated with accelerometers. In this way, physical activity is associated with the exercise tolerance and with hemodynamic measures (AU)

[Non-tuberculous mycobacterial infection in patients with non-cystic fibrosis bronchiectasias]. / Infección por micobacterias no tuberculosas en pacientes con bronquiectasias no causadas por fibrosis quística.

AIMS: To know the characteristics and prevalence of non-tuberculous mycobacterial infection infection in patients with non-cystic fibrosis bronchiectasis. PATIENTS AND METHODS: A retrospective descriptive study of NCFB adult patients whose disease had been followed-up for at least two years was performed. RESULTS: A total of 68 subjects were included, 50 females (73.5%), with mean age of 63.31± 16.2 years. The most frequent etiology of the non-cystic fibrosis bronchiectasis was COPD in 28 cases (41.2%) with a light-moderate pulmonary involvement and Pseudomonas aeruginosa (P. aeruginosa) colonization (70.6%). Seven patients (10.3%) had MNT infection, six of whom had Mycobacterium avium complex (7.35%). Four patients (57.14%) were treated. In the infected patients, P. aeruginosa and the use of inhaled steroids were observed with less frequency. There were no significant differences between the infected and non-infected patients in relation to spirometric values. CONCLUSIONS: The non-cystic fibrosis bronchiectasis could be considered a risk factor for non-tuberculous mycobacterial infection.