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1.
J Clin Microbiol ; 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32719030

RESUMO

Interferon-gamma (IFN-γ) release assays (IGRAs) are increasingly used to test for latent TB infection. Although highly specific, IGRAs have a relatively high false-negative rate in active TB patients. A more sensitive assay is needed. IP-10 is an alternative biomarker with a 100 fold high expression level compared to IFN-γ, allowing for different analysis platforms including molecular detection. The PCR technique is already an integrated tool in most TB laboratories and thus an obvious platform to turn to. In this case-control study, we investigated the diagnostic sensitivity and specificity of a molecular assay detecting IP-10 mRNA expression following antigen stimulation of a blood sample. We included 89 TB patients and 99 healthy controls. Blood was drawn in QuantiFERON-TB Gold In-Tube (QFT) tubes. Eight hours post-stimulation IP-10 mRNA expression was analyzed and 20 hours post-stimulation IP-10 and IFN-γ protein plasma levels were analyzed using an in-house IP-10 ELISA and the official QFT ELISA, respectively. The IP-10 mRNA assay provided a high specificity (98%) and sensitivity (80%) and AUC=0.97, however, the QFT assay provided a higher overall diagnostic potential with specificity (100%) and sensitivity (90%) and AUC=0.99. The IP-10 protein assay performed on par with the QFT assay with specificity (98%) and sensitivity (87%) and AUC=0.98. We have provided proof of high technical performance of a molecular assay detecting IP-10 mRNA expression. As a diagnostic tool, this assay would gain from further optimization especially on the kinetics of IP-10 mRNA expression.

2.
Arch Bronconeumol ; 56(8): 514-521, 2020 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32446667

RESUMO

New evidence and knowledge about the clinical management of drug-resistant tuberculosis (TB) in the last 3 years, makes it necessary to update the recent guideline published by SEPAR in 2017, mainly in relation to new diagnostic methods, drug classification, and regimens of treatment recommended to treat patients with isoniazid-resistance TB, rifampicin resistance TB and multidrug-resistant TB. With respect to tuberculosis diagnosis, we recommend the use of rapid molecular assays that also help to detect mutations associated with resistance. In relation to the treatment of multidrug-resistant TB we prioritize effective all-oral shorter treatment regimens including bedaquiline, a fluoroquinolone (levofloxacin or moxifloxacin), bedaquiline and linezolid, instead of the previously recommended short-course treatment with aminoglycosides and other less effective and more toxic drugs. The design of these regimens (initial schedule and changes in the regimen if necessary) should be made in accordance with drug-resistant TB experts; the treatment should be the responsibility of personnel with experience in the treatment of TB and in TB units guaranteeing the follow-up of the treatment and the management of drugs adverse effects.

3.
Arch Bronconeumol ; 2020 Jan 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32007265

RESUMO

STUDY OBJECTIVES: To evaluate the diagnostic accuracy of a non-invasive technology based on image processing for the identification of obstructive sleep apnea (OSA) and its severity at patients' home. METHODS: Observational, prospective, diagnostic accuracy study to evaluate the degree of measure agreement between Sleepwise (SW), in-laboratory attended polysomnography (PSG) and a home sleep apnea test (HSAT). 38 consecutive subjects with suspected OSA referred as outpatients to the sleep unit were recruited from September 2016 to September 2017. All patients underwent in-laboratory attended PSG and image processing with SW simultaneously overnight. Subsequently, a HSAT and image processing with SW were performed simultaneously overnight at patients' home, and the 2 nights after, patients underwent only image processing with SW consecutively. RESULTS: In-laboratory polysomnography and SW had a Lin's concordance correlation coefficient of 0.933 and a κ of 0.930. Between HSAT and SW the Lin's concordance correlation coefficient was 0.842 and a κ of 0.571. Agreement between two consecutive nights with SW recording showed a Lin's concordance correlation coefficient of 0.923 and a κ of 0. 837. CONCLUSIONS: SW was highly accurate for non-invasive and automatic diagnosis of OSA in outpatients compared to standard methods for OSA diagnosis either in-laboratory attended PSG or HSAT. SW proved to be a technique with repeatable and concordant results on different nights for the same patient. We conclude SW is a non-invasive, easy-to-use, portable, effective and highly accurate system for the in-home diagnosis of OSA.

4.
Arch Bronconeumol ; 2019 Nov 25.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31780285

RESUMO

OBJECTIVE: The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. METHOD: Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend. RESULTS: A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses. CONCLUSIONS: PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.

5.
Med. clín (Ed. impr.) ; 152(9): 333-338, mayo 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183657

RESUMO

Introducción y objetivo: La relación entre la contaminación ambiental y las enfermedades respiratorias ha sido ampliamente descrita, pero existen menos trabajos referentes a la contaminación y asma en nuestro medio. El objetivo del estudio fue analizar el efecto de la contaminación ambiental sobre las agudizaciones de asma. Material y métodos: Se trata de un estudio observacional. Se incluyeron en el análisis los ingresos hospitalarios diarios y las consultas a urgencias diarias en el Hospital Universitari Germans Trias i Pujol (Badalona, Barcelona) entre 2008 y 2016 de aquellos pacientes con diagnóstico de asma agudizada. Se obtuvieron los valores diarios de temperatura, humedad relativa, presión atmosférica y los niveles de NO2, SO2 y CO. Mediante regresión de Poisson simple se estudió la asociación entre estos factores y el número de hospitalizaciones y urgencias mediante regresiones simples para el mismo día y para entre uno y 4 días más tarde (lags 0 a 4). Se corrigió el efecto de las múltiples comparaciones. Resultados: Se asociaron con un incremento en las hospitalizaciones por asma la baja temperatura (lags 0 a 4) y los incrementos en los niveles de NO2 (lags 0, 1, 2 y 4) y presión atmosférica (lags 2 y 3). Al analizar las urgencias, estas se asociaron con la baja temperatura (lags 0, 1, 2, 3 y 4) y los incrementos en los niveles de NO2 (lags 2, 3 y 4). Conclusiones: La baja temperatura y la elevada concentración ambiental de NO2 se asocian con un incremento en las consultas a urgencias y hospitalizaciones por agudización de asma bronquial


Introduction and objective: Air pollution has been widely associated with respiratory diseases. Nevertheless, association between air pollution and exacerbations of asthma in our area has been less studied. To analyse the effect of air pollution on exacerbations of asthma in Badalona. Material and methods: This was an observational study conducted in Badalona. The number of daily hospital admissions and accident and emergency visits related to exacerbation of asthma between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, atmospheric pressure, relative humidity, and NO2, SO2 and CO levels on asthma-related emergencies and hospitalisations the same day and 1-4 days after. All p-values were corrected for multiple comparisons. Results: The number of hospitalisations was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 0, 1, 2 and 4) and atmospheric pressure (lags 2 and 3). The number of accident and emergency visits was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 2, 3 and 4). Conclusions: The number of accident and emergency visits and hospitalisations for exacerbation of asthma is associated with higher levels of NO2 and with lower temperatures


Assuntos
Humanos , Masculino , Feminino , Adulto , Efeitos da Contaminação do Ar/efeitos adversos , Asma/etiologia , Exacerbação dos Sintomas , Asma/epidemiologia , Espanha/epidemiologia , Estudos Retrospectivos , Dióxido de Enxofre/efeitos adversos , Dióxido de Enxofre/análise , Dióxido de Nitrogênio/efeitos adversos , Dióxido de Nitrogênio/análise , Monóxido de Carbono/efeitos adversos , Monóxido de Carbono/análise
6.
Med Clin (Barc) ; 152(9): 333-338, 2019 05 03.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30149947

RESUMO

INTRODUCTION AND OBJECTIVE: Air pollution has been widely associated with respiratory diseases. Nevertheless, association between air pollution and exacerbations of asthma in our area has been less studied. To analyse the effect of air pollution on exacerbations of asthma in Badalona. MATERIAL AND METHODS: This was an observational study conducted in Badalona. The number of daily hospital admissions and accident and emergency visits related to exacerbation of asthma between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, atmospheric pressure, relative humidity, and NO2, SO2 and CO levels on asthma-related emergencies and hospitalisations the same day and 1-4 days after. All p-values were corrected for multiple comparisons. RESULTS: The number of hospitalisations was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 0, 1, 2 and 4) and atmospheric pressure (lags 2 and 3). The number of accident and emergency visits was associated with low temperature (lags 0 to 4) and higher levels of NO2 (lags 2, 3 and 4). CONCLUSIONS: The number of accident and emergency visits and hospitalisations for exacerbation of asthma is associated with higher levels of NO2 and with lower temperatures.

7.
Respiration ; 96(2): 111-116, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29772571

RESUMO

INTRODUCTION: Air pollution has been widely associated with respiratory diseases. Nevertheless, the association between air pollution and exacerbations of bronchiectasis has been less studied. OBJECTIVE: To analyze the effect of air pollution on exacerbations of bronchiectasis. METHODS: This was a retrospective observational study conducted in Badalona. The number of daily hospital admissions and emergency room visits related to exacerbation of bronchiectasis (ICD-9 code 494.1) between 2008 and 2016 was obtained. We used simple Poisson regressions to test the effects of daily mean temperature, SO2, NO2, CO, and PM10 levels on bronchiectasis-related emergencies and hospitalizations on the same day and 1-4 days after. All p values were corrected for multiple comparisons. RESULTS: SO2 was significantly associated with an increase in the number of hospitalizations (lags 0, 1, 2, and 3). None of these associations remained significant after correcting for multiple comparisons. The number of emergency room visits was associated with higher levels of SO2 (lags 0-4). After correcting for multiple comparisons, the association between emergency room visits and SO2 levels was statistically significant for lag 0 (p = 0.043), lag 1 (p = 0.018), and lag 3 (p = 0.050). CONCLUSIONS: The number of emergency room visits for exacerbation of bronchiectasis is associated with higher levels of SO2.


Assuntos
Poluição do Ar/efeitos adversos , Bronquiectasia/etiologia , Hospitalização/estatística & dados numéricos , Dióxido de Enxofre/análise , Idoso , Poluentes Atmosféricos/análise , Asma/complicações , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Distribuição de Poisson , Doença Pulmonar Obstrutiva Crônica/complicações , Análise de Regressão , Estudos Retrospectivos , Espanha , Dióxido de Enxofre/efeitos adversos
9.
Ann Thorac Surg ; 106(2): 398-403, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29630875

RESUMO

BACKGROUND: To evaluate the accuracy of systematic mediastinal staging by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) (sampling of all visible nodes measuring ≥5 mm from stations N3 to N1 regardless of their positron emission tomography/computed tomography [PET/CT] features) and compare this staging approach with targeted EBUS-TBNA staging (sampling only 18F-fluorodeoxyglucose [FDG]-avid nodes) in patients with N2 non-small cell lung cancer on PET/CT. METHODS: Retrospective study of 107 patients who underwent systematic EBUS-TBNA mediastinal staging. The results were compared with those of a hypothetical scenario where only FDG-avid nodes on PET/CT would be sampled. RESULTS: Systematic EBUS-TBNA sampling demonstrated N3 disease in 3 patients, N2 disease in 60 (42 single-station or N2a, 18 multiple-station or N2b) and N0/N1 disease in 44. Of these 44, 7 underwent mediastinoscopy, which did not show mediastinal disease; 6 of the 7 proceeded to lung resection, which also showed no mediastinal disease. Thirty-four N0/N1 patients after EBUS-TBNA underwent lung resection directly: N0/N1 was found in 30 and N2 in 4 (1 N2b with a PET/CT showing N2a disease, 3 N2a). Sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy of systematic EBUS-TBNA were 94%, 100%, 90%, 100% and 96%, respectively. Compared with targeted EBUS-TBNA, systematic EBUS-TBNA sampling provided additional important clinical information in 14 cases (13%): 3 N3 cases would have passed unnoticed, and 11 N2b cases would have been staged as N2a. CONCLUSIONS: In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Idoso , Broncoscopia/métodos , Estudos de Coortes , Feminino , Fluordesoxiglucose F18 , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Espanha
10.
Med. clín (Ed. impr.) ; 150(7): 257-261, abr. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-173425

RESUMO

Introducción: La relación entre los factores ambientales y las exacerbaciones de enfermedades respiratorias ha sido ampliamente estudiada. No obstante, no existen estudios que analicen la relación entre la contaminación ambiental y las agudizaciones por bronquiectasias. El objetivo de nuestro estudio es analizar la asociación entre la contaminación ambiental y los ingresos por bronquiectasias. Material y métodos: Se trata de un estudio observacional y retrospectivo, realizado en 2 hospitales de Badalona. Se obtuvo el número de ingresos hospitalarios por agudización de bronquiectasias entre los años 2007 y 2015. Mediante regresión binomial negativa se analizó la posible influencia de la temperatura ambiental y los valores mensuales medios de dióxido de azufre (SO2), óxido nítrico, dióxido de nitrógeno, ozono y monóxido de carbono en el número de ingresos mensuales por bronquiectasias. Todos los p-valores se corrigieron por comparaciones múltiples. Resultados: Todos los factores analizados, pero especialmente la temperatura, se asociaron de forma estadísticamente significativa con el número de ingresos por exacerbación de bronquiectasias. Al controlar el efecto de la temperatura en las variables de contaminación, solamente el SO2 mantuvo la significación estadística (p=0,008). Conclusión: El número de ingresos hospitalarios por agudización de bronquiectasias parece ser mayor en los meses con bajas temperaturas y/o altas concentraciones de SO2. Se necesitan estudios prospectivos con diferentes áreas geográficas que confirmen estos resultados


Introduction: The relationship between environmental factors and the exacerbation of respiratory diseases has been widely studied. However, there are no studies examining the relationship between these factors and bronchiectasis exacerbations. Our objective was to analyse the association between various environmental factors and hospitalisation for bronchiectasis. Material and methods: This was a retrospective observational study conducted at two hospitals in Badalona (Barcelona). The number of hospital admissions for exacerbation of bronchiectasis between 2007 and 2015 was obtained. Through multiple regression we analysed the relationship between the number of exacerbations and mean monthly values of temperature, SO2, NO, NO2, O3 and CO. Results: Temperature, SO2, NO, NO2, O3 and CO were significantly associated with an increase in admissions due to exacerbation of bronchiectasis. By controlling the effect of temperature on the pollution variables, only SO2 maintained statistical significance (P=.008). Conclusion: We have detected an increase in hospital admissions for exacerbation of bronchiectasis with increases in the atmospheric concentration of SO2 and the decrease in temperature. Prospective studies with different geographical locations to confirm these results are needed


Assuntos
Humanos , Bronquiectasia/epidemiologia , Poluição Ambiental/efeitos adversos , Dióxido de Enxofre/efeitos adversos , Hospitalização/estatística & dados numéricos , Exacerbação dos Sintomas , Fatores de Risco , Temperatura Extrema , Dióxido de Enxofre/isolamento & purificação , Estudos Retrospectivos , Dióxido de Nitrogênio/efeitos adversos
12.
Front Immunol ; 9: 3094, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30687314

RESUMO

The immunological characterization of different cell markers has opened the possibility of considering them as immune tools for tuberculosis (TB) management, as they could correlate with TB latency/disease status and outcome. CD4+ T-cells producing IFN-γ+ with a low expression of CD27 have been described as an active TB marker. In addition, there are unknown homing receptors related to TB, such as CCR4, which might be useful for understanding TB pathogenesis. The aim of our study is focused on the assessment of several T-cell subsets to understand immune-mechanisms in TB. This phenotypic immune characterization is based on the study of the specific immune responses of T-cells expressing CD27 and/or CCR4 homing markers. Subjects enrolled in the study were: (i) 22 adult patients with active TB, and (ii) 26 individuals with latent TB infection (LTBI). Blood samples were drawn from each patient. The expression of CD27 and/or CCR4 markers were analyzed within CD4+ T-cells producing: (i) IFN-γ+, (ii) TNF-α+, (iii) TNF-α+IFN-γ+, and (iv) IFN-γ+ and/or TNF-α+. The percentage of CD27- within all CD4+ T-cell populations analyzed was significantly higher on active TB compared to LTBI after PPD or ESAT-6/CFP-10 stimulation. As previously reported, a ratio based on the CD27 median fluorescence intensity (MFI) was also explored (MFI of CD27 in CD4+ T-cells over MFI of CD27 in IFN-γ+CD4+ T-cells), being significantly increased during disease (p < 0.0001 after PPD or ESAT-6/CFP-10 stimulation). This ratio was also assessed on the other CD4+ T-cells functional profiles after specific stimulation, being significantly associated with active TB. Highest diagnostic accuracies for active TB (AUC ≥ 0.91) were achieved for: (i) CD27 within IFN-γ+TNF-α+CD4+ T-cells in response to ESAT-6/CFP-10, (ii) CD27 and CCR4 markers together within IFN-γ+CD4+ T-cells in response to PPD, and (iii) CD27 MFI ratio performed on IFN-γ+TNF-α+CD4+ T-cells after ESAT-6/CFP-10 stimulation. The lowest diagnostic accuracy was observed when CCR4 marker was evaluated alone (AUC ≤ 0.77). CD27 and CCR4 expression detection could serve as a good method for immunodiagnosis. Moreover, the immunological characterization of markers/subset populations could be a promising tool for understanding the biological basis of the disease.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Interações Hospedeiro-Patógeno/imunologia , Tuberculose Latente/imunologia , Tuberculose Latente/microbiologia , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Tuberculose/microbiologia , Adulto , Biomarcadores , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Citocinas/metabolismo , Feminino , Humanos , Imunofenotipagem , Tuberculose Latente/terapia , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Curva ROC , Receptores CCR4/metabolismo , Especificidade do Receptor de Antígeno de Linfócitos T/imunologia , Tuberculose/terapia , Membro 7 da Superfamília de Receptores de Fatores de Necrose Tumoral/metabolismo , Adulto Jovem
13.
Med Clin (Barc) ; 150(7): 257-261, 2018 04 13.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28755827

RESUMO

INTRODUCTION: The relationship between environmental factors and the exacerbation of respiratory diseases has been widely studied. However, there are no studies examining the relationship between these factors and bronchiectasis exacerbations. Our objective was to analyse the association between various environmental factors and hospitalisation for bronchiectasis. MATERIAL AND METHODS: This was a retrospective observational study conducted at two hospitals in Badalona (Barcelona). The number of hospital admissions for exacerbation of bronchiectasis between 2007 and 2015 was obtained. Through multiple regression we analysed the relationship between the number of exacerbations and mean monthly values of temperature, SO2, NO, NO2, O3 and CO. RESULTS: Temperature, SO2, NO, NO2, O3 and CO were significantly associated with an increase in admissions due to exacerbation of bronchiectasis. By controlling the effect of temperature on the pollution variables, only SO2 maintained statistical significance (P=.008). CONCLUSION: We have detected an increase in hospital admissions for exacerbation of bronchiectasis with increases in the atmospheric concentration of SO2 and the decrease in temperature. Prospective studies with different geographical locations to confirm these results are needed.


Assuntos
Poluição do Ar/efeitos adversos , Bronquiectasia/etiologia , Exposição Ambiental/efeitos adversos , Idoso , Bronquiectasia/epidemiologia , Estudos Epidemiológicos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos , Espanha/epidemiologia , Fatores de Tempo
14.
Int J Chron Obstruct Pulmon Dis ; 12: 2909-2915, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29042767

RESUMO

OBJECTIVES: To analyze whether the introduction of nebulized colistin in patients with chronic obstructive pulmonary disease (COPD) and infection with Pseudomonas aeruginosa (PA) is associated with a decrease of the number and duration of severe exacerbations. MATERIALS AND METHODS: Thirty six patients with COPD and infection with PA treated with nebulized colistin attending a day hospital during a 5-year (January 2010-December 2014) period were prospectively included. Repeated-measures t-tests were used to assess whether the introduction of colistin was associated with changes in the number of exacerbations or the length of the hospitalizations, comparing for each patient the year prior to the introduction of colistin with the year after. RESULTS: After the introduction of colistin, the number of admissions decreased from 2.0 to 0.9 per individual year (P=0.0007), and hospitalizations were shorter (23.3 vs 10.9 days, P=0.00005). These results persisted when patients with and without bronchiectasis or with and without persistence of Pseudomonas were separately analyzed. No pre-post differences were detected in the number of exacerbations not requiring admission. CONCLUSION: Nebulized colistin seems associated with a strong decrease in the number and duration of hospitalizations due to exacerbation in patients with COPD and infection with PA. Clinical trials with a larger number of patients are needed in order to confirm these results.


Assuntos
Antibacterianos/administração & dosagem , Colistina/administração & dosagem , Pulmão/efeitos dos fármacos , Infecções por Pseudomonas/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Idoso , Antibacterianos/efeitos adversos , Colistina/efeitos adversos , Progressão da Doença , Feminino , Volume Expiratório Forçado , Humanos , Tempo de Internação , Pulmão/microbiologia , Pulmão/fisiopatologia , Masculino , Nebulizadores e Vaporizadores , Admissão do Paciente , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/microbiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Capacidade Vital
15.
Arch. bronconeumol. (Ed. impr.) ; 53(9): 501-509, sept. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-166280

RESUMO

En las últimas 2 décadas la tuberculosis con resistencia a fármacos se ha convertido en una amenaza y un reto para la salud pública mundial. El diagnóstico y el tratamiento de estas formas de tuberculosis es mucho más complejo, y el pronóstico empeora claramente a medida que se incrementa el patrón de las resistencias. Sin embargo, es necesario destacar cómo con el manejo clínico y programático adecuado de estos enfermos se puede conseguir la curación de una mayoría de ellos. En esta normativa se razonan las bases del diagnóstico y tratamiento de todos los pacientes afectos de tuberculosis, desde aquellos que tienen formas de la enfermedad con sensibilidad a todos los fármacos hasta aquellos que son portadores de los patrones más extensos de resistencia. Asimismo, se dan recomendaciones específicas para cada uno de estos supuestos. También se aborda el papel que ya están teniendo y pueden tener en un futuro inmediato los nuevos métodos moleculares de detección de resistencias, los esquemas acortados de tratamiento de la tuberculosis multi-farmacorresistente (TB-MDR) y los nuevos fármacos con actividad frente a Mycobacterium tuberculosis (AU)


In the last 2 decades, drug-resistant tuberculosis has become a threat and a challenge to worldwide public health. The diagnosis and treatment of these forms of tuberculosis are much more complex and prognosis clearly worsens as the resistance pattern intensifies. Nevertheless, it is important to remember that with the appropriatesystematic clinical management, most of these patients can be cured. These guidelines itemize the basis for the diagnosis and treatment of all tuberculosis patients, from those infected by strains that are sensitive to all drugs, to those who are extensively drug-resistant. Specific recommendations are given forall cases. The current and future role of new molecular methods for detecting resistance, shorter multi-drug-resistant tuberculosis regimens, and new drugs with activity against Mycobacterium tuberculosis are also addressed (AU)


Assuntos
Humanos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Padrões de Prática Médica , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/patogenicidade , Fatores de Risco , Técnicas de Diagnóstico Molecular
16.
Arch. bronconeumol. (Ed. impr.) ; 53(6): 304-310, jun. 2017. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-163654

RESUMO

Introducción: La información sobre la asociación del cáncer de pulmón (CP) y combinación de fibrosis pulmonar y enfisema (CFPE) es limitada y procedente casi exclusivamente de series asiáticas. El objetivo principal del estudio fue valorar el impacto del CP en la supervivencia en la CFPE y en pacientes diagnosticados de fibrosis pulmonar idiopática (FPI). Métodos: Se realizó un estudio retrospectivo con los datos de pacientes con CFPE y FPI diagnosticados en nuestro centro en un periodo de 5 años. Resultados: Se incluyó a 66 pacientes, 29 en el grupo de CFPE y 37 pacientes con FPI. Nueve tenían un diagnóstico de CP (6 con CFPE y 3 con FPI); 6 pacientes (67%) recibieron tratamiento paliativo a pesar de que 3 de ellos presentaban estadios I y II. No hubo diferencias significativas en la mortalidad global de los 2 grupos; sin embargo, en los pacientes con CP la supervivencia fue significativamente menor con respecto a los que no tenían CP (p = 0,044). Las causas más frecuentes de muerte fue la insuficiencia respiratoria secundaria a la exacerbación de la fibrosis pulmonar (44%). En el análisis multivariante, la odds ratio de morir en los pacientes con CP respecto a los pacientes sin CP fue de 6,20 (p = 0,037, intervalo de confianza [IC] del 95%: 1,11 a 34,48). Conclusión: El CP empeora la supervivencia de estas 2 entidades. El manejo diagnóstico y terapéutico del CP se ve dificultado por el mayor riesgo de complicaciones posteriores al tratamiento elegido, incluso tras el tratamiento paliativo (AU)


Introduction: Information on the association of lung cancer (LC) and combined pulmonary fibrosis and emphysema (CPFE) is limited and derived almost exclusively from series in Asian populations. The main objective of the study was to assess the impact of LC on survival in CPFE patients and in patients with idiopathic pulmonary fibrosis (IPF). Methods: A retrospective study was performed with data from patients with CFPE and IPF diagnosed in our hospital over a period of 5 years. Results: Sixty-six patients were included, 29 with CPFE and 37 with IPF. Nine had a diagnosis of LC (6 with CPFE and 3 with IPF). Six patients (67%) received palliative treatment even though 3 of them were diagnosed atstage I-II. Overall mortality did not differ significantly between groups; however, in patients with LC, survival was significantly lower compared to those without LC (P =.044). The most frequent cause of death was respiratory failure secondary to pulmonary fibrosis exacerbation (44%). In a multivariate analysis, the odds ratio of death among patients with LC compared to patients without LC was 6.20 (P =.037, 95% confidence interval: 1.11 to 34.48). Conclusions: Lung cancer reduces survival in both entities. The diagnostic and therapeutic management of LC is hampered by the increased risk of complications after any treatment modality, even after palliative treatment (AU)


Assuntos
Humanos , Masculino , Idoso , Neoplasias Pulmonares/epidemiologia , Enfisema Pulmonar/complicações , Fibrose Pulmonar/complicações , Fibrose Pulmonar Idiopática/complicações , Epidemiologia Descritiva , Estudos Retrospectivos , Fumar/epidemiologia , Fatores de Risco
17.
Arch Bronconeumol ; 53(9): 501-509, 2017 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28359606

RESUMO

In the last 2 decades, drug-resistant tuberculosis has become a threat and a challenge to worldwide public health. The diagnosis and treatment of these forms of tuberculosis are much more complex and prognosis clearly worsens as the resistance pattern intensifies. Nevertheless, it is important to remember that with the appropriatesystematic clinical management, most of these patients can be cured. These guidelines itemize the basis for the diagnosis and treatment of all tuberculosis patients, from those infected by strains that are sensitive to all drugs, to those who are extensively drug-resistant. Specific recommendations are given forall cases. The current and future role of new molecular methods for detecting resistance, shorter multi-drug-resistant tuberculosis regimens, and new drugs with activity against Mycobacterium tuberculosis are also addressed.


Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Antituberculosos/classificação , Antituberculosos/farmacologia , Busca de Comunicante , Gerenciamento Clínico , Quimioterapia Combinada , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Técnicas de Genotipagem , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Guias de Prática Clínica como Assunto , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia
18.
BMC Pulm Med ; 17(1): 46, 2017 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-28241873

RESUMO

BACKGROUND: The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario. METHODS: We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated. RESULTS: Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively. CONCLUSIONS: EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Idoso , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Sensibilidade e Especificidade , Espanha , Tomografia Computadorizada por Raios X
19.
PLoS One ; 12(2): e0171455, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28178317

RESUMO

BACKGROUND: A thorough analysis of continuous adventitious sounds (CAS) can provide distinct and complementary information about bronchodilator response (BDR), beyond that provided by spirometry. Nevertheless, previous approaches to CAS analysis were limited by certain methodology issues. The aim of this study is to propose a new integrated approach to CAS analysis that contributes to improving the assessment of BDR in clinical practice for asthma patients. METHODS: Respiratory sounds and flow were recorded in 25 subjects, including 7 asthma patients with positive BDR (BDR+), assessed by spirometry, 13 asthma patients with negative BDR (BDR-), and 5 controls. A total of 5149 acoustic components were characterized using the Hilbert spectrum, and used to train and validate a support vector machine classifier, which distinguished acoustic components corresponding to CAS from those corresponding to other sounds. Once the method was validated, BDR was assessed in all participants by CAS analysis, and compared to BDR assessed by spirometry. RESULTS: BDR+ patients had a homogenous high change in the number of CAS after bronchodilation, which agreed with the positive BDR by spirometry, indicating high reversibility of airway obstruction. Nevertheless, we also found an appreciable change in the number of CAS in many BDR- patients, revealing alterations in airway obstruction that were not detected by spirometry. We propose a categorization for the change in the number of CAS, which allowed us to stratify BDR- patients into three consistent groups. From the 13 BDR- patients, 6 had a high response, similar to BDR+ patients, 4 had a noteworthy medium response, and 1 had a low response. CONCLUSIONS: In this study, a new non-invasive and integrated approach to CAS analysis is proposed as a high-sensitive tool for assessing BDR in terms of acoustic parameters which, together with spirometry parameters, contribute to improving the stratification of BDR levels in patients with obstructive pulmonary diseases.


Assuntos
Broncodilatadores/uso terapêutico , Sons Respiratórios/efeitos dos fármacos , Sons Respiratórios/diagnóstico , Adulto , Idoso , Algoritmos , Asma/diagnóstico , Asma/tratamento farmacológico , Asma/fisiopatologia , Broncodilatadores/farmacologia , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Reprodutibilidade dos Testes , Espirometria , Resultado do Tratamento
20.
Arch Bronconeumol ; 53(6): 304-310, 2017 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27986408

RESUMO

INTRODUCTION: Information on the association of lung cancer (LC) and combined pulmonary fibrosis and emphysema (CPFE) is limited and derived almost exclusively from series in Asian populations. The main objective of the study was to assess the impact of LC on survival in CPFE patients and in patients with idiopathic pulmonary fibrosis (IPF). METHODS: A retrospective study was performed with data from patients with CFPE and IPF diagnosed in our hospital over a period of 5 years. RESULTS: Sixty-six patients were included, 29 with CPFE and 37 with IPF. Nine had a diagnosis of LC (6 with CPFE and 3 with IPF). Six patients (67%) received palliative treatment even though 3 of them were diagnosed atstage i-ii. Overall mortality did not differ significantly between groups; however, in patients with LC, survival was significantly lower compared to those without LC (P=.044). The most frequent cause of death was respiratory failure secondary to pulmonary fibrosis exacerbation (44%). In a multivariate analysis, the odds ratio of death among patients with LC compared to patients without LC was 6.20 (P=.037, 95% confidence interval: 1.11 to 34.48). CONCLUSIONS: Lung cancer reduces survival in both entities. The diagnostic and therapeutic management of LC is hampered by the increased risk of complications after any treatment modality, even after palliative treatment.


Assuntos
Fibrose Pulmonar Idiopática/epidemiologia , Neoplasias Pulmonares/epidemiologia , Enfisema Pulmonar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Suscetibilidade a Doenças , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Espanha/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
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