Survivin is a negative prognostic factor in malignant pleural effusion.

BACKGROUND: Survivin is a well-known member of the inhibitor of apoptosis family, and has been related to increased tumour aggressivity, both in tissue and in pleural fluid. OBJECTIVES: In patients with malignant pleural effusion, we sought to investigate the changes in pleural fluid survivin concentrations induced by talc instillation into the pleural space. Those changes were also examined in relation to pleurodesis outcome and patient survival. METHODS: We investigated 84 patients with malignant pleural effusion who underwent talc pleurodesis. Of them, 32 had breast cancer, 25 lung cancer and 27 had mesothelioma. Serial samples of pleural fluid were obtained before thoracoscopy (baseline) and 24 hours thereafter. RESULTS: Survivin levels were successfully quantified in all pleural fluid samples, and they were significantly higher in samples obtained after thoracoscopic talc poudrage compared with baseline (P < .001). Patients with higher pleural fluid survivin levels at baseline had a significantly poorer pleurodesis outcome (P = .004). A 30 pg/mL cut-off for baseline survivin in pleural fluid predicted failure of pleurodesis with a 54% sensitivity and 79% specificity (P = .009). Moreover, median postpleurodesis survival of patients with baseline survivin levels ≥30 pg/mL was 4 months (range: 0.1-38), compared with 13 months (range: 0.1-259) in patients below that cut-off (P < .001). CONCLUSION: Elevated pleural fluid survivin concentrations are useful to predict failure of pleurodesis and are associated with shorter survival in patients with malignant pleural effusion.

MicroRNA clusters: dysregulation in lung adenocarcinoma and COPD.

Lung adenocarcinoma and chronic obstructive pulmonary disease (COPD) are pulmonary diseases that share common aetiological factors (tobacco smoking) and probable dysregulated pathways. MicroRNAs (miRNAs) play an essential role in regulating numerous physiological and pathological processes. The purpose of this study was to assess global miRNA expression patterns in patients with COPD and/or adenocarcinoma to elucidate distinct regulatory networks involved in the pathogenesis of these two smoking-related diseases. Expression of 381 miRNAs was quantified by TaqMan Human MicroRNA A Array v2.0 in bronchoalveolar lavage fluid samples from 87 patients classified into four groups: COPD, adenocarcinoma, adenocarcinoma with COPD, and control (neither COPD nor adenocarcinoma). 11 differentially expressed miRNAs were randomly selected for validation in an independent cohort of 40 patients. Distinct miRNA expression profiles were identified and validated for each pathological group, involving 66 differentially expressed miRNAs. Four miRNA clusters (the mir-17-92 cluster and its paralogues, mir-106a-363 and mir-106b-25; and the miR-192-194 cluster) were upregulated in patients with adenocarcinoma and one miRNA cluster (miR-132-212) was upregulated in patients with COPD. These results contribute to unravelling miRNA-controlled networks involved in the pathogenesis of adenocarcinoma and COPD, and provide new tools of potential use as biomarkers for diagnosis and/or therapeutic purposes.

Ultrasound in the Study of Thoracic Diseases: Innovative Aspects.

Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation. The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases. In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis. With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward. In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising. In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness. In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. In neuromuscular patients, ultrasound is a good predictor of impaired lung function. Currently, in Neuromuscular Disease Units, TU is an indispensable tool. Ultrasound study of the intercostal musculature is also effective in the study of respiratory function, and is widely used in Respiratory Rehabilitation. In Intermediate Care Units, thoracic ultrasound is indispensable for patient management. In these units there are ultrasound protocols for the management of patients with acute dyspnoea that have proven to be very effective.

Identification of oxidative stress related proteins as biomarkers for lung cancer and chronic obstructive pulmonary disease in bronchoalveolar lavage.

Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) commonly coexist in smokers, and the presence of COPD increases the risk of developing LC. Cigarette smoke causes oxidative stress and an inflammatory response in lung cells, which in turn may be involved in COPD and lung cancer development. The aim of this study was to identify differential proteomic profiles related to oxidative stress response that were potentially involved in these two pathological entities. Protein content was assessed in the bronchoalveolar lavage (BAL) of 60 patients classified in four groups: COPD, COPD and LC, LC, and control (neither COPD nor LC). Proteins were separated into spots by two dimensional polyacrylamide gel electrophoresis (2D-PAGE) and examined by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/TOF). A total of 16 oxidative stress regulatory proteins were differentially expressed in BAL samples from LC and/or COPD patients as compared with the control group. A distinct proteomic reactive oxygen species (ROS) protein signature emerged that characterized lung cancer and COPD. In conclusion, our findings highlight the role of the oxidative stress response proteins in the pathogenic pathways of both diseases, and provide new candidate biomarkers and predictive tools for LC and COPD diagnosis.

Diagnosis and Treatment of Pleural Effusion. Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022.

Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE.

Management of malignant pleural effusions.

PURPOSE OF REVIEW: Malignant pleural effusions (MPEs) are one of the most common problems faced by clinicians and, since there is no optimum treatment available, they deserve efforts aimed to improve their management. RECENT FINDINGS: We have reviewed the most recent articles regarding treatment of MPE, with special emphasis on pleurodesis and indwelling pleural catheter placement. Although iodopovidone, silver nitrate and doxycycline are useful, talc continues to be the most effective agent available for pleurodesis. Use of calibrated talc with large particle size is now firmly established, in order to prevent complications. Indwelling pleural catheters are gaining general acceptance, and they are currently a valid option for patients with lung entrapment or those who have a previous failed pleurodesis. Advances in translational medicine related to this topic are also described. SUMMARY: The above results may contribute to improve significantly management of patients with malignant pleural effusions, especially those with advanced disease who are not suitable for pleurodesis procedures.

[Evaluation of a strategy for the control of tuberculosis in a health district of andalusia, Spain]. / Evaluación de una estrategia para el control de la tuberculosis en un distrito sanitario de Andalucía.

BACKGROUND: Tuberculosis in Spain and Andalusia, the incidence rates above those of surrounding countries. Many authors emphasize the need for improved epidemiological information, the organization of health services and social support to patients. The aim of this study was to evaluate the results obtained after developing a strategy involving the three elements outlined in the Primary Care District of Andalusia. METHODS: We followed up to 234 TB patients residing in the District and reported to the Epidemiological Surveillance System of Andalusia during the period 2004-2008. Were considered as indicators for evaluating the percentage of patients who completed treatment, the percentage of smear-positive contacts with study, new cases detected in the same and the incidence in children under 15 years. RESULTS: Of the 234 patients were followed up cash 95% of them completed treatment 182 (78%) died 18, moved from home, 10 and 12 still remained in treatment. Of the 130 cases that presented positive sputum studied 112 contacts (86%). 27 new cases were detected among the contacts studied, and the annual incidence in children under 15 years was 6.65 per 100,000 population. Tracking losses were reduced by 30%, and terminations of treatment and contact studies improved by 25% and 30% respectively compared to data from the whole of Andalusia. CONCLUSIONS: The strategy has helped improve the proposed assessment indicators. The% of new cases detected in studies of contacts and the annual incidence in children under 15 years was similar in this study than in Andalusia.

Diagnosis and Treatment of Pleural Effusion. Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022

Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE. (AU)

Is the bronchodilator test an useful tool to measure asthma control?

INTRODUCTION: Asthma control includes the control of symptoms and future risk. We sought to evaluate the usefulness of the degree of spirometric reversibility of the forced expiratory volume in one second (FEV1) as the target parameter of control. METHODOLOGY: Patients with bronchial asthma were followed up for one year. The clinical, functional, inflammatory and control parameters of the asthma were collected. The area under the curve (AUC) was estimated to establish the cutoff point of the post-bronchodilator FEV1 reversibility in relation to non-control asthma. In the univariate analysis, the differences between groups were studied based on the degree of estimated reversibility. Factors with a significance <0.1 were included in the multivariate analysis by binary logistic regression. RESULTS: A total of 407 patients with a mean age of 38.1 ± 16.7 years were included. When the patients were grouped into controlled and non-controlled groups, compared with post-bronchodilator FEV1 reversibility, the cutoff point obtained for the non-controlled group was ≥10% (sensitivity: 65.8%, specificity: 48.4%, positive predictive value: 69.5%, and AUC: 0.619 [0.533-0.700], p < 0.01). In the year-long follow-up of this group (post-bronchodilator FEV1 ≥10), an increased use of relief medication was observed, along with a significantly progressive drop in post-bronchodilator FEV1 and post-bronchodilator FEV1/FVC (forced expiratory volume in one second/forced vital capacity). CONCLUSIONS: Spirometric reversibility can be useful in assessing control in asthmatic patients and can predict future risk parameters. The cutoff point related to the non-control of asthma found in our work was ≥10%.

Predictors of 10-year smoking abstinence in smokers abstinent for 1 year after treatment.

AIMS: To identify factors predicting long-term relapse to smoking in people attending smoking treatment services who have maintained at least 1 year abstinence. DESIGN: Observational, prospective study with multiple logistic regression used to model predictors of relapse between 1 and 10 years from cessation using variables measured pre-cessation. SETTING AND PARTICIPANTS: Among smokers receiving behavioural support for cessation in a clinic in Spain, in some cases with nicotine patches or bupropion, 366 had remained abstinent after 1 year of follow-up and were included into the study. MEASUREMENTS: Predictive measures (disease history, psychological disorder, age of starting smoking, years of smoking, cigarette dependence and smoking cessation treatment used) were obtained at the time of the quit attempt, and 'failure' (defined as reported smoking, loss to follow-up, died or an expired air carbon monoxide reading of > 5 parts per million) was assessed 10 years later. FINDINGS: At follow-up, abstinence status was confirmed in 50.5% (n = 185) of participants, while 21.0% (n = 77) reported that they had resumed smoking, and 28.5% (n = 104) were lost to follow-up (also counted as having resumed smoking). In the multiple regression model, the main factor that predicted relapse had a psychological disorder (odds ratio = 1.85, 95% confidence interval = 1.13-3.05; P < 0.02). CONCLUSIONS: Having a psychological disorder at the time of stopping smoking is a risk factor for relapse to smoking, even after more than 1 year of abstinence.

Ultrasound in the Study of Thoracic Diseases: Innovative Aspects

Thoracic ultrasound (TU) has rapidly gained popularity over the past 10 years. This is in part because ultrasound equipment is available in many settings, more training programmes are educating trainees in this technique, and ultrasound can be done rapidly without exposure to radiation.The aim of this review is to present the most interesting and innovative aspects of the use of TU in the study of thoracic diseases.In pleural diseases, TU has been a real revolution. It helps to differentiate between different types of pleural effusions, guides the performance of pleural biopsies when necessary and is more cost-effective under these conditions, and assists in the decision to remove thoracic drainage after talc pleurodesis.With the advent of COVID19, the use of TU has increased for the study of lung involvement. Nowadays it helps in the diagnosis of pneumonias, tumours and interstitial diseases, and its use is becoming more and more widespread in the Pneumology ward.In recent years, TU guided biopsies have been shown to be highly cost-effective, with other advantages such as the absence of radiation and the possibility of being performed at bedside. The use of contrast in ultrasound to increase the cost-effectiveness of these biopsies is very promising.In the study of the mediastinum and peripheral pulmonary nodules, the introduction of echobronchoscopy has brought about a radical change. It is a fully established technique in the study of lung cancer patients. The introduction of elastography may help to further improve its cost-effectiveness.In critically-ill patients, diaphragmatic ultrasound helps in the assessment of withdrawal of mechanical ventilation, and is now an indispensable tool in the management of these patients. (AU)

Current and future options for the diagnosis of malignant pleural effusion.

INTRODUCTION: Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion. AREAS COVERED: Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: 'diagnosis' + 'malignant' + 'pleural' + 'effusion' (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years). EXPERT OPINION: Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and 'spheroids' are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes ('theranostics')-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.

[Comparison of the Asthma Control Test (ACT) with lung function, levels of exhaled nitric oxide and control according to the Global Initiative for Asthma (GINA)]. / Relación del test de control del asma (ACT) con la función pulmonar, niveles de óxido nítrico exhalado y grados de control según la Iniciativa Global para el Asma (GINA).

INTRODUCTION: The current goal of asthma treatment is to achieve and maintain control. This study aimed to explore the relationship between the ACT (Asthma Control Test) questionnaire and the levels of control according to GINA (Global Initiative for Asthma) to establish the cut-off points for the ACT and evaluate its relationship with lung function and fractionated exhaled nitric oxide level (FeNO). PATIENTS AND METHODS: A multi-centre prospective study including 441 patients followed up in an outpatient Chest Clinic. A clinical protocol was followed, and FeNO, spirometry and ACT performed. Disease was classified according to levels of control using GINA. The study analysed sensitivity, specificity and area under the curve (ROC), and the ACT cut-off points. We studied the differences between the functional parameters and FeNO between levels of control. RESULTS: For controlled asthma the cut-off obtained was ACT> or =21 (area under the curve 0.791) and for uncontrolled < or =18 (AUC 0.774). We found significant differences in FeNO levels and pulmonary function among ACT> or =21 and ACT< or =18, although only 26.3% of patients with ACT< or =18 had a FEV1 <80% and 40% higher FeNO (> or =35 ppb). We found a correlation between baseline FEV1 and ACT (r=0.19, P<0.01) and between ACT and FeNO (r=-0.16, P<0.01). CONCLUSIONS: The cut-off points would be, for controlled asthma ACT> or =21, partly controlled asthma ACT=19-20 and uncontrolled asthma ACT< or =18. A more complete assessment would require including monitoring operating parameters and FeNO.

Evaluación de una estrategia para el control de la tuberculosis en un distrito sanitario de Andalucía / Evaluation of a strategy for the control of tuberculosis in a health district of Andalusia, Spain

Fundamento: La tuberculosis en España y Andalucía presenta tasas de incidencia por encima de las de países de nuestro entorno. Muchos autores señalan la necesidad de mejorar la información epidemiológica, la organización de los servicios sanitarios y el apoyo social a los pacientes. El objetivo de este trabajo es evaluar los resultados de una estrategia que contemplaba los tres elementos reseñados en un Distrito de Atención Primaria de Andalucía.Métodos: Se realizó el seguimiento a 234 enfermos de tuberculosis residentes en el Distrito y notificados al Sistema de Vigilancia Epidemiológica de Andalucía durante el período 2004-2008. Se consideraron como indicadores de evaluación el porcentaje que finalizó el tratamiento, el porcentaje de pacientes bacilíferos con estudio de contactos, los nuevos casos detectados en los mismos y la incidencia en menores de 15 años.Resultados:.De los 234 pacientes incluidos se realizó un seguimiento efectivo en el 95%, de ellos finalizaron el tratamiento 182 (78%), fallecieron 18, se trasladaron de domicilio 10 y continuaban aún en tratamiento12. De los 130 casos que presentaron baciloscopia positiva se estudiaron a los contactos de 112 (el 86%). Se detectaron 27 nuevos casos entre los contactos estudiados y la incidencia anual en menores de 15 años fue del 6.65 por 100.000. Las perdidas del seguimiento se redujeron un 30% y las finalizaciones del tratamiento y los estudios de contactos mejoraron un 25% y 30% respectivamente, respecto a los datos del conjunto de Andalucía.Conclusiones: La estrategia seguida ha permitido mejorar los indicadores de evaluación propuestos. El % de casos nuevos detectados en los estudios de contactos y la incidencia anual en menores de 15 años ha sido similar en este estudio que en Andalucía(AU)

Background: Tuberculosis in Spain and Andalusia, the incidence rates above those of surrounding countries. Many authors emphasize the need for improved epidemiological information, the organization of health services and social support to patients. The aim of this study was to evaluate the results obtained after developing a strategy involving the three elements outlined in the Primary Care District of Andalusia.Methods: We followed up to 234 TB patients residing in the District and reported to the Epidemiological Surveillance System of Andalusia during the period 2004-2008. Were considered as indicators for evaluating the percentage of patients who completed treatment, the percentage of smear-positive contacts with study, new cases detected in the same and the incidence in children under 15 years.Results:. Of the 234 patients were followed up cash 95% of them completed treatment 182 (78%) died 18, moved from home, 10 and 12 still remained in treatment. Of the 130 cases that presented positive sputum studied 112 contacts (86%). 27 new cases were detected among the contacts studied, and the annual incidence in children under 15 years was 6.65 per 100,000 population. Tracking losses were reduced by 30%, and terminations of treatment and contact studies improved by 25% and 30% respectively compared to data from the whole of Andalusia.Conclusions: The strategy has helped improve the proposed assessment indicators. The% of new cases detected in studies of contacts and the annual incidence in children under 15 years was similar in this study than in Andalusia(AU)

Relación del test de control del asma (ACT) con la función pulmonar, niveles de óxido nítrico exhalado y grados de control según la Iniciativa Global para el Asma (GINA) / Comparison of the Asthma Control Test (ACT) with Lung Function, Levels of Exhaled Nitric Oxide and Control According to the Global Initiative for Asthma (GINA)

Introducción. El objetivo actual en el tratamiento del asma es conseguir y mantener el control. Este estudio tiene como objetivos estudiar la relación entre el cuestionario ACT (Asthma Control Test) y los niveles de control según Global Initiative for Asthma para establecer los puntos de corte del ACT y evaluar su relación con la función pulmonar y la Fracción exhalada de óxido nítrico (FeNO). Pacientes y métodos. Estudio prospectivo multicéntrico con inclusión de 441 pacientes seguidos en consultas externas de neumología. Se realizó protocolo clínico, FeNO, espirometría forzada y ACT. Se clasificó la enfermedad según los niveles de control de la Global Initiative for Asthma. Se realizó estudio de sensiblidad, especificidad y área bajo la curva (ROC), estimándose los puntos de corte de ACT. Se estudiaron las diferencias entre los parámetros funcionales y FeNO entre los niveles de control. Resultados. Para el asma controlada el punto de corte obtenido fue ACT≥21 (área bajo la curva 0,791) y para el no controlada fue ≤18 (área bajo la curva 0,774). Encontramos diferencias significativas en niveles de FeNO y función pulmonar entre ACT≥21 y ACT≤18, aunque solo el 26,3% de pacientes con ACT≤18 presentaron un FEV1<80% y el 40% FeNO elevado (≥35 ppb). Encontramos correlación entre FEV1 basal y ACT (r=0,19, p<0,01), así como entre ACT y FeNO (r=−0,16, p<0,01). Conclusiones. Los puntos de corte para el asma controlada serían ACT≥21, para el asma parcialmente controlada ACT=19–20 y para el asma no controlada ACT≤18. Una valoración más completa del control requeriría incluir parámetros funcionales y FeNO.(AU)

Introduction. The current goal of asthma treatment is to achieve and maintain control. This study aimed to explore the relationship between the ACT (Asthma Control Test) questionnaire and the levels of control according to GINA (Global Initiative for Asthma) to establish the cut-off points for the ACT and evaluate its relationship with lung function and fractionated exhaled nitric oxide level (FeNO). Patients and methods. A multi-centre prospective study including 441 patients followed up in an outpatient Chest Clinic. A clinical protocol was followed, and FeNO, spirometry and ACT performed. Disease was classified according to levels of control using GINA. The study analysed sensitivity, specificity and area under the curve (ROC), and the ACT cut-off points. We studied the differences between the functional parameters and FeNO between levels of control. Results. For controlled asthma the cut-off obtained was ACT≥21 (area under the curve 0.791) and for uncontrolled ≤18 (AUC 0.774). We found significant differences in FeNO levels and pulmonary function among ACT≥21 and ACT≤18, although only 26.3% of patients with ACT≤18 had a FEV1 <80% and 40% higher FeNO (≥35 ppb). We found a correlation between baseline FEV1 and ACT (r=0.19, P<0.01) and between ACT and FeNO (r=−0.16, P<0.01). Conclusions. The cut-off points would be, for controlled asthma ACT≥21, partly controlled asthma ACT=19–20 and uncontrolled asthma ACT≤18. A more complete assessment would require including monitoring operating parameters and FeNO. (AU)

Estudio prospectivo de 221 neumonías adquiridas en la comunidad seguidas de forma ambulatoria. Etiología y evolución clinicorradiológica / Prospective study of 221 community acquired pneumonias followed up in an outpatient clinic. Etiology and clinical-radiological progression

FUNDAMENTO: Se estudiaron de forma prospectiva las neumonías adquiridas en la comunidad seguidas en una consulta neumológica extrahospitalaria, con objeto de determinar la etiología, las características clinicorradiológicas y su evolución con unas pautas de actuación y tratamiento protocolizadas. PACIENTES Y MÉTODO: Se realizaron protocolos de evaluación clínica, diagnóstico etiológico por serología (en la primera visita y a las tres semanas) y, en los casos necesarios, por fibrobroncoscopia (cepillo microbiológico protegido), así como protocolos de evolución clínica y radiológica (hasta tres revisiones) tras pautas de tratamiento empírico previamente establecidos. RESULTADOS: Se incluyó inicialmente a 240 pacientes, siendo seguidos un total de 221 casos. Obtuvimos el diagnóstico etiológico en 86 pacientes (39 por ciento), siendo el germen más frecuente Coxiella burnetii (12,2 por ciento), seguido de Mycoplasma pneumoniae y Legionella pneumophila. Se diagnosticaron dos casos de Sptreptococcus pneumoniae. La forma de presentación radiológica más frecuente fue la condensación alveolar (86 por ciento). Se emplearon como tratamiento empírico inicial macrólidos (71 por ciento) o cefalosporinas de segunda generación (22 por ciento). La evolución clínica y radiológica fue satisfactoria en la mayoría de los pacientes, siendo necesario el ingreso hospitalario en dos casos (< 1 por ciento del total). CONCLUSIONES: En las neumonías adquiridas en la comunidad en régimen ambulatorio encontramos un elevado número de gérmenes 'atípicos'. En pacientes ambulatorios creemos apropiado el tratamiento empírico con macrólidos o cefalosporinas de segunda generación (AU)

Neumonías adquiridas en la comunidad en pacientes mayores de 60 años. Incidencia de gérmenes atípicos y evolución clinicorradiológica / Community acquired pneumonia in patients older than 60 years. Incidence of atypical agents and clinical-radiological progression

FUNDAMENTO: Se estudiaron de forma prospectiva 75 pacientes mayores de 60 años con neumonías adquiridas en la comunidad (NAC) seguidos de forma ambulatoria, evaluando la incidencia de gérmenes atípicos, las características clinicorradiológicas, su evolución y los datos diferenciales con neumonías de pacientes más jóvenes. MÉTODO: Se realizaron protocolos de evaluación clinicorradiológica en la primera visita, y durante el seguimiento en dos revisiones más. El diagnóstico etiológico se efectuó por serología (en la primera visita y a las tres semanas). RESULTADOS: Se incluyó inicialmente a 85 pacientes mayores de 60 años, de los que fueron seguidos un total de 75 casos no hospitalizados. Además, se incluyó en el estudio comparativo a 216 pacientes con edad igual o menor de 60 años, controlados de forma ambulatoria en el mismo espacio temporal. En el primer grupo la incidencia de gérmenes atípicos fue del 33,3 por ciento, siendo el patógeno más frecuente Coxiella burnetii (13,3 por ciento), seguido de virus y Legionella pneumophila. No se diagnosticó ningún caso debido a Mycoplasma pneumoniae. La forma de presentación radiológica más frecuente fue la condensación alveolar (85 por ciento). En el análisis comparativo entre las dos poblaciones (mayores o menores de 60 años), encontramos escasas diferencias clínicas (disnea más frecuente en población mayor, escalofríos en población más joven) y en semiología respiratoria (crepitantes más frecuentes en población mayor), no hallando diferencias en el resto de los datos clinicorradiológicos o de laboratorio. La evolución clínica y radiológica f e satisfactoria, siendo necesario el ingreso hospitalario en sólo dos casos (2,7 por ciento). CONCLUSIONES: Encontramos un elevado número de casos debidos a gérmenes atípicos en las NAC de pacientes mayores de 60 años. Con seguimiento ambulatorio, la evolución clinicorradiológica ha sido satisfactoria en la mayoría de ellos, por lo que no consideramos la edad un factor fundamental para decidir la hospitalización (AU)