[Treatment of cytomegalovirus disease]. / Tratamiento de la enfermedad por citomegalovirus.

For years, intravenous ganciclovir has been the recommended treatment for cytomegalovirus (CMV) in transplant recipients. Recently, oral valganciclovir has been shown to induce a response to CMV similar to that produced by intravenous ganciclovir and could consequently be an alternative to ganciclovir in patients with non-severe disease. Sequential therapy with ganciclovir followed by valganciclovir, after the onset of clinical improvement, reduces costs and avoids prolonged hospital stays, thus benefitting patients. Optimal treatment duration is guided by clinical response and virological monitoring (polymerase chain reaction or antigenemia) and is maintained until the results are negative. Some groups use secondary prophylaxis in patients with risk factors for recurrence of CMV disease. Reducing the intensity of immunosuppression or complementing antiviral therapy with immunoglobulins can be considered in patients with severe disease or immunodepression. There are no conclusive data on the most effective treatment in ganciclovir-resistant CMV. Therapeutic decisions should be based on genotypic resistance studies, the patient's immune status and disease severity. Treatment consists of foscarnet alone or in combination with ganciclovir in the most severe forms and in high-resistance mutations, or in increasing the dose of ganciclovir in clinical forms or in mild resistance. There are no conclusive data on alternative antiviral drugs or complementary therapy with mTOR inhibitors. Several CMV vaccines are under development and the preclinical results are encouraging.

Prevalence of tobacco consumption among young physicians at a regional university hospital in southern Spain: a cross-sectional study.

INTRODUCTION: The aim of the study is to analyse the prevalence of smoking among resident physicians at a regional university hospital. In addition, we examined the trends in the smoking behaviour of physicians in relation to results obtained in other studies carried out previously at this hospital, as well as those published nationally and internationally METHOD: A cross-sectional observational study evaluating tobacco consumption in young physicians was carried out at the level of secondary healthcare in a regional university hospital in Cordoba, Spain. All the study subjects were resident physicians who underwent a mandatory preliminary occupational health examination between 2012 and 2016. There was no sampling selection as anyone who took this examination was considered to be within the target population. We calculated the proportions of smokers, former smokers and non-smokers, with 95% CIs. Univariate and multivariate analyses (binary logistic regression) were used to analyse the results (P<0.05). RESULTS: The response rate was 99.4%, with a sample size of 324 out of a possible 326 physicians. The average age was 28.6±3.7-DT-(95% CI 28.2 to 29.0), and 62.3% (202/324; 95% CI 57.3 to 67.2) were women. Smoking prevalence was 6.5% (21/324; 95% CI 3.5 to 9.3) with a further 5.2% (17/324; 95% CI 2.7 to 7.8) being ex-smokers. There were no significant differences in the prevalence of tobacco consumption according to age (P=0.266), sex (9.0% for men and 5.0% for women; P=0.128), medical specialty (P=0.651) or year of residency (P=0.975). A 52.7% decline in the number of young physician smokers was noted between 1986 and 2016 (95% CI -44.0 to -63.5), together with a 64.4% increase in non-smokers (95% CI 55.2 to 77.3). CONCLUSIONS: We observed a significantly low prevalence of tobacco use among trainee physicians in the cohort, an effect of new antismoking laws, with positive role model implications for new physicians and medical students.

COVID and CARE@. Mobile application for monitoring SARS-CoV-2 positive patients after hospitalization / COVID and CARE@. Aplicación móvil para el seguimiento tras hospitalización de pacientes SARS-CoV-2 positivo

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Comorbidities impacting on prognosis after lung transplant.

The aim of this review is to give an overview of the clinical circumstances presenting before lung transplant that may have negative repercussions on the long and short-term prognosis of the transplant. Methods for screening and diagnosis of common comorbidities with negative impact on the prognosis of the transplant are proposed, both for pulmonary and extrapulmonary diseases, and measures aimed at correcting these factors are discussed. Coordination and information exchange between referral centers and transplant centers would allow these comorbidities to be detected and corrected, with the aim of minimizing the risks and improving the life expectancy of transplant receivers.

Retrasplante pulmonar. Visión contraria / Lung Re-Transplantation. The Opposite View Point

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Reduction in size of renal angiomyolipoma after treatment with everolimus in lung transplantation due to lymphangioleiomyomatosis.

Lymphangioleiomyomatosis (LAM) is a rare disease characterized by abnormal proliferation of immature smooth muscle cells and cystic lung destruction, which determines the prognosis of the disease. The kidney angiomyolipomas are usually very common in this disease and are usually asymptomatic unless complications arise. In the absence of a curative treatment, recent publications show promising results in molecular therapy to prevent functional decline and to control the size of the angiomyolipomas. These therapies include mTOR complex inhibitors, especially sirolimus. We report a case of a patient diagnosed with LAM who underwent lung transplantation with reduction of renal angiomyolipoma size after treatment with the mTOR inhibitor everolimus.

Comorbilidades con impacto pronóstico tras el trasplante pulmonar / Comorbidities Impacting on Prognosis After Lung Transplant

Esta revisión pretende exponer de forma sucinta aquellas circunstancias clínicas previas al trasplante pulmonar que pueden repercutir negativamente en el pronóstico del trasplante a corto y largo plazo. Se plantean los métodos de rastreo y diagnóstico de comorbilidades comunes de impacto pronóstico negativo sobre el trasplante, tanto de patologías pulmonares como extrapulmonares, y se proponen medidas dirigidas a su corrección. La coordinación y el intercambio de información entre los centros que remiten a los candidatos y los centros trasplantadores permitirán detectar y corregir estas comorbilidades con el fin de minimizar los riesgos y de mejorar las expectativas de supervivencia de los pacientes trasplantados

The aim of this review is to give an overview of the clinical circumstances presenting before lung transplant that may have negative repercussions on the long and short-term prognosis of the transplant. Methods for screening and diagnosis of common comorbidities with negative impact on the prognosis of the transplant are proposed, both for pulmonary and extrapulmonary diseases, and measures aimed at correcting these factors are discussed. Coordination and information exchange between referral centers and transplant centers would allow these comorbidities to be detected and corrected, with the aim of minimizing the risks and improving the life expectancy of transplant receivers

Reducción de tamaño del angiomiolipoma renal tras el tratamiento con everolimus en trasplante pulmonar por linfangioleiomiomatosis / Reduction in Size of Renal Angiomyolipoma after Treatment with Everolimus in Lung Transplantation due to Lymphangioleiomyomatosis

La linfangioleiomiomatosis (LAM) es una enfermedad rara caracterizada por la proliferación anormal de células musculares lisas inmaduras y una destrucción quística del pulmón, que condiciona el pronóstico de la enfermedad. Los angiomiolipomas renales suelen ser muy frecuentes en esta enfermedad, generalmente de curso asintomático, salvo complicaciones. Ante la ausencia de un tratamiento curativo, las últimas publicaciones reflejan resultados esperanzadores en la terapia molecular para evitar el deterioro funcional y el control del tamaño de los angiomiolipomas. Entre estas terapias destacan los inhibidores del complejo mTOR, sobre todo sirolimus. Presentamos un caso clínico de una paciente diagnosticada de LAM sometida a trasplante pulmonar con reducción del tamaño del angiomiolipoma renal tras el tratamiento con el inhibidor mTOR everolimus(AU)

Lymphangioleiomyomatosis (LAM) is a rare disease characterized by abnormal proliferation of immature smooth muscle cells and cystic lung destruction, which determines the prognosis of the disease. The kidney angiomyolipomas are usually very common in this disease and are usually asymptomatic unless complications arise. In the absence of a curative treatment, recent publications show promising results in molecular therapy to prevent functional decline and to control the size of the angiomyolipomas. These therapies include mTOR complex inhibitors, especially sirolimus. We report a case of a patient diagnosed with LAM who underwent lung transplantation with reduction of renal angiomyolipoma size after treatment with the mTOR inhibitor everolimus(AU)

Estenosis bronquial postrasplante pulmonar / Bronchial stenosis after lung transplantation

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Tratamiento de la enfermedad por citomegalovirus / Treatment of cytomegalovirus disease

Durante años, ganciclovir intravenoso ha sido el tratamiento recomendado para la enfermedad por citomegalovirus (CMV) en pacientes trasplantados. En los últimos años, valganciclovir oral ha mostrado una similar respuesta frente a CMV que ganciclovir intravenoso, por lo que puede ser utilizado alternativamente a ganciclovir en pacientes con enfermedad no grave. La terapia secuencial con ganciclovir seguido de valganciclovir, tras iniciarse la mejoría clínica, reduce costes y evita hospitalizaciones prolongadas, lo que supone un beneficio para los pacientes. La duración óptima del tratamiento irá guiada por la respuesta clínica y los controles virológicos (PCR o antigenemia), manteniéndose hasta que éstos sean negativos. Algunos grupos utilizan profilaxis secundaria ante la presencia de factores de riesgo de recidiva de la enfermedad por CMV. Reducir la intensidad de la inmunosupresión o complementar la terapia antiviral con inmunoglobulinas son medidas a considerar en casos graves o en grandes inmunodeprimidos. No hay datos firmes acerca del mejor tratamiento alternativo ante la evidencia de CMV resistente a ganciclovir. Las decisiones terapéuticas deberán sustentarse en el estudio genotípico de resistencias, el estado inmune del paciente y en la gravedad de la enfermedad. El tratamiento consiste en foscarnet solo o con ganciclovir en las formas más graves y en mutaciones de alta resistencia, o en el incremento de las dosis de ganciclovir en las formas clínicas o de resistencia más benignas. No hay datos concluyentes acerca de antivirales alternativos o de terapia complementaria con inhibidores de mTOR. Se ensayan diversas vacunas frente a CMV con resultados preclínicos esperanzadores (AU)

For years, intravenous ganciclovir has been the recommended treatment for cytomegalovirus (CMV) in transplant recipients. Recently, oral valganciclovir has been shown to induce a response to CMV similar to that produced by intravenous ganciclovir and could consequently be an alternative to ganciclovir in patients with non-severe disease. Sequential therapy with ganciclovir followed by valganciclovir, after the onset of clinical improvement, reduces costs and avoids prolonged hospital stays, thus benefitting patients. Optimal treatment duration is guided by clinical response and virological monitoring (polymerase chain reaction or antigenemia) and is maintained until the results are negative. Some groups use secondary prophylaxis in patients with risk factors for recurrence of CMV disease. Reducing the intensity of immunosuppression or complementing antiviral therapy with immunoglobulins can be considered in patients with severe disease or immunodepression. There are no conclusive data on the most effective treatment in ganciclovir-resistant CMV. Therapeutic decisions should be based on genotypic resistance studies, the patient’s immune status and disease severity. Treatment consists of foscarnet alone or in combination with ganciclovir in the most severe forms and in high-resistance mutations, or in increasing the dose of ganciclovir in clinical forms or in mild resistance. There are no conclusive data on alternative antiviral drugs or complementary therapy with mTOR inhibitors. Several CMV vaccines are under development and the preclinical results are encouraging (AU)