Influencia de las comorbilidades en la mortalidad de pacientes con EPOC estables / The influence of comorbidities in the mortality of patients with stable COPD

Objetivo: Estudiar la relación entre las comorbilidades y la mortalidad por cualquier causa en pacientes con EPOC en fase estable, en nuestro ámbito geográfico. Material y métodos: Estudio observacional prospectivo longitudinal multicéntrico de una cohorte de pacientes con EPOC en situación estable. Se recogieron datos demográficos, funcionales respiratorios, índice de comorbilidad de Charlson y escala hospitalaria de ansiedad y depresión. Los pacientes fueron seguidos durante 3 años. En el caso de fallecimiento se indagó para determinar la causa de la muerte. Resultados: Se estudiaron 138 pacientes con una edad media de 66,3 ± 10,3 años y FEV1 medio de 51,3 ± 16,9%. El índice de Charlson medio fue de 4,66 ± 1,57. Presentaban depresión el 17,2% y ansiedad el 12,7%. Fallecieron 13 (9,5%) pacientes, 5 de cáncer de pulmón, 5 por agudización de la EPOC, 1 por carcinoma de colon, otro por infarto agudo de miocardio (IAM) y otro por insuficiencia cardiaca congestiva (ICC). En el análisis multivariado el número de comorbilidades (HR 1,926; IC 95%: 1,384 - 2,680) y la existencia de tratamiento ansiolítico (HR 4,072; IC 95%: 1,106 - 14,987) se asociaron a mayor mortalidad. El análisis mediante curvas de supervivencia de KaplanMeier, mostró que los pacientes con 2 o más comorbilidades, además de la EPOC, presentaban mayor mortalidad que los que tenían una o ninguna (35,52 ± 0,2 vs 33 ± 1,3 meses, p = 0,039). Conclusiones: La prevalencia de comorbilidades en pacientes con EPOC estable fue elevada. La mortalidad de estos pacientes se relacionó con el número de comorbilidades y el tratamiento ansiolítico. La mortalidad fue superior en aquellos pacientes con 2 o más comorbilidades

Objective: to assess the relationship between comorbidities and all-cause mortality in stable chronic obstructive pulmonary disease (COPD) patients, in our geographic area. Methods: Prospective, multicenter, longitudinal study of patients with stable COPD. We recorded demographic characteristics, respiratory functional tests, Charlson comorbidity index and hospital anxiety and depression scale. Patients were followed up for 3 years. In the case of death it was investigated to determine the real cause of death. Results: 138 patients were studied with a mean age of 66.3 ± 10.3 years and mean FEV1 of 51.3 ± 16.9%. The mean Charlson index was 4.66 ± 1.57. 17.2% had depression and 12.7% anxiety. Thirteen (9.5%) patients died, 5 of lung cancer, 5 COPD exacerbation, 1 colon cancer, another for acute myocardial infarction (AMI) and another one for congestive heart failure (CHF). In the multivariate analysis the number of comorbidities (HR 1.926; IC 95%: 1.384 - 2.680) and anxiolytic treatment (HR 4.072; IC 95%: 1.106 - 14.987) showed relationship with mortality. Kaplan-Meier suvival plots showed that patients with 2 o more comorbilities, in addition to COPD, have higher mortality than patients with 1 or no comorbidity (35.52 ± 0.2 vs 33 ± 1.3 months, p = 0,039). Conclusions: The prevalence of comorbidities in patients with stable COPD was high. Mortality in these patients is related to the number of comorbidities and anxiolytic treatment. Mortality was higher in patients with 2 o more comorbidilites

Contaminación medioambiental por colillas del tabaco: el tabaco de cuarta mano / Environmental contamination from tobacco ends: fourth hand tobacco

No disponible

Recomendación de la vacuna antineumocócica en las enfermedades respiratorias crónicas / Pneumococcal vaccine recommendations in chronic respiratory diseases

La neumonía adquirida en la comunidad (NAC) es una enfermedad infecciosa respiratoria aguda que tiene una incidencia de 3-8 casos/1.000 habitantes, y que aumenta con la edad y las comorbilidades. El neumococo es el microorganismo más frecuentemente implicado en la neumonía adquirida en la comunidad en los adultos (30-35%). El 40% de los pacientes con neumonía adquirida en la comunidad requieren ingreso hospitalario, y alrededor del 10% necesitan ser admitidos en una unidad de cuidados intensivos. Las formas más graves de infección neumocócica se incluyen en la enfermedad neumocócica invasiva (ENI), que agrupa los casos de bacteriemia (asociadas o no a neumonía), meningitis, pleuritis, artritis, peritonitis primaria y pericarditis. En la actualidad, el mayor problema con el neumococo es la aparición de resistencias a los agentes antimicrobianos y su elevada morbimortalidad, a pesar del uso de antibióticos apropiados y de un tratamiento médico correcto. Ciertas condiciones médicas subyacentes aumentan el riesgo de ENI y de sus complicaciones, destacando, desde el punto de vista neumológico, el tabaquismo y las enfermedades respiratorias crónicas. La enfermedad neumocócica, según la OMS, es la primera causa de muerte prevenible en el mundo en niños y adultos. Entre las estrategias para prevenir la ENI se encuentra la vacunación. La OMS considera esencial y prioritaria su introducción e implementación frente al neumococo, de forma universal, en todos los países. Actualmente disponemos de 2 vacunas antineumocócicas para el adulto: la polisacárida de 23 serotipos y la conjugada de 13 serotipos. Las sociedades científicas aquí representadas han trabajado para elaborar unas recomendaciones, basadas en la evidencia científica actual, respecto a la vacunación antineumocócica en el adulto inmunocompetente con enfermedad respiratoria crónica y en fumadores con riesgo de padecer ENI (AU)

Community-acquired pneumonia is an acute respiratory infectious disease which has an incidence of 3-8 cases/1,000 inhabitants, and increases with age and comorbidities. The pneumococcus is the organism most frequently involved in community-acquired pneumonia in the adult (30-35%). Around 40% of patients with community-acquired pneumonia require hospital admission, and around 10% need to be admitted to an intensive care unit. The most serious forms of pneumococcal infection include invasive pneumococcal disease (IPD), which covers cases of bacteremia (associated or not to pneumonia), meningitis, pleuritis, arthritis, primary peritonitis and pericarditis. Currently, the biggest problem with the pneumococcus is the emergence of resistance to antimicrobial agents, and its high morbimortality, despite the use of appropriate antibiotics and proper medical treatment. Certain underlying medical conditions increase the risk of IPD and its complications, especially, from the respiratory diseases point of view, smoking and chronic respiratory diseases. Pneumococcal disease, according to the WHO, is the first preventable cause of death worldwide in children and adults. Among the strategies to prevent IPD is vaccination. WHO considers that its universal introduction and implementation against pneumococcus is essential and a priority in all countries. There are currently 2 pneumococcal vaccines for adults: the 23 serotypes polysaccharide and conjugate 13 serotypes. The scientific societies represented here have worked to develop some recommendations, based on the current scientific evidence, regarding the pneumococcal vaccination in the immunocompetent adult with chronic respiratory disease and smokers at risk of suffering from IPD (AU)

[Pneumococcal vaccine recommendations in chronic respiratory diseases]. / Recomendación de la vacuna antineumocócica en las enfermedades respiratorias crónicas.

Community-acquired pneumonia is an acute respiratory infectious disease which has an incidence of 3-8 cases/1,000 inhabitants, and increases with age and comorbidities. The pneumococcus is the organism most frequently involved in community-acquired pneumonia in the adult (30-35%). Around 40% of patients with community-acquired pneumonia require hospital admission, and around 10% need to be admitted to an intensive care unit. The most serious forms of pneumococcal infection include invasive pneumococcal disease (IPD), which covers cases of bacteremia (associated or not to pneumonia), meningitis, pleuritis, arthritis, primary peritonitis and pericarditis. Currently, the biggest problem with the pneumococcus is the emergence of resistance to antimicrobial agents, and its high morbimortality, despite the use of appropriate antibiotics and proper medical treatment. Certain underlying medical conditions increase the risk of IPD and its complications, especially, from the respiratory diseases point of view, smoking and chronic respiratory diseases. Pneumococcal disease, according to the WHO, is the first preventable cause of death worldwide in children and adults. Among the strategies to prevent IPD is vaccination. WHO considers that its universal introduction and implementation against pneumococcus is essential and a priority in all countries. There are currently 2 pneumococcal vaccines for adults: the 23 serotypes polysaccharide and conjugate 13 serotypes. The scientific societies represented here have worked to develop some recommendations, based on the current scientific evidence, regarding the pneumococcal vaccination in the immunocompetent adult with chronic respiratory disease and smokers at risk of suffering from IPD.

Fiebre, disnea e infiltrados pulmonares en pacientes con infección por VIH / Fever, dyspnea and infiltrated lungs in HIV patients

Las infecciones pulmonares en pacientes con infección por el VIH (virus de inmunodeficiencia humana) han sufrido variaciones desde la instauración de profilaxis para el Pneumocystis jiroveci y el tratamiento antirretroviral de gran actividad (TARGA), apareciendo infecciones por otros gérmenes resistentes a los antibióticos habitualmente utilizados y ocasionando problemas diagnósticos y terapéuticos. Presentamos el caso de un paciente varón de 59 años con infección por el VIH y en tratamiento con TARGA, que debutó con un cuadro febril e infiltrados pulmonares. Ante su falta de mejoría con tratamiento antibiótico empírico, se le realizó una broncoscopia y biopsia bronquial que permitió el diagnóstico del eishmaniosis visceral ante la visión directa de amastigotes intra y extracelulares debajo del epitelio bronquial (AU)

Lung infections in HIV (human immunodeficiency virus) patients have suffered variations since the establishment of prophylaxis treatment against Pneumocystis jiroveci with highly active antiretroviral therapy (HAART), with infections appearing due to other germs that are resistant to the antibiotics generally used and causing diagnostic and therapeutic problems. We present the case of a 59 year old male, HIV patient undergoing treatment with HAART, who suffered fever and pulmonary infiltration. Due to his lack of improvement with empiric antibiotic treatment, a bronchoscopy and bronchial biopsy were performed, which allowed the diagnosis of visceral leishmaniasis due to the direct vision of intra- and subcellular amastigotes under the bronchial epithelium (AU)

Utilidad de las clasificaciones pronósticas en el tratamiento de la neumonía adquirida en la comunidad / No disponible

No disponible

Importancia de los polimorfismos de la ciclooxigenasa-2 en la presentación clínica de la sarcoidosis / Importance of cyclooxigenase-2 polymorphismsin the clinical presentation of sarcoidosis

OBJETIVO: Estudiar la posible relación entre las manifestaciones clínicas de la sarcoidosis y los polimorfismos del gen de laciclooxigenasa-2 (COX-2).MÉTODO: Estudio multicéntrico observacional transversal en el que participaron 7 hospitales de España. Se incluyeron pacientes diagnosticados de sarcoidosis según criterios internacionales. De cada caso se recogió edad, sexo, método diagnóstico, enzima convertidora de angiotensina, pruebas de función respiratoria, estadio radiológico y clínica del paciente en el momento del diagnóstico. Los hallazgos clínicos se agruparon en respiratorios y sistémicos. Los estudios genéticos se realizaron a partir del ADN obtenido de linfocitos de sangre periférica. El ADN se amplificó mediante PCR convencional y los polimorfismos fueron analizados por sondas de hibridación fluorescentes y curvas de disociación. Se determinaron4 variantes alélicas del gen de la COX-2: COX2.5909T>G,COX2.8473T>C, COX2.926G>C y COX2.3050G>C. RESULTADOS: La muestra se compuso de 131 casos de sarcoidosis (63 hombres; edad: 47 ± 15 años), todos con diagnóstico histológico menos 5 casos. El polimorfismo COX2.3050G>C en homocigosis resultó estar significativamente presente entre los pacientes con manifestaciones sistémicas frente al resto de pacientes (4,6% vs 0%;p=0,045). La presencia de manifestaciones sistémicas de la enfermedad estuvo significativamente asociada a los pacientes portadores del alelo C de dicho polimorfismo (34,4% vs. 18,6%; p=0,031; OR:2,3; IC 95%: 1,03-5,12). El resto de polimorfismos estudiados no estuvieron relacionados con la expresión clínica de la enfermedad. CONCLUSIÓN: La presencia de manifestaciones sistémicas parece estar relacionada con los portadores del alelo C del polimorfismoCOX2.3050G>C de la COX-2 (AU)

OBJECTIVE: To study clinical manifestations of sarcoidosis according to cyclooxigenase-2 (COX-2) polymorphisms. METHOD: Observational cross-sectional multicentre trial in which 7 Spanish hospitals participated. Patients diagnosed withs arcoidosis according to international criteria were included. Age, gender, diagnostic method, angiontens in converting enzyme, pulmonary function tests, radiological stage and clinical findings at the moment of the diagnosis were recorded for each case included. Clinical findings were grouped as respiratory or systemic. Genetic studies were performed on DNA extracted from peripheral blood lymphocytes. DNA was amplified by conventional PCR and polymorphisms were studied by Fluorescent Hybridization Probe-Melting Curves. COX-2 polymorphisms genotyped were COX2.5909T>G, COX2.8473 T>C, COX2.926 G>C y COX2.3050 G>C.RESULTS: 131 sarcoidosis patients (63 males, age: 47 ± 15years) were included. All included patients had a histological diagnosis except for 5 patients. COX2.3050G>C homozygote polymorphism resulted to be significantly present in patients with a systemic manifestation of the disease as compared with the rest of the sample(4,6% vs 0%; p = 0,045). Systemic manifestations were significantly associated with allele C carriers of this polymorphism (34.4% vs.18.6%; p = 0.031; OR: 2.3; IC 95%: 1.03 – 5.12). The rest of the studied polymorphisms were not significantly related to the clinical manifestations of the disease. CONCLUSION: Our results suggest that allele C carriers ofCOX2.3050G>C polymorphism are associated with the systemic manifestations of sarcoidosis (AU)

Eficacia clínica de la vacunación antineumocócica en pacientes con enfermadad pulmonar obstructiva crónica / Clinical efficacy of anti-pneumoccocal vaccination in patients with COPD

El objetivo ha sido valorar la eficacia clínica de la vacuna antineumocócica(VANP) en pacientes inmunocompetentes con diagnósticoespirométrico de enfermedad pulmonar obstructiva crónica(EPOC).Método: Ensayo clínico prospectivo, controlado y aleatorizadoen 596 pacientes con EPOC, (edad media 66.9±9,6 años). De éstos,298 recibieron la VANP. La variable principal fue el primer episodiode neumonía adquirida en la comunidad (NAC) de etiologíaneumocócica o desconocida. Seguimiento de 3 años (media 979días).Resultados: Hubo 67 primeros episodios de NAC, de etiologíaneumocócica o desconocida. La eficacia de la VANP en la prevenciónde NAC de etiología neumocócica o desconocida en el grupototal era del 24%(IC 95%, -24 a 54; p= 0,333). En el subgrupo delos pacientes menores de 65 años, la eficacia aumentó hasta un76% (IC 95%, 20 a 93; p=0,013). En los que tenían una obstrucciónbronquial con un FEV1 <40%, la eficacia era del 48% (IC95%, -7 a 80; p=0,076). En los pacientes menores de 65 años y conFEV1<40%, la eficacia aumentaba hasta el 91% (IC95%, 35 a 99;p=0,002). Hubo 5 casos de NAC neumocócica no bacteriémica,todas ellas en el grupo control (long rank test = 5,03; p=0,0250). Sehizo un análisis multivariante de regresión de Cox para ajustar lavacunación a la edad y a la obstrucción bronquial, con respecto apresentar NAC: RR, 0,20; (IC 95% 0,06 a 0,68; p=0,01).Conclusiones: La VANP es efectiva para prevenir NAC de etiologíaneumocócica o desconocida en pacientes EPOC menores de65 años y con FEV1<40% (AU)

Objective: The aim of this study is to evaluate the clinical efficacyof the 23-valent pneumococcal polysaccharide vaccine (PPV)in immunocompetent patients with chronic obstructive pulmonarydisease (COPD).Methods: A randomised controlled trial was carried out in 596patients with COPD (age 66.9±9.6 yr). 298 of whom received PPV.The main outcome was radiographically proven communityacquired pneumonia (CAP) of pneumococcal or unknown aetiologyafter a mean period of 3 yr.Results: There were 67 first episodes of CAP caused by pneumococcusor of unknown aetiology. The efficacy of PPV in allpatients was 24% (95%CI -24 to 54; p = 0.333). In the subgroupaged, 65 years the efficacy of PPV was 76% (95% CI 20 to 93; p =0.013), while in those with severe functional obstruction(FEV1<40%) it was 48% (95% CI -7 to 80; p = 0.076). In youngerpatients with severe airflow obstruction the efficacy was 91%(95%CI 35 to 99; p = 0.002). There were only five cases of non-bacteriemicpneumococcal CAP, all in the non-intervention group (logrank test = 5.03; p = 0.0250). Multivariate analysis gave forunknown and pneumococcal CAP in the vaccinated group,adjusted for age was HR 0.20 (95%CI 0.06 to 0.68; p = 0.01).Conclusions: PPV is effective in preventing CAP in patientswith COPD aged less than 65 years and in those with severe airflowobstruction. No differences were found among the othergroups of patients with COPD (AU)

Eficacia clínica de la vacunación antineumocócica en pacientes con enfermedad pulmonar obstructiva crónica / Clinical efficacy of anti-pneumoccocal vaccination in patients with COPD

El objetivo ha sido valorar la eficacia clínica de la vacuna antineumocócica (VANP) en pacientes inmunocompetentes con diagnóstico espirométrico de enfermedad pulmonar obstructiva crónica (EPOC).Método: Ensayo clínico prospectivo, controlado y aleatorizado en 596 pacientes con EPOC, (edad media 66.9±9,6 años). De éstos, 298 recibieron la VANP. La variable principal fue el primer episodio de neumonía adquirida en la comunidad (NAC) de etiología neumocócica o desconocida. Seguimiento de 3 años (media 979 días).Resultados: Hubo 67 primeros episodios de NAC, de etiología neumocócica o desconocida. La eficacia de la VANP en la prevención de NAC de etiología neumocócica o desconocida en el grupo total era del 24%(IC 95%, -24 a 54; p= 0,333). En el subgrupo de los pacientes menores de 65 años, la eficacia aumentó hasta un 76% (IC 95%, 20 a 93; p=0,013). En los que tenían una obstrucción bronquial con un FEV1 <40%, la eficacia era del 48% (IC95%, -7 a 80; p=0,076). En los pacientes menores de 65 años y con FEV1<40%, la eficacia aumentaba hasta el 91% (IC95%, 35 a 99; p=0,002). Hubo 5 casos de NAC neumocócica no bacteriémica, todas ellas en el grupo control (long rank test = 5,03; p=0,0250). Se hizo un análisis multivariante de regresión de Cox para ajustar la vacunación a la edad y a la obstrucción bronquial, con respecto a presentar NAC: RR, 0,20; (IC 95% 0,06 a 0,68; p=0,01).Conclusiones: La VANP es efectiva para prevenir NAC de etiología neumocócica o desconocida en pacientes EPOC menores de 65 años y con FEV1<40%

Objective: The aim of this study is to evaluate the clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV) in immunocompetent patients with chronic obstructive pulmonary disease (COPD).Methods: A randomised controlled trial was carried out in 596 patients with COPD (age 66.9±9.6 yr). 298 of whom received PPV. The main outcome was radiographically proven community acquired pneumonia (CAP) of pneumococcal or unknown aetiology after a mean period of 3 yr. Results: There were 67 first episodes of CAP caused by pneumococcus or of unknown aetiology. The efficacy of PPV in all patients was 24% (95%CI -24 to 54; p = 0.333). In the subgroup aged, 65 years the efficacy of PPV was 76% (95% CI 20 to 93; p = 0.013), while in those with severe functional obstruction (FEV1<40%) it was 48% (95% CI -7 to 80; p = 0.076). In younger patients with severe airflow obstruction the efficacy was 91%(95%CI 35 to 99; p = 0.002). There were only five cases of non-bacteriemic pneumococcal CAP, all in the non-intervention group (log rank test = 5.03; p = 0.0250). Multivariate analysis gave for unknown and pneumococcal CAP in the vaccinated group, adjusted for age was HR 0.20 (95%CI 0.06 to 0.68; p = 0.01).Conclusions: PPV is effective in preventing CAP in patients with COPD aged less than 65 years and in those with severe airflow obstruction. No differences were found among the other groups of patients with COPD

Masa torácica en varón fumador de 47años / No disponible

No disponible

Pruebas funcionales respiratorias: espirometría, estudio de la hiperreactividad bronquial volúmenes pulmonares y test de difusión del CO / No disponible

No disponible

[Prognosis in patients with pneumonia and chronic obstructive pulmonary disease]. / Evaluación pronóstica de las neumonías en pacientes con EPOC.

OBJECTIVE: To study the incidence, severity, and mortality rates of pneumonia in a cohort of chronic obstructive pulmonary disease (COPD) patients monitored over 3 years. PATIENTS AND METHODS: A total of 596 patients diagnosed with COPD according to spirometric criteria were included in the study. The variables assessed were mortality and severity according to the Pneumonia Severity Index (PSI) for community-acquired pneumonia (CAP). RESULTS: Of the 596 patients included in the study, 75 (12.6%) developed at least 1 episode of pneumonia during the 3 years of the study. The overall incidence of pneumonia was 55.1 per 1000 person-years. There were 88 episodes in 75 patients. COPD severity, evaluated based on percentage of predicted FEV1, was mild in 9 patients, moderate in 24, and severe in 42. Seventy-six (86.3%) episodes were CAP and 12 (13.6%) were acquired in hospital. Fourteen CAP cases corresponded to PSI group V, 28 to group IV, 20 to group III, and 14 to groups I and II. Overall mortality was 12.5% (11/88). The mortality rate was 41.7% (5/12) for nosocomial cases and 7.8% (6/76) for CAP cases (OR, 6.67; 95% confidence interval, 1.65-26.93). Assessing CAP mortality by level of severity, we found that the mortality rate was 35.7% (5/14) for group V and 3.5% (1/28) for group IV. No deaths occurred among patients in the other severity groups. CONCLUSIONS: The incidence of pneumonia in COPD patients is high. More than half the cases of CAP (55.2%) in our COPD patients were classified in PSI risk groups IV and V.

Evaluación pronóstica de las neumonías en pacientes con EPOC / Prognosis in patients with pneumonia and chronic obstructive pulmonary disease

Objetivo: Estudiar la incidencia, gravedad y mortalidad de las neumonías ocurridas en una cohorte de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) seguidos durante 3 años. Pacientes y métodos: Se incluyó en el estudio a 596 pacientes con diagnóstico espirométrico de EPOC. Los parámetros a evaluar fueron la mortalidad y la gravedad valorada de acuerdo con el Pneumonia Severity Index (PSI) para la neumonía adquirida en la comunidad (NAC). Resultados: De 596 pacientes incluidos en el estudio, 75 (12,6%) desarrollaron al menos un episodio de neumonía durante el seguimiento. La incidencia global de neumonía fue de 55,1 por 1.000 personas-año. Hubo 88 episodios en 75 pacientes. El grado de la EPOC, valorado según el FEV1 como porcentaje del teórico, era en 9 pacientes leve, en 24 moderado y en 42 grave. De los episodios de neumonía, 76 (86,3%) fueron adquiridos en la comunidad y 12 (13,6%) en el hospital. Al valorar la gravedad de la NAC, 14 episodios correspondían al grupo V, 28 al grupo IV, 20 al grupo III y 14 a los grupos I y II. La mortalidad global fue del 12,5% (11/88). La mortalidad en las neumonías nosocomiales fue del 41,7% (5/12) y la mortalidad en las NAC fue del 7,8% (6/76) (OR: 6,67; intervalo de confianza del 95%, 1,65-26,93). Al valorar la mortalidad en las NAC según la gravedad, se encontró que la mortalidad en el grupo V fue de un 35,7% (5/14), en el grupo IV del 3,5% (1/28) y nula en el resto de los grupos. Conclusiones: Hay una elevada incidencia de neumonía en los pacientes con EPOC. Más de la mitad de las NAC (55,2%) ocurridas en nuestros pacientes con EPOC están dentro de los grupos de riesgo del PSI IV y V

Objective: To study the incidence, severity, and mortality rates of pneumonia in a cohort of chronic obstructive pulmonary disease (COPD) patients monitored over 3 years. Patients and methods: A total of 596 patients diagnosed with COPD according to spirometric criteria were included in the study. The variables assessed were mortality and severity according to the Pneumonia Severity Index (PSI) for community-acquired pneumonia (CAP). Results: Of the 596 patients included in the study, 75 (12.6%) developed at least 1 episode of pneumonia during the 3 years of the study. The overall incidence of pneumonia was 55.1 per 1000 person-years. There were 88 episodes in 75 patients. COPD severity, evaluated based on percentage of predicted FEV1, was mild in 9 patients, moderate in 24, and severe in 42. Seventy-six (86.3%) episodes were CAP and 12 (13.6%) were acquired in hospital. Fourteen CAP cases corresponded to PSI group V, 28 to group IV, 20 to group III, and 14 to groups I and II. Overall mortality was 12.5% (11/88). The mortality rate was 41.7% (5/12) for nosocomial cases and 7.8% (6/76) for CAP cases (OR, 6.67; 95% confidence interval, 1.65-26.93). Assessing CAP mortality by level of severity, we found that the mortality rate was 35.7% (5/14) for group V and 3.5% (1/28) for group IV. No deaths occurred among patients in the other severity groups. Conclusions: The incidence of pneumonia in COPD patients is high. More than half the cases of CAP (55.2%) in our COPD patients were classified in PSI risk groups IV and V

Vacunación en el enfermo respiratorio / No disponible

No disponible

[Sarcoidosis following combined ribavirin and interferon therapy: a case report and review of the literature]. / Sarcoidosis tras tratamiento con interferón y ribavirina. Presentación de un caso y revisión de la bibliografía.

Treatment of active chronic viral hepatitis type C with interferon alpha has proved effective and therefore its use is being extended to a large number of patients. Common side effects include respiratory manifestations. One side effect attributable to the immunomodulatory effect of interferon is the possible triggering or exacerbation of systemic or cutaneous sarcoidosis. We report a new case and offer an exhaustive review of the literature. A 49-year-old man with type C chronic, active hepatitis developed new respiratory symptoms and pulmonary infiltrates with hilar and mediastinal adenopathy after 4 months of treatment with pegylated interferon and ribavirin. The transbronchial biopsy showed multiple sarcoid granulomas. When the patient was diagnosed, he had already taken the total dose of interferon and no specific treatment was started. His hepatitis did not respond to therapy and his viral load and transaminase levels remained high.

Sarcoidosis tras tratamiento con interferón y ribavirina. Presentación de un caso y revisión de la bibliografía / Sarcoidosis following combined ribavirin and interferon therapy: a case report and review of the literature

El tratamiento con interferón alfa en la hepatitis crónica activa por el virus C tiene una eficacia demostrada, por ello se está generalizando su uso a gran número de pacientes.Entre los efectos secundarios, las manifestaciones respiratorias banales son muy frecuentes. Un efecto secundario atribuible al efecto inmunomodulador del interferón es la posibilidad de agravar o desencadenar una sarcoidosis cutánea o sistémica. Presentamos un nuevo caso y hacemos una exhaustiva revisión de la bibliografía.Se comunica el caso de un varón de 49 años con hepatitis crónica activa por el virus C que a los 4 meses de tratamiento con interferón pegilado más ribavirina presentó sintomatología respiratoria que no tenía previamente e infiltrados pulmonares con adenopatías hiliares y mediastínicas. En la biopsia transbronquial se apreciaron abundantes granulomas sarcoideos. Cuando se diagnosticó, el paciente había finalizado toda la dosis de interferón y no se instauró ningún tratamiento específico. La hepatitis no respondió a la terapia, permaneciendo elevada la carga viral y las transaminasas (AU)

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[Setting up written informed consent for fiberoptic bronchoscopy in the pneumology units of Spanish hospitals]. / Indice de implantación del consentimiento informado escrito para fibrobroncoscopia en las unidades de neumología de los hospitales españoles.

OBJECTIVES: To assess the implantation and quality of written IC in the pulmonology units of Spanish hospitals. METHOD: A descriptive study was initiated with a nation-wide mail and/or telephone survey of 117 Spanish hospitals to determine whether or not written ICs were signed before fiberoptic bronchoscopy. If the respondents answered affirmatively, a copy of the form was requested for evaluation. Evaluation criteria were a) whether IC was specific for fiberoptic bronchoscopy, and if it was, b) whether it contained information as well as a declaration of consent, and c) whether the information and declaration were adequate, fulfilling minimum requirements. RESULTS: Seventy-three pulmonology units (60%) responded and 49 of them (67.1%) reported that they obtained written ICs while 24 (32.9%) did not. Of the 49 departments that reported asking for written IC, 41 (83%) used forms that were specific for fiberoptic bronchoscopy and 8 (17%) used nonspecific forms. The 41 units with specific IC forms submitted papers containing both information and declaration sections. The information was adequate in 10 cases (24%) and the declaration was appropriate in 17 (41%); only 6 (14%) had both adequate information and an appropriate declaration. CONCLUSIONS: Written ICs are increasingly common and are present in 67% of the pulmonology units that responded to the questionnaire. The low number of forms meeting minimum requirements is remarkable. It would be useful to design an IC form that respects our specific sociocultural context for use nation-wide in Spain.

[Pneumonia due to varicella zoster virus in adults: a review of 13 cases]. / Neumonía varicelosa en adultos: revisión de 13 casos.

Pneumonia due to varicella-zoster virus is a complication of chickenpox that appears almost solely in adults. The clinical picture ranges from varieties with few symptoms to those with severe respiratory insufficiency. This retrospective study of adult varicella pneumonia cases treated at our hospital over a seven-year period enrolled 13 patients (9 men and 4 women) whose diagnosis of varicella pneumonia was based on clinical and radiologic criteria during the course of disease. Three patients were immunodepressed (two with HIV infection and one with systemic lupus) and one patient was in her third month of pregnancy. Seventy-seven percent of the patients were active smokers. The most common symptoms apart from skin rash and fever were coughing and dyspnea. All had extensive bilateral nodular patterns visible on the chest film, with no pleural involvement or mediastinal adenopathy. All received intravenous acyclovir and outcome was good in all but one HIV-infected patient, who died. The pregnant patient required intensive care.