[Treatment of pulmonary tuberculosis]. / Tratamiento de la tuberculosis pulmonar.

The treatment of tuberculosis is important both to preserve the health of the patient and to prevent the spread of the disease amongst the population. Its bacteriological bases are found in the high number of bacillae existing in the majority of human TB lesions and the capacity to mutate of Mycobacterium tuberculosis when it achieves a high number of divisions; this makes it essential to associate drugs that avoid the selection of resistant mutants. In our setting the pharmacological therapy that has shown greatest efficacy consists in the association during two months of isoniacide, rifampicine and pyrazinamide followed by four additional months with the first two drugs. In general the first choice tuberculostatic drugs are well tolerated, but they can produce potentially serious secondary effects that it is necessary to understand and know how to manage. This article also describes how to act from the therapeutic point of view facing certain special situations and when the initial treatments have been abandoned or have failed. In the last five years in Navarre, there has been a significant increase in the presence of immigrants proceeding from developing countries with high rates of tuberculosis and primary resistances. Because of its specific socio-economic conditions and its cultural idiosyncrasy, this group frequently generates difficulties with respect to complying with the treatment, as well in follow-up and control. The treatment of tuberculosis must always be carried out by expert doctors.

Tratamiento de la tuberculosis pulmonar / Treatment of pulmonary tuberculosis

El tratamiento de la tuberculosis es importante tanto para preservar la salud del paciente como para prevenir la propagación de la enfermedad entre la población. Sus bases bacteriológicas estriban en el elevado número de bacilos que existen en la mayor parte de lesiones humanas de la TB y en la capacidad de mutar que tiene el M. tuberculosis cuando alcanza un número elevado de divisiones; ello hace imprescindible la asociación de fármacos que eviten la selección de mutantes resistentes. En nuestro medio la terapia farmacológica que se ha demostrado más eficaz consiste en la asociación durante dos meses de isoniacida, rifampicina y piracinamida seguida durante cuatro meses más con los dos primeros fármacos. En general los tuberculostáticos de primera elección son bien tolerados, pero pueden producir efectos secundarios potencialmente graves que conviene conocer y saber manejar. En el presente trabajo describimos también cómo se debe actuar desde el punto de vista terapéutico ante determinadas situaciones especiales y cuando los tratamientos iniciales se han abandonado o han fracasado. En los últimos cinco años en Navarra, se ha incrementado de forma importante la presencia de inmigrantes procedentes de países en vías de desarrollo con altas tasas de tuberculosis y de resistencias primarias. Este colectivo genera con frecuencia, como consecuencia de sus particulares condiciones socioeconómicas y su idiosincrasia cultural, dificultades respecto al cumplimiento del tratamiento, así como en los seguimientos y controles. El tratamiento de la tuberculosis siempre debe ser realizado por médicos expertos en el tema

The treatment of tuberculosis is important both to preserve the health of the patient and to prevent the spread of the disease amongst the population. Its bacteriological bases are found in the high number of bacillae existing in the majority of human TB lesions and the capacity to mutate of Mycobacterium tuberculosis when it achieves a high number of divisions; this makes it essential to associate drugs that avoid the selection of resistant mutants. In our setting the pharmacological therapy that has shown greatest efficacy consists in the association during two months of isoniacide, rifampicine and pyrazinamide followed by four additional months with the first two drugs. In general the first choice tuberculostatic drugs are well tolerated, but they can produce potentially serious secondary effects that it is necessary to understand and know how to manage. This article also describes how to act from the therapeutic point of view facing certain special situations and when the initial treatments have been abandoned or have failed. In the last five years in Navarre, there has been a significant increase in the presence of immigrants proceeding from developing countries with high rates of tuberculosis and primary resistances. Because of its specific socio-economic conditions and its cultural idiosyncrasy, this group frequently generates difficulties with respect to complying with the treatment, as well in follow-up and control. The treatment of tuberculosis must always be carried out by expert doctors

[Benign pleural diseases induced by asbestos]. / Enfermedades pleurales benignas inducidas por asbesto.

Exposure to asbestos is an important cause of pleural pathology and can be produced with light or moderate tendencies given the capacity of asbestos to concentrate in the pleura. Together with the prolonged latency existing between exposure and the disease, this means that for many years we will continue to see pleural clinical manifestations from past exposure, in spite of the increasingly limited use of asbestos in recent decades. This exposure can show itself in different manifestations, both malign, such as mesothelioma, and benign, principally benign pleural effusion, pleural plaques, diffuse pleural fibrosis and massive atelectasis.

[Building related ilness]. / Enfermedades relacionadas con los edificios.

Following the changes carried out in recent years in buildings, such as ventilation systems, computers, etc., a series of diseases, that are related to this, have been described. This paper concentrates on the syndrome of the sick building, which is formed by a group of symptoms normally suffered by workers in the same "sick" building. This syndrome is related to its interior ambience, since the clinical manifestations appear some hours after entering the building and improves a few minutes after leaving this ambience. The origin is probably multifactorial: volatile airborne pollutants, the ventilation system, factors related to work organisation, or even dependent on the host. Since there is no single cause, we enumerate the risk factors in developing this syndrome as well as the steps for reaching a diagnosis and useful measures for preventing the sick building.

[Registry of occupational respiratory diseases in Navarre]. / Registro de enfermedades respiratorias de origen laboral en Navarra.

BACKGROUND: In January 2002 an occupational respiratory diseases record was established in Navarre so that the number and characteristics of the occupational respiratory pathology could be analysed. METHODS: The cases reported by doctors who collaborated in 2002, 2003 and 2004, were entered in a database for subsequently analysis. This database has several variables: gender, age, tobacco habit, hospital department and notifying doctor, diagnosis, job and causal agent. RESULTS: 125 cases were reported. 97 males (77.6%) and 28 females (22.4%). Average age was 55,4 years old. Eighty-eight were non-smokers (70.4%) and 37 were smokers (29.6%). Pneumology reported 84 cases (67.2%) and Allergology 41 (32.8%). The diagnoses were: 50 bronchial asthma (40%), 31 benign pleural disease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8 mesothelioma (6.4%), 7 bronchopulmonary cancer (5.6%), 5 acute inhalations (4%), 3 amianthinopsy (2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD (0.8%). The most reported jobs were: 13 painting and varnishing (10.4%), 12 spinning asbestos yarn (9.6%) and 8 bakery and confectionery (6.4%). The main causal agents were: 49 cases of asbestos (39.2%), 15 isocyanates (12%) and 8 silica (6.4%). CONCLUSIONS: The most frequent pathology was bronchial asthma, followed by benign pleural disease. The most reported job was painting and varnishing and secondly spinning asbestos yarn. Asbestos was the first substance involved and the second was isocyanates. Most of the patients were males and non-smokers. The Pneumology Service of the Virgen del Camino Hospital reported most of the cases. Ratio contrast analysis showed a certain tendency towards a statistical significance in rhinitis, occupational asthma and amianthinopsy.

Enfermedades pleurales benignas inducidas por asbesto / Benign pleural diseases induced by asbestos

La exposición al asbesto es una causa importantede patología pleural y se puede producir con intensidadesmoderadas o ligeras dada la capacidad delasbesto de concentrarse en la pleura. Ello motiva juntoa la prolongada latencia existente entre la exposición yla enfermedad, que sigamos viendo durante muchosaños manifestaciones clínicas pleurales de exposiciónprevia, a pesar del uso del asbesto cada vez más limitadoen las últimas décadas. Dicha exposición puedepresentarse con distintas manifestaciones tanto malignascomo el mesotelioma como benignas, siendo lasprincipales de éstas el derrame pleural benigno, lasplacas pleurales, la fibrosis pleural difusa y la atelectasiaredonda

Exposure to asbestos is an important cause ofpleural pathology and can be produced with light ormoderate tendencies given the capacity of asbestos toconcentrate in the pleura. Together with the prolongedlatency existing between exposure and the disease,this means that for many years we will continue to seepleural clinical manifestations from past exposure, inspite of the increasingly limited use of asbestos inrecent decades. This exposure can show itself indifferent manifestations, both malign, such asmesothelioma, and benign, principally benign pleuraleffusion, pleural plaques, diffuse pleural fibrosis andmassive atelectasis

Enfermedades relacionadas con los edificios / Building related ilness

Tras los cambios realizados en los últimos años enlos edificios modernos como sistemas de ventilaciónforzada, ordenadores, etc., se han descrito una serie deenfermedades relacionadas con ello. El presente trabajose centra en el síndrome del edificio enfermo, queconstituye un grupo de síntomas que lo padecen habitualmentetrabajadores de un mismo edificio “enfermo”y relacionado con su ambiente interior, ya quecomienza la clínica a las horas de entrar en el edificio ymejora a los minutos de alejarse de dicho ambiente. Elorigen probablemente sea multifactorial causado porcontaminantes volátiles del aire interior del edificio,sistema de ventilación, factores relacionados con laorganización del trabajo e incluso dependientes delhuésped. Dado que no existe una única causa se enumeranlos factores de riesgo para desarrollar dicho síndromeasí como los pasos para llegar a su diagnósticoy medidas útiles para evitarlo

Following the changes carried out in recent yearsin buildings, such as ventilation systems, computers,etc., a series of diseases, that are related to this, havebeen described. This paper concentrates on thesyndrome of the sick building, which is formed by agroup of symptoms normally suffered by workers inthe same “sick” building. This syndrome is related toits interior ambience, since the clinical manifestationsappear some hours after entering the building andimproves a few minutes after leaving this ambience.The origin is probably multifactorial: volatile airbornepollutants, the ventilation system, factors related towork organisation, or even dependent on the host.Since there is no single cause, we enumerate the riskfactors in developing this syndrome as well as thesteps for reaching a diagnosis and useful measures forpreventing the sick building

Registro de enfermedades respiratorias de origen laboral en Navarra / Registry of occupational respiratory diseases in Navarre

Fundamento. Con objeto de analizar la incidenciay características de la patología respiratoria ocupacionalen Navarra, se implantó en enero de 2002 el Registrode Enfermedades Respiratorias de Origen Laboral.Métodos. Los casos notificados por los médicoscolaboradores durante los años 2002, 2003 y 2004, seintrodujeron en una base de datos diseñada para suanálisis posterior, que constaba de distintas variables:sexo, edad, tabaco, servicio y médico declarante, diagnóstico,profesión y agente causal.Resultados. Se notificaron 125 casos. 97 varones(77,6%) y 28 mujeres (22,4%). La media de edad fue 55,4años. Ochenta y ocho pacientes no fumaban (70,4%) y37 eran fumadores (29,6%). Neumología declaró 84casos (67,2%) y Alergología 41 (32,8%). Los diagnósticosfueron: 50 casos de asma bronquial (40%), 31 deenfermedad pleural benigna (24,8%), 8 alveolitis alérgicaextrínseca (6,4%), 8 mesotelioma (6,4%), 7 cáncerbroncopulmonar (5,6%), 5 inhalaciones agudas (4%), 3asbestosis (2,4%), 2 rinitis (1,6%), 1 RADS (0,8%) y 1EPOC (0,8%). Las profesiones más declaradas: 13 pintura/barnizado (10,4%), 12 hilado de ovillos de amianto(9,6%) y 8 panadería/pastelería (6,4%). Como agentescausales principales: 49 casos de asbesto (39,2%),15 isocianatos (12%) y 8 sílice (6,4%).Conclusiones. La patología más frecuente fue elasma bronquial, seguida de la enfermedad pleuralbenigna. La profesión más notificada era pintura/barnizadoy en segundo lugar hilado de ovillos. El asbestofue la primera sustancia implicada seguida de los isocianatos.La mayoría de pacientes eran varones y nofumadores. El Servicio de Neumología del Hospital Virgendel Camino notificó el mayor número de casos. Elanálisis de contraste de proporciones mostró ciertatendencia a la significación en rinitis, asma bronquial yasbestosis

Background. In January 2002 an occupationalrespiratory diseases record was established in Navarreso that the number and characteristics of theoccupational respiratory pathology could be analysed.Methods. The cases reported by doctors whocollaborated in 2002, 2003 and 2004, were entered in adatabase for subsequently analysis. This database hasseveral variables: gender, age, tobacco habit, hospitaldepartment and notifying doctor, diagnosis, job andcausal agent.Results. 125 cases were reported. 97 males (77.6%)and 28 females (22.4%). Average age was 55,4 years old.Eighty-eight were non-smokers (70.4%) and 37 weresmokers (29.6%). Pneumology reported 84 cases(67.2%) and Allergology 41 (32.8%). The diagnoseswere: 50 bronchial asthma (40%), 31 benign pleuraldisease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8mesothelioma (6.4%), 7 bronchopulmonary cancer(5.6%), 5 acute inhalations (4%), 3 amianthinopsy(2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD(0.8%). The most reported jobs were: 13 painting andvarnishing (10.4%), 12 spinning asbestos yarn (9.6%)and 8 bakery and confectionery (6.4%). The maincausal agents were: 49 cases of asbestos (39.2%), 15isocyanates (12%) and 8 silica (6.4%).Conclusions. The most frequent pathology wasbronchial asthma, followed by benign pleural disease.The most reported job was painting and varnishing andsecondly spinning asbestos yarn. Asbestos was thefirst substance involved and the second wasisocyanates. Most of the patients were males and nonsmokers.The Pneumology Service of the Virgen delCamino Hospital reported most of the cases. Ratiocontrast analysis showed a certain tendency towards astatistical significance in rhinitis, occupational asthmaand amianthinopsy

[Respiratory emergencies]. / Urgencias respiratorias.

Respiratory emergencies in a patient with cancer can have their origin in pathologies of the airway, of the pulmonary parenchyma or the large vessels. The cause can be the tumour itself or concomitant complications. Obstruction of the airway should be initially evaluated with endoscopic procedures. Surgery is rarely possible in serious situations. The endobronchial placement of stents or radioactive isotopes (brachytherapy), tumoural ablation by laser or photodynamic therapy can quickly alleviate the symptoms and re-establish the air flow. Treatment of haemoptysis depends on the cause that is provoking it and on its quantity. Bronchoscopy continues to be the front line procedure in the majority of cases; it provides diagnostic information and can interrupt bleeding through washes with ice-cold serum, endobronchial plugging or topical injections of adrenaline or thrombin. External radiotherapy continues to be an extraordinarily useful procedure in treating haemoptysis caused by tumours and in carefully selected situations of endobronchial therapy with laser or brachytherapy, and bronchial arterial embolisation can provide a great palliative effect. Respiratory emergencies due to pulmonary parenchyma disease in the oncology patient can have a tumoural, iatrogenic or infectious cause. Early recognition of each of these will determine the administration of a specific treatment and the possibilities of success.

Urgencias respiratorias / Respiratory emergencies

Las urgencias respiratorias en un paciente con cáncer pueden tener su origen en patologías de la vía aérea, del parénquima pulmonar o de los grandes vasos. La causa puede ser el propio tumor o complicaciones concomitantes. La obstrucción de la vía aérea debería ser inicialmente evaluada con procedimientos endoscópicos. En situaciones severas, la cirugía raramente es posible. El emplazamiento endobronquial de stents e isótopos radiactivos (braquiterapia), la ablación tumoral por láser o la terapia fotodinámica, pueden aliviar de forma rápida los síntomas y reestablecer el flujo aéreo. El manejo de la hemoptisis depende de la causa que la provoque y de la cuantía de la misma. La broncoscopia sigue siendo el procedimiento de primera línea en la mayor parte de los casos; aporta información diagnóstica y puede interrumpir el sangrado mediante lavados con suero helado, taponamiento endobronquial o inyecciones tópicas de adrenalina o trombina. La radioterapia externa sigue siendo un procedimiento extraordinariamente útil para tratar la hemoptisis de causa tumoral y en situaciones bien seleccionadas la terapia endobronquial con láser o braquiterapia y la embolización arterial bronquial pueden proporcionar un gran rendimiento paliativo. Las urgencias respiratorias por enfermedad del parénquima pulmonar en un paciente oncológico, pueden tener causa tumoral, iatrogénica o infecciosa. El reconocimiento precoz de cada una de ellas determina la administración del tratamiento específico y las posibilidades de éxito (AU)

Respiratory emergencies in a patient with cancer can have their origin in pathologies of the airway, of the pulmonary parenchyma or the large vessels. The cause can be the tumour itself or concomitant complications. Obstruction of the airway should be initially evaluated with endoscopic procedures. Surgery is rarely possible in serious situations. The endobronchial placement of stents or radioactive isotopes (brachytherapy), tumoural ablation by laser or photodynamic therapy can quickly alleviate the symptoms and re-establish the air flow. Treatment of haemoptysis depends on the cause that is provoking it and on its quantity. Bronchoscopy continues to be the front line procedure in the majority of cases; it provides diagnostic information and can interrupt bleeding through washes with ice-cold serum, endobronchial plugging or topical injections of adrenaline or thrombin. External radiotherapy continues to be an extraordinarily useful procedure in treating haemoptysis caused by tumours and in carefully selected situations of endobronchial therapy with laser or brachytherapy, and bronchial arterial embolisation can provide a great palliative effect. Respiratory emergencies due to pulmonary parenchyma disease in the oncology patient can have a tumoural, iatrogenic or infectious cause. Early recognition of each of these will determine the administration of a specific treatment and the possibilities of success (AU)

Situación en Navarra del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño / Diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome: the situation in Navarra (Spain)

OBJETIVO: Evaluar la situación del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño (SAHS) y conocer algunas características de los pacientes tratados con presión nasal positiva continua en la vía aérea (n-CPAP) en nuestra comunidad. METODOLOGÍA: Se incluyó en el estudio a todos los pacientes que en julio de 2000 recibían tratamiento con n-CPAP a cargo del Servicio Navarro de Salud. Una enfermera realizó una visita a cada paciente en la que rellenaba un formulario con datos epidemiológicos, antropométricos y clínicos; posteriormente llevaba a cabo las siguientes exploraciones: medición del CO en el aire espirado, determinación de la presión de n-CPAP utilizada y lectura del contador horario de la n-CPAP.Entre uno y 2 meses después, y sin previo aviso, se ponía de nuevo en contacto con el usuario y se procedía a una segunda visita en la que realizaba una segunda determinación de CO en el aire espirado y nueva lectura del contador. RESULTADOS: La tasa de prevalencia de tratamientos con n-CPAP en nuestra comunidad fue de 125 por 100.000 habitantes, y se comprobó un progresivo incremento de las prescripciones anuales. Se visitó en el domicilio a 535 pacientes (el 80,7 per cent del total). El 83,5 per cent de las indicaciones fueron realizadas por neumólogos; la media de horas/día reales de utilización de n-CPAP fue de 6,1 y existió una correlación estadísticamente significativa entre las horas de uso de n-CPAP declaradas y las reales; el índice de apneas-hipopneas (IAH) medio fue de 51,5 y este índice no se determinó en el 4,2 per cent de los casos. Un 83,7 per cent de los pacientes declaraban tener una tolerancia del tratamiento muy buena o buena y el 24,8 per cent llevaba más de 4 años con esta terapia. La enfermedad asociada con el SAHS más frecuente fue la obesidad, presente en el 73,4 per cent de las personas, seguida de la hipertensión arterial en el 40 per cent; 299 enfermos (55,8 per cent) padecían dos o más enfermedades asociadas y 54 (9,7 per cent) no tenían ninguna. El 45,9 per cent de los casos disponía de polisomnografía convencional como método diagnóstico y un 49,7 per cent de poligrafía respiratoria; en el 19,4 per cent la nivelación de la presión se realizó con polisomnografía y el 32,1 per cent no disponía de ningún estudio para este fin. Un 50,8 per cent de las personas referían presentar algún efecto secundario al tratamiento. CONCLUSIONES: Elevada tasa de prevalencia de tratamientos con n-CPAP en Navarra y progresivo incremento de prescripciones. Buena tolerancia y cumplimiento de la terapia por parte de los pacientes. Disponibilidad en la mayoría de los casos de polisomnografía o poligrafía respiratoria como métodos diagnósticos de SAHS y alto porcentaje de titulaciones de n-CPAP sin haberse realizado los estudios recomendados (AU)

[Diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome: the situation in Navarra (Spain)]. / Situación en Navarra del diagnóstico y tratamiento en el síndrome de apneas-hipopneas obstructivas durante el sueño.

OBJECTIVE: To assess the diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in Navarra (Spain) and to know the characteristics of patients treated with nasal continuous positive airway pressure (n-CPAP) in our community. METHOD: All patients receiving nasal n-CPAP from the public health service of Navarra in July 2000 were enrolled. A nurse visited each patient and filled in a form with epidemiological data, and patient and clinical characteristics. The nurse then measured CO in expired air and the n-CPAP pressure used and recorded the hour counter reading on the n-CPAP device. Between one and two months later and without prior warning, the patient was once again contacted and a second visit was made. The counter was read again and expired CO was measured. RESULTS: The prevalence of treatment with n-CPAP in Navarra was 125/100,000 inhabitants, and a gradual increase in annual prescriptions was observed. Home visits were made to 535 patients (80.7% of the total). Pneumologists wrote 83.5% of the prescriptions. n-CPAP was used a mean 6.1 hours/day, and the numbers of declared and real hours of use were statistically correlated. The mean apnea-hypopnea index was 51.5, although results were not available for 4.2% of the patients. The treatment was well tolerated according to 83.7% of the patients and 24.8% had been following it for over four years. The pathology most often associated with OSAHS was obesity (73.4% of the patients), followed by high blood pressure (40%); 299 patients (55.8%) had two or more associated diseases and 54 (9.7%) had none. Conventional polysomnography was the diagnostic method used in 45.9% of the cases, and respiratory polygraphs were available for 49.7%. Pressure was adjusted with the aid of polysomnography for 19.4% patients, whereas 32.1% had undergone no testing. Side effects of treatment were reported by 50.8%. CONCLUSIONS: a) The prevalence of n-CPAP treatment in Navarra is high and prescriptions are increasing; b) patient tolerance of and compliance with therapy are good, c) polysomnographs or respiratory polygraphs are available for diagnosis of OSAHS in most cases but the n-CPAP pressure level is adjusted without the recommended studies for many patients.

Study of the interaction of cadmium with membrane-bound succinate dehydrogenase.

Cadmium ions inhibit membrane-bound succinate dehydrogenase with a second-order rate constant of 10.42 mM-1 s-1 at pH 7.35 and 25 degrees C. Succinate and malonate protect the enzyme against cadmium ion inhibition. The protection pattern exerted by succinate and malonate suggests that the group modified by cadmium is located at the active site. The pH curve of inactivation by Cd2+ indicates the involvement of an amino acid residue with pKa of 7.23.

Electron paramagnetic resonance of the mitochondrial respiratory chain in the presence of phenazine methosulfate.

The EPR spectra of phenazine methosulfate (PMS) generated under different conditions, as reduction or excitation with light were studied. In addition, results show the EPR spectra of reduced-submitochondrial particles and reduced-submitochondrial particles in the presence of PMS. Combined systems of this last type have been repeatedly utilized in EPR studies. This work proves that such systems give rise to characteristic signals around g = 2, which behaviour reflects the presence of particular prosthetic groups of the respiratory chain combined with the reduced dye. The consequences of these findings are discussed.