Impact of the 2005 and 2010 Spanish smoking laws on hospital admissions for tobacco-related diseases in Valencia, Spain.

OBJECTIVES: This study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. STUDY DESIGN: A retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995-2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. METHODS: General population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic Data Set. Diagnoses were codified according to the International Classification of Diseases-9th revision. Data from all hospitals of the Valencian Community from 1995 to 2013 were analysed. Trend analyses in the periods before and after the approval of the 2005 law were conducted using least-squares linear regression models. RESULTS: Adjusted hospital admission rates per 100,000 inhabitants for cardiovascular diseases significantly decreased after the 2005 Law (from 550.0/100,000 in 2005 to 500.5/100,000 in 2007), with a further decrease (to 434.6/100,000) in 2013, after the 2010 Law. Reductions in hospital admissions were seen in men and women, although declining trends were more marked in men. Hospital admission rates for respiratory diseases showed a reduction of a lower magnitude, whereas for smoking-related cancer admissions there was a slight decline only among men. CONCLUSIONS: The Spanish comprehensive smoking ban resulted in a remarkable reduction of the adjusted rate of hospital admissions mainly associated to cardiovascular diseases. The decrease in the number of persons requiring in-patient care is relevant and may be viewed as an improvement of the public's health.

Neumonía familiar grave con aislamiento de Streptococcus pneumoniae / No disponible

Introducción: Presentamos una agregación intrafamiliar de neumonía grave, con aislamiento de Streptococcus pneumoniae en la esposa. Caso 1: Hombre de 54 años, ingresa el 27 de julio por dolor torácico y fiebre. Radiografía de tórax consolidación LID. Microbiología: antígenos urinarios negativos. Hemocultivos y cultivo de esputo negativos. A las pocas horas es trasladado a Cuidados Intensivos por shock séptico. Se instauró levofloxacino y ceftriaxona. Fiebre persistente, que mejoró tras la administración de vancomicina. Evolución favorable. Caso 2: Mujer de 50 años, esposa del caso 1, consulta el 31 de julio por fiebre y tos. Rx tórax condensación alveolar basal bilateral, pequeño derrame pleural derecho. Microbiología: antígeno neumococo en orina positivo, Streptococcus pneumoniae serotipo 1 en los hemocultivos. Toracocentesis exudado pleural con pH 7,46, cultivo negativo. Presentó hipotensión, oliguria, sepsis grave, e ingreso en UCI el mismo día del ingreso. Inicialmente se trata con ceftriaxona y azitromicina. Por persistencia de la fiebre, posteriormente con levofloxacino y vancomicina, con recuperación. Conclusiones: Presentamos un brote familiar de neumonía grave con aislamiento de neumococo serotipo 1

Introduction: We present a case of family aggregation of severe pneumonia with Streptococcus pneumoniae isolation in wife. Case 1: A 54 year old man was admited on July 27 for chest pain and fever. The chest radiograph LID consolidation. Microbiology: Streptococcus pneumoniae urinary antigens and Legionella pneumophila serogroup 1: negative. Negative blood cultures and sputum culture. A few hours later he was transferred to intensive care from septic shock. It was established antibiotic therapy with levofloxacin and ceftriaxone. He had persistent fever despite antibiotic, which improved after administration of vancomycin. Favorable clinical evolution. Case 2: 50 year old woman, wife of case 1, consulting on July 31 with fever and cough. The Rx chest bilateral basal alveolar condensation, small right pleural effusion. Microbiology: positive urine pneumococcus antigen, was isolated Streptococcus pneumoniae serotype 1 in blood cultures. Thoracentesis pleural exudate with pH 7.46, negative culture. He presented hypotension, oliguria, severe sepsis, and ICU admission the day of admission. Initially it treated with ceftriaxone and azithromycin. By persistent fever, later with levofloxacin and vancomycin, with recovery. Conclusions: We present a family outbreak of severe pneumonia with pneumococcal serotype 1 isolation

Empiema pleural por Actinomyces meyeri. Un nuevo caso / No disponible

Varón de 23 años que ingresa por presentar dolor costal izquierdo de dos semanas de evolución, tos y sudoración nocturna. Entre los antecedentes, fumador de 15 cigarrillos al día, consumo esporádico de alcohol, deportista aficionado al boxeo y traumatismo craneoencefálico 6 años antes por accidente doméstico. En la exploración física, temperatura 39°C. En el análisis de sangre, leucocitos 21.890/μL, neutrófilos 90%, proteína C reactiva 246,8 mg/L. La radiografía de tórax presentaba un pequeño derrame pleural izquierdo. En la toracocentesis, líquido pleural amarillento, exudado de predominio polinuclear (neutrófilos 93%), ADA 93 U/L, glucosa 1 mg/dL, pH 6,8. La citología resultó negativa y en el cultivo bacteriológico del líquido pleural se aisló Actinomyces meyeri. Al día siguiente a la hospitalización presentó empeoramiento del derrame pleural, con empiema masivo tabicado. Se indicó tratamiento antibiótico con amoxicilina/ácido clavulánico (intravenoso 14 días y oral 30 días), drenaje torácico y uroquinasa intrapleural, con recuperación completa

A 23 year old male was admitted to hospital two weeks left to submit evolution, coughing and night sweats rib pain. The background, smoking 15 cigarettes a day, occasional consumption of alcohol, boxing fan and athlete head injury six years ago by domestic accident. On physical examination, temperature 39°C. In the blood, leukocytes 21,890/PL, 90% neutrophils, CRP 246.8 mg/L. Chest radiography showed a small left pleural effusion. In thoracentesis, pleural fluid yellowish exudate polynuclear predominance (93% neutrophils), ADA 93 U/L, glucose 1 mg/dL, pH 6.8. The cytology negative bacterial culture and pleural fluid Actinomyces meyeri was isolated. The day after hospitalization presented worsening pleural effusion, with partitioning massive empyema. Antibiotic treatment was indicated with amoxicillin/clavulanate acid (intravenous 14 days and oral 30 days), thoracic drainage and intrapleural urokinase, with complete recovery

Neumonía por citomegalovirus en un adulto inmunocompetente / No disponible

No disponible

Neumonitis linfocitaria en la colitis ulcerosa. Presentación de un caso y revisión de la literatura / No disponible

La colitis ulcerosa (CU) afecta sobre todo al tubo digestivo distal, aunque debe ser considerada un trastorno sistémico, ya que puede presentar síntomas extraintestinales que tienen un impacto importante en la morbi-mortalidad de los pacientes. Las complicaciones pulmonares pueden comprometer el parénquima pulmonar, el árbol bronquial y la pleura. La prevalencia y etiología de estas lesiones son desconocidas, no siempre se asocian a la actividad de la enfermedad. Pueden presentarse de forma sintomática o asintomática. Los casos publicados sobre afectación pulmonar en la CU son excepcionales, por lo que presentamos el caso de un varón con diagnóstico de colitis ulcerosa que desarrolló un cuadro de neumonitis linfocitaria, con clínica de fiebre, tos y expectoración, e infiltrados pulmonares bilaterales en la radiografía y en la TAC de tórax. El lavado broncoalveolar presentaba predominio de linfocitos. La biopsia transbronquial descartó la NOC. Se descartó la toxicidad por fármacos. Se prescribe corticoide con evolución favorable

Ulcerative colitis (UC) affects mainly the digestive tract distal, although it should be considered a systemic disorder and extraintestinal symptoms may have a major impact on morbidity and mortality of patients. Pulmonary complications may compromise the lung parenchyma, the bronchial tree and pleura. Prevalence and etiology of these lesions is unknown, is not always associated with disease activity. There may be symptomatic or asymptomatic form. The reported cases of pulmonary involvement in UC are exceptional, so we present the case of a man diagnosed with ulcerative colitis who developed lymphocytic pneumonitis with clinical signs of fever, cough and expectoration. The chest radiograph and TAC showed alveolar infiltrates bilateral. Bronchoalveolar lavage showed lymphocyte predominance. Transbronchial biopsy ruled out the NOC. Was discarded drug toxicity. Corticosteroid is prescribed with favorable evolution

Síndrome de las uñas amarillas. Presentación de un caso y revisión de la literatura / No disponible

El síndrome de uñas amarillas es una enfermedad muy poco frecuente, con alrededor de 200 casos comunicados hasta la actualidad, que se caracteriza por la presencia de dos o más de las siguientes manifestaciones: uñas amarillas, afectación pulmonar y afectación linfática con linfedema. Es una entidad poco conocida y, por lo tanto, poco diagnosticada. Por su rareza, presentamos un nuevo caso de síndrome de las uñas amarillas en un varón de 56 años de edad con bronquiectasias infectadas y mielopatía cervical (AU)

The yellow nail syndrome is a very rare disease, with about 200 cases repoted to date, which is characterized by the presence of two or more of the following manifestations: yellow nails, lung involvement and lymphatic involvement with lymphedema. It is a barely known and therefore not diagnosed. We present a new case of yellow nail syndrome in a 56 year old man with infected bronchiestasis and cervical myelopaty (AU)

Agenesia de la arteria pulmonar / No disponible

No disponible

Silicoproteinosis pulmonar. Un caso con supervivencia prolongada / Pulmonary silicoproteinosis. A case of prolonged survival

La silicoproteinosis pulmonar es una forma muy rara de la silicosis, que puede desarrollarse con un período de latencia entre pocos meses y 5 años de la primera exposición a sílice y cursa, invariablemente, con un rápido deterioro de la función pulmonar, sin respuesta eficaz a tratamiento alguno. Por su rareza y por su excepcional evolución, comunicamos el caso de una mujer de 55 años, diagnosticada en nuestro hospital de silicoproteinosis, que mejoró al retirar la exposición laboral al polvo de sílice y que permanece estable, sin empeoramiento radiológico ni de la función pulmonar 4 años después del diagnóstico de la enfermedad. En nuestro conocimiento, se trata del primer caso de silicoproteinosis que cursa con una buena evolución(AU)

Alveolar silicoproteinosis is a very rare form of silicosis that can develop after a latency period of between a few months and 5 years after the first exposure to silica, and courses invariably, with rapid deterioration of lung function, without an effective response to treatment. Because of its rarity and its unique outcome, the case is presented of a 55 year old woman, diagnosed with alveolar silicoproteinosis in our hospital, who improved by removing the occupational exposure to silica dust and remains stable with no radiological or lung function worsening four years after diagnosis of the disease. To our knowledge, this is the first case of alveolar silicoproteinosis that had a good outcome(AU)

[Pulmonary silicoproteinosis. A case of prolonged survival]. / Silicoproteinosis pulmonar. Un caso con supervivencia prolongada

Alveolar silicoproteinosis is a very rare form of silicosis that can develop after a latency period of between a few months and 5 years after the first exposure to silica, and courses invariably, with rapid deterioration of lung function, without an effective response to treatment. Because of its rarity and its unique outcome, the case is presented of a 55 year old woman, diagnosed with alveolar silicoproteinosis in our hospital, who improved by removing the occupational exposure to silica dust and remains stable with no radiological or lung function worsening four years after diagnosis of the disease. To our knowledge, this is the first case of alveolar silicoproteinosis that had a good outcome.

El coste del tabaquismo en tiempos de crisis económica / The cost of the smoking habit in times of economic crisis

No disponible

Asbetosis pulmonar / No disponible

No disponible

Epidemiología del tabaquismo pasivo en España antes de la ley 28/2005, de medidas sanitarias frente al tabaquismo. Resultados de un estudio de base poblacional / Passive smoking epidemiology in Spain before the law 28/2005, on health care measures against

Objetivo: Conocer el porcentaje de personas no fumadoras que están expuestas al humo ambiental de tabaco en España, antes de la Ley28/2005, de medidas sanitarias frente al tabaquismo. Material y Métodos: Encuesta epidemiológica, observacional y transversal (sistema CATI), de una muestra aleatoria de 6.800 personas, representativa de la población española. Mediante muestreo aleatorio, polietápico, utilizando cuotas por grupos de sexo (hombre/mujer), edad (<13 años; 13-40 años; 41-65 años; y > 65 años), hábitat (rural/urbano) y Comunidad Autónoma de residencia. Resultados: El 49,5% de los no fumadores está expuesto al humo ambiental del tabaco (hogar 13,1%, escuela 17,8%, lugar de trabajo 25,8%, lugar de ocio, 37,4%). La tasa de exposición es mayor entre los hombres que entre las mujeres (50,9% vs 42,9%, p<0,0001) y mayor en el grupo de 13 a 40 años de edad (65,6%, p<0,0001). No hay diferencias en cuanto al hábitat ni a la Comunidad Autónoma de residencia.Conclusiones: El tabaquismo pasivo constituye un importantísimo problema sanitario en España, que afecta a la mitad de la población. Este estudio permitirá evaluar el impacto de la Ley 28/2005 mediante la repetición de la investigación y, en su caso, sugerir modificaciones a las autoridades sanitarias (AU)

Objective: To know the percentage of non-smokers who are exposed to environmental tobacco smoke in Spain in regards to the Law 28/2005on health care measures against smoking. Material and Methods: Epidemiological, observational and crosssectional survey (CATI system) of a random sample of 6800 persons, representative of the Spanish population. Random, multistage sampling was used with quotas for groups of gender (man/women), age (<13 years;13-40 years; 41-65 years; and > 65 years), site of residence (rural/urban) and Regional Community of residence. Results: A total of 49.5% of the non-smokers are exposed to environmental tobacco smoke (home 13.1%, school 17.8%, place of work 25.8%, leisure activity site, 37.4%). Rate of exposure is greater among men than among women (50.9% vs 42.9%, p<0.0001) and greater in the 13 to 40 year old age group (65.6%, p<0.0001). There are no differences regarding residential site or the Regional Community of residence. Conclusions: Passive smoking is a very important health care problem in Spain, that affects half of the population. This study will make it possible to evaluate the impact of Law 28/2005 by repeating the investigation and, if appropriate, to suggest modifications to the regulatory health authorities (AU)

[Evaluation of the management of inhalers by the nursing personnel in a reference hospital]. / Valoración del manejo de los inhaladores por el personal de enfermería en un hospital de referencia.

OBJECTIVES: To evaluate the knowledge and skills of nurses on the management of inhaled therapy in different hospitalization wards. MATERIAL AND METHODS: We carried out a cross-sectional study, in which nurses were asked to perform a practical demonstration of the management of a pressurized canister with an inhalation chamber, without previous theoretical instruction about the technique. The inhalation technique was evaluated step by step following the recommendations of the Spanish Society of Pneumologists and Chest Surgeons (SEPAR). RESULTS: We could obtain the participation of 144 of the 177 nurses working in different wards (29 males, 115 females, mean age 42.5 + 7 years). Previous knowledge of the management of inhalers was declared by 85.4%. We found that 70.8% of the nurses did not correctly perform all the steps: 24.5% made only one mistake, while the rest had mistakes in two or more steps. The most common mistakes were: not to perform a slow and deep exhalation before using the inhaler (27.3%), not to hold the breath after the inhalation (24.4%), and not to wait 30 seconds between inhalation manoeuvres (21.5%). When evaluating different wards, we found that 44.4% of the nurses in the Short Stay Unit performed the technique correctly in contrast to 31.3% of the nurses in the Pneumology Ward. CONCLUSIONS: The percentage of mistakes in the inhalation technique by the nursing personnel was high. The health personnel must have an adequate level of training in order to correctly instruct the patient, because the efficacy of inhaled treatment greatly depends on the adequacy of the technique.

Valoración del manejo de los inhaladores por el personal de enfermería en un hospital de referencia / Evaluation of the managemente of inhalers by the nursing personner in a reference hospital

Objetivo: valorar los conocimientos y adiestramiento del personal de enfermería con el paciente respiratorio en el manejo de la terapia inhalada en distintas salas de hospitalización.Material y métodos: se diseñó un estudio prospectivo con 144 enfermos/as mediante una encuesta individual en la que se solicitó a cada unode ellos una demostración práctica del manejo del cartucho presurizado con cámara inhalatoria, sin realizar una instrucción teórica previa sobrela técnica. Se revisó la técnica inhalatoria siguiendo los pasos establecidos en la normativa SEPAR.Resultados: participaron 144 de los 177 enfermeros/as (81,4%) que trabajan en las diferentes salas de hospitalización (29 varones, 115 mujeres,edad media 42,5 + 7 años). El 85,4% (123/144) reconocía tener conocimientos previos del manejo de los inhaladores. Tras la demostración práctica se comprobó que el 70,8% de los enfermeros realizaban incorrectamente algún paso de la maniobra inhalatoria; de ellos el 24,5% cometió un sólo error y el resto dos o más. Los errores más frecuentes fueron: no efectuar una espiración lenta y profunda antes de iniciar la inhalación (27,3%), no aguantar la respiración durante 10 segundos (24,4%), y no esperar 30 segundos antes de iniciar la siguiente inhalación (21,5%). Analizando estos resultados por salas de hospitalización, el 44,4% de la Unidad de Corta Estancia efectuaba correctamente la técnica frente al 31,3% en Neumología. Conclusiones: el porcentaje de errores en la técnica de inhalación es elevado por parte del personal de enfermería. Es importante que el personal sanitario posea un grado de conocimientos adecuado para poder instruir adecuadamente al paciente, ya que de ello depende en gran medida la eficacia del tratamiento

Objectives: To evaluate the knowledge and skills of nurses on the management of inhaled therapy in different hospitalization wards. Material and methods: We carried out a cross-sectional study, in which nurses were asked to perform a practical demonstration of the management of a pressurized canister with an inhalation chamber, without previous theoretical instruction about the technique. The inhalation technique was evaluated step by step following the recommendations of the Spanish Society of Pneumologists and Chest Surgeons (SEPAR). Results: We could obtain the participation of 144 of the 177 nurses working in different wards (29 males, 115 females, mean age 42.5 + 7 years). Previous knowledge of the management of inhalers was declared by 85.4%. We found that 70.8% of the nurses did not correctly perform all the steps: 24.5% made only one mistake, while the rest had mistakes in two or more steps. The most common mistakes were: not to perform a slow and deep exhalation before using the inhaler (27.3%), not to hold the breath after the inhalation (24.4%), and not to wait 30 seconds between inhalation manoeuvres (21.5%). When evaluating different wards, we found that 44.4% of the nurses in the Short Stay Unit performed the technique correctly in contrast to 31.3% of the nurses in the Pneumology Ward. Conclusions: The percentage of mistakes in the inhalation technique by the nursing personnel was high. The health personnel must have an adequate level of training in order to correctly instruct the patient, because the efficacy of inhaled treatment greatly depends on the adequacy of the technique

Candidiasis pulmonar en un paciente no inmunodeprimido / No disponible

No disponible

Exposición al humo ambiental de tabaco en el medio laboral / No disponible

No disponible

El tabaquismo pasivo / Passive smoking

No disponible