Subject(s)
Humans , Female , Middle Aged , Pleural Effusion/complications , Amyloidosis/complications , Heart Failure/complications , DrainageABSTRACT
No disponible
Subject(s)
Humans , Spirometry/methods , Respiratory Tract Diseases/diagnosis , Bronchospirometry/methods , Spirometry/instrumentation , Primary Health Care/methods , Respiratory Function Tests , Reference Values , Reproducibility of ResultsABSTRACT
No disponible
No disponible
Subject(s)
Female , Humans , Male , Pulmonary Disease, Chronic Obstructive/mortality , Pulmonary Disease, Chronic Obstructive/pathology , Patient Care/psychology , Smoking/mortality , Dyspnea/pathology , Cough/pathology , Vaccines/administration & dosage , Societies/legislation & jurisprudence , Nutritional Status/genetics , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/radiotherapy , Patient Care/methods , Smoking/prevention & control , Dyspnea/complications , Cough/prevention & control , Vaccines , Societies/methods , Nutritional Status/physiologyABSTRACT
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)
Subject(s)
Humans , Cyclooxygenase 2/genetics , Sarcoidosis, Pulmonary/genetics , Polymorphism, Genetic , Alleles , Observational Studies as TopicABSTRACT
No disponible
Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/epidemiology , Smoking/adverse effects , Spirometry , Diagnosis, Differential , Severity of Illness Index , Nutritional Status , Lung Transplantation , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Pulmonary Medicine/trends , Health Services/trends , Public Sector/trends , SpainABSTRACT
No disponible
Subject(s)
Humans , Health Systems/organization & administration , Hospitals, Community/organization & administration , Public Sector/trends , Health Care Levels/organization & administration , Respiratory Tract Diseases/epidemiology , Diagnostic Techniques, Respiratory System , Sleep Wake Disorders/epidemiologyABSTRACT
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is one of the diseases that causes more readmissions in our hospitals. The objective of our study was to establish the influence of quality of inpatient care on the risk of early readmission in the acute exacerbation of COPD. DESIGN: case and controls study. SETTING: general acute care hospital. SUBJECTS OF STUDY: random sample of admissions with acute exacerbation of COPD and discharged alive. CASES: patients who were readmitted within 30 days with a related diagnosis. CONTROLS: patients who were not readmitted and finished alive the mentioned period. INTERVENTIONS: audit of clinical charts with evaluation of clinical severity and adherence to explicit criteria of quality of inpatient care in OCFA. Bivariate and multivariate logistic regression (LR) analysis. RESULTS: 45 cases and 45 controls were analyzed. LR model detected the risk of readmission within 1 month was explained by the higher severity of patients (Apache III: OR 1,03) and their principal diagnosis(emphysema: OR 6,9 and bronchiectasias: OR 2,2, respect to chronic bronchitis). The less score of quality of care scale was predictive of the risk of readmission in the subgroup of patients who were readmitted within 1 week (OR 0,9). CONCLUSIONS: Risk of readmission within 1 month in the acute exacerbation of COPD were explained mainly by the clinical characteristics of patients. Otherwise, readmissions within 1 week were related to quality of care, so it could be a valid indicator of quality of inpatient care.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Quality of Health Care , APACHE , Aged , Case-Control Studies , Female , Hospitalization/statistics & numerical data , Humans , Logistic Models , Male , Patient Discharge , Patient Readmission/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , RecurrenceABSTRACT
Fundamento: La enfermedad pulmonar obstructiva crónica (EPOC) es una de las patologías que causa más reingresos en nuestros hospitales. El objetivo de nuestro estudio fue conocer la influencia de la calidad de los cuidados intrahospitalarios sobre el riesgo de reingreso precoz en la exacerbación aguda de la EPOC. Material y métodos: Estudio de casos y controles. Ámbito: hospital general de agudos. Sujetos de estudio: muestra aleatoria de ingresos por exacerbación aguda de la EPOC y alta a domicilio. Casos: pacientes que reingresaron antes de un mes por un diagnóstico relacionado. Controles: pacientes que no reingresaron y seguían con vida en dicho plazo. Instrumentalización: auditoría de historias clínicas con evaluación del grado de severidad clínica y de la adherencia a criterios explícitos de calidad de los cuidados hospitalarios en la EPOC. Análisis estadístico bivariado y regresión logística (RL) multivariante. Resultados: Se analizaron 45 casos y 45 controles. El modelo de RL detectó que el riesgo de reingreso en 1 mes se explicaba por la mayor severidad de los pacientes (Apache III: OR 1,03) y por su diagnóstico principal (enfisema: OR 6,9 y bronquiectasias: OR 2,2, respecto a la bronquitis crónica). La menor puntuación de la escala de calidad asistencial resultó predictiva del riesgo de reingreso en el subgrupo de pacientes que reingresaron en una semana (OR 0,9). Conclusiones: El riesgo de reingreso en un mes en la exacerbación aguda de la EPOC se explicó principalmente por las características clínicas de los pacientes. En cambio, los reingresos en una semana se relacionaron con la calidad de los cuidados aplicados, por lo que pueden ser un indicador válido de calidad de la asistencia intrahospitalaria (AU)
Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the diseases that causes more readmissions in our hospitals. The objective of our study was to establish the influence of quality of inpatient care on the risk of early readmission in the acute exacerbation of COPD. Material and methods: Design: case and controls study. Setting: general acute care hospital. Subjects of study: random sample of admissions with acute exacerbation of COPD and discharged alive. Cases: patients who were readmitted within 30 days with a related diagnosis. Controls: patients who were not readmitted and finished alive the mentioned period. Interventions: audit of clinical charts with evaluation of clinical severity and adherence to explicit criteria of quality of inpatient care in OCFA. Bivariate and multivariate logistic regression (LR) analysis. Results: 45 cases and 45 controls were analyzed. LR model detected the risk of readmission within 1 month was explained by the higher severity of patients (Apache III: OR 1,03) and their principal diagnosis (emphysema: OR 6,9 and bronchiectasias: OR 2,2, respect to chronic bronchitis). The less score of quality of care scale was predictive of the risk of readmission in the subgroup of patients who were readmitted within 1 week (OR 0,9). Conclusions: Risk of readmission within 1 month in the acute exacerbation of COPD were explained mainly by the clinical characteristics of patients. Otherwise, readmissions within 1 week were related to quality of care, so it could be a valid indicator of quality of inpatient care (AU)
Subject(s)
Aged , Male , Female , Humans , Quality of Health Care , Case-Control Studies , Logistic Models , APACHE , Patient Readmission , Patient Discharge , Recurrence , Pulmonary Disease, Chronic Obstructive , HospitalizationABSTRACT
No disponible
Subject(s)
Aged , Humans , Aneurysm, False , Pulmonary Artery , Bronchi , Angiography , Asthma , Biopsy , Cardiac CatheterizationABSTRACT
OBJECTIVE: To analyze the impact of admissions for chronic obstructive pulmonary disease (COPD) in Andalusia during 2000. METHODS: All patients with DRG codes 088 and 541, which would receive ICD-9 codes 491, 492, 493.2, 494 and 496 in the cause of admission field, were extracted from the Minimum Basic Data Set for Andalusia. We compiled descriptive statistics from these data, calculated the cost per day of hospitalization for our own hospital, and then extrapolated to estimate the cost for Andalusia. RESULTS: COPD exacerbations generated 10,386 admissions in 2000, leading to 117,011 days of hospitalization. Eighty-three percent of the patients were men and the mean age was 70 12 years. The average hospital stay was 11 10 days. Huelva was the province with the shortest hospital stay (9 days). Mortality was 6.7%. The minimum expenditure generated was E 27 million, not counting the cost of intensive care unit admissions. CONCLUSIONS: Admissions due to COPD have great impact on the Andalusian health care system. Further studies are needed to evaluate alternatives to hospitalization.
Subject(s)
Pulmonary Disease, Chronic Obstructive/economics , Pulmonary Disease, Chronic Obstructive/epidemiology , Aged , Aged, 80 and over , Analysis of Variance , Costs and Cost Analysis , Data Interpretation, Statistical , Female , Hospitalization/economics , Humans , Length of Stay , Male , Middle Aged , Spain/epidemiology , Time FactorsABSTRACT
OBJETIVO: Analizar el impacto que han tenido los ingresos por enfermedad pulmonar obstructiva crónica (EPOC) en Andalucía durante el año 2000. MÉTODOS: Se seleccionaron del Conjunto Mínimo Básico de Datos de Andalucía 2000 todos los pacientes con el código GRD 088 y aquellos con GRD 541 que tuvieran como causa de ingreso algunos de estos códigos CIE-9: 491, 492, 493.2, 494 y 496. Con estos datos se realizó un estudio descriptivo. Posteriormente, se realizó el cálculo del coste de una estancia en nuestro centro y se extrapoló al resto de Andalucía, calculando el coste mínimo generado. RESULTADOS: Durante el año 2000 hubo 10.386 ingresos por reagudización de EPOC, lo que generó 117.011 estancias. El 83 per cent de los ingresos fueron varones. La edad media fue de 70 ñ 12 años. La estancia media fue de 11 ñ 10 días. La provincia con la estancia menor fue Huelva con 9 días. La mortalidad fue del 6,7 per cent. El gasto sanitario mínimo generado fue de 27 millones de euros (4.500 millones de pesetas), sin contar con las estancias de UCI. CONCLUSIONES: Los ingresos por EPOC generan un gran impacto asistencial y económico en la sanidad andaluza. Son necesarios estudios que valoren otras alternativas al ingreso (AU)
Subject(s)
Middle Aged , Aged , Aged, 80 and over , Male , Female , Humans , Spain , Time Factors , Pulmonary Disease, Chronic Obstructive , Costs and Cost Analysis , Data Interpretation, Statistical , Analysis of Variance , Hospitalization , Length of StayABSTRACT
BACKGROUND: Peak oxygen uptake (peak VO(2)) is a reference parameter in the assessment of functional capacity of patients with chronic heart failure, but the procedure for cardiopulmonary exercise testing with expired gas analysis is complex and expensive, so more simple and available methods are desirable. METHODS: We compared the usefulness of a time-limited walk test, the 6-minute walk test (6-MT), with that of a symptom-limited walk test, the shuttle walk test (SWT), in the evaluation of patients with moderate to severe chronic heart failure. We prospectively studied 46 clinically stable patients in New York Heart Association class II to IV heart failure with left ventricular ejection fraction <40% (aged 53 +/- 10 years, ejection fraction 23% +/- 8%, New York Heart Association functional class 2.8 +/- 0.7). Each patient performed two 6-MT, two SWT and a cardiopulmonary exercise testing within 2 weeks. RESULTS: We found a close correlation between distance walked in SWT and peak VO(2 ) (r = 0.83, P <.001) and a moderate correlation between distance in 6-MT and peak VO(2) (r = 0.69, P <.001). Both walk tests showed to be reproducible after just one practice walk. All patients who walked > 450 m in SWT had a peak VO(2) >14 mL/kg/min. The overall discriminatory accuracy for SWT distance was greater than that for 6-MT distance for predicting a peak VO(2 ) <14 mL/kg/min (area under receiver operator characteristic curves 0.97 and 0.83 respectively, P =.02). Stepwise multivariate regression analysis, including clinical, exercise testing, echocardiographic, radionuclide-angiographic, and rest hemodynamic data, showed that distance walked in SWT was the only independent predictor of peak VO(2) (P <.001) and the strongest predictor of percent achieved of age- and sex-predicted peak VO(2) (%PVO(2)) (P <.001), with only age offering additional information (P =.02). CONCLUSIONS: The SWT shows to be a feasible and safe method to evaluate patients with chronic heart failure that strongly and independently predicts peak VO(2) and %PVO(2.) This symptom-limited walk test seems to be more useful than 6-MT in the assessment of functional capacity in these patients.
Subject(s)
Exercise Test/methods , Heart Failure/physiopathology , Oxygen Consumption , Adult , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , WalkingABSTRACT
To analyze the reproducibility of the shuttle walking test (SWT) in comparison to the six min walking test in patients with chronic obstructive pulmonary disease (COPD). The stress tests were performed by 13 patients diagnosed of COPD with moderate-to-severe air flow obstruction (FEV1 45.85 +/- 18.82% of theoretical values). Each patient performed the SWT six times (twice a week over three consecutive weeks). The 6 min walking test was performed an equal number of times. At baseline and at the end of both types of test, heart rate and degree of dyspnea (on a modified version of Borg's scale) were recorded, as well as the level reached and the number of meters walked. No significant differences in distance walked, heart rate or degree of dyspnea were found for the six SWTs performed. The interclass correlation coefficients for the aforementioned parameters were 0.875, 0.879 and 0.896, respectively; the variation coefficient for distance covered ranged between -10.7% and 10.2%. In the six min walking test significant differences were seen between distance walked in the first two tests and the other four tests. The variation co-efficient ranged between 11.4% and 17.5%. The SWT is a reproducible stress test in which the patient must exert progressively greater effort. The low degree of variability observed assures that the level of effort attained is steady and consistent.
Subject(s)
Exercise Test/methods , Lung Diseases, Obstructive/physiopathology , Aged , Analysis of Variance , Forced Expiratory Volume , Heart Rate , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
To validate a shuttle walking test in a group of patients with COPD, comparing responses to those produced by a conventional stress test limited by symptoms on the cycle ergometer, and to analyze the relation between the shuttle walking test and maximal effort parameters. We enrolled 20 patients with COPD, mean age 60 years (SD 7), FEV1/46.6% (SD 19.2) of theoretical value and FEV1/FVC% 47.3% (SD 11.2). All the patients underwent a maximal effort test on the cycle ergometer, determination of initial dyspnea by applying Mahler's baseline dyspnea index, and a quality of life questionnaire specific to COPD the Chronic Respiratory Disease Questionnaire). To compare the responses of patients to the two tests, we analyzed heart rate, dyspnea and lactic acid at the end of each test. To see the relations between the two tests, we examined distance walked and maximal effort parameters. The relation between the walking test and lung function parameters at rest, initial dyspnea and quality of life were also analyzed. No statistically significant differences were found for heart rate [128.2 (SD 19.8) versus 131.6 (SD 12.9)], dyspnea 17.1 (SD 1.78) versus 7.24 (SD 2.64)] or lactic acid [5.24 (SD 2.34) versus 6.19 (SD 2.12)] at the end of the tests. Distance covered on the shuttle walking test correlated significantly with V'O2ml/min/Kgmax (r = 0.71), as well as with the remaining parameters of maximal effort. There was only a slight relation between lung function at rest and quality of life. The COPD patient's cardiovascular, metabolic and subjective responses to the shuttle walking test are similar to those of the cycle ergometer test, and oxygen consumption is significantly correlated. The shuttle walking test gives a valid estimate of the functional capacity of COPD patients.
Subject(s)
Exercise Test/methods , Lung Diseases, Obstructive/physiopathology , Humans , Respiratory Function TestsABSTRACT
The objective of this study was to assess ventilatory response to stimulation with CO2 in patients suffering obstructive sleep apnea syndrome (OSAS) but without chronic obstructive pulmonary disease (COPD), by examining differences between hyper- and normocapnic patients and comparing the results obtained with the usual techniques used to stimulate hypercapnia (rebreathing and stable-state). To this end, we studied 15 obese patients, all with an apnea-hypopnea index greater than 10 from a polysomnograph lasting a full night. The following lung function tests were performed: spirometry, air way resistance measures and static lung volumes by plethysmograph and arterial gasometry. We later analyzed ventilatory response by the stable-state method, with increasing CO2 concentrations (from 1 to 9%) and by the rebreathing method. Results from the two methods were similar for all patients: delta VE/delta PCO2 (0.64 +/- 0.35 vs 0.67 +/- 0.48 l/min/mmHg; p = 0.59), delta Vt/delta PCO2 (28.33 +/- 16.23 vs 26.42 +/- 16.94 ml/mmHg; p = 0.9), delta Vt/Ti/delta PCO2 (28.82 +/- 20.9 vs 29.41 +/- 23.78 ml/s/mmHg; p = 0.89) y delta P0.1/delta PCO2 (0.11 +/- 0.07 vs 0.117 +/- 0.05 cmH2O/mmHg; p = 0.58). We compared the results obtained by the two techniques by dividing the sample into two groups of 7 and 8 patients, respectively, depending on whether PaCO2 level before stimulation was higher or lower than 45 mmHg. The hypercapnic patients (group I) were older (61 +/- 3.5 vs 50 +/- 9 years; p = 0.04) but were not different with respect to body mass from the normocapnic patients (group II) (37.59 +/- 6.4 vs 34.56 +/- 4.75 kg/m2; p = 0.33). The results from the two techniques for stimulating hypercapnia were similar within each group, with a statistically significant decrease (p < 0.03) in patients with daytime hypercapnia in delta VE/delta PCO2 delta Vt/delta PCO2, delta Vt/Ti/delta PCO2 and delta P0.1/delta PCO2. We conclude that there are no differences in the results obtained with the rebreathing and stable state techniques. Likewise, ventilatory response to stimulation with CO2 in individuals with OSAS and daytime hypoventilation is less than of normocapnic patients.
Subject(s)
Carbon Dioxide , Hypercapnia/physiopathology , Obesity/physiopathology , Respiration/physiology , Sleep Apnea Syndromes/physiopathology , Female , Humans , Male , Middle AgedABSTRACT
UNLABELLED: Poor correlation among the various methods for measuring anaerobic threshold (AT) has been reported, and some authors have even reported interobserver variability within a single method. It is unknown whether such variability exists in patients with metabolic myopathies (MM). OBJECTIVE: To determine intra- and interobserver variability in the measurement of AT in patients with MM and analyze the differences for each method used. We enrolled 16 patients with differing forms of MM for exercise testing. AT was determined by 4 methods: lactic threshold (LT), semi-log LT, respiratory equivalent and V-slope. AT was assessed by 2 observers, who analyzed plots in random order on 2 different occasions, locating the AT in each plot. The respiratory equivalent method gave the best intraobserver correlation (r' = 0.95; p < 0.05) and was superior to the LT method (r' = 0.68; p < 0.05). Interobserver correlation was equally acceptable for all except the V-slope method (r' = 0.36; p > 0.05). The most important finding after comparison of the methods was the significant difference in VO2 (ml/min) in AT between the LT method and the non invasive methods (LT = 1,006; respiratory equivalent 1,312; p < 0.05; LT = 1,095; V-slope = 1,251; p < 0.05). CONCLUSION: Intra- and interobserver variability is slight in patients with MM; the best method in this respect is that of the V-slope. AT appears later with non invasive methods and for that reason, invasive measurement (LT) is preferable.
