¿Ha influido la pandemia por COVID-19 en el diagnóstico del cáncer de mama? / Has the COVID-19 pandemic influenced the diagnosis of breast cancer?

Introducción: con la situación creada por la pandemia de COVID-19, los hospitales asumieron protocolos que podrían concluir en una demora en el proceso oncológico, sumando a ello, el miedo de las pacientes a acudir a consultas médicas ante determinadas molestias. Métodos: estudio retrospectivo, observacional y analítico realizado en pacientes diagnosticadas de cáncer mamario. Se determinaron 2 cohortes según el periodo pandémico, una previa al auge de la COVID-19, entre enero de 2019 y febrero de 2020, y otra expuesta a la situación de urgencia, entre marzo de 2020 y diciembre de 2021. El objetivo principal fue determinar el estadio tumoral durante la pandemia para comprobar si era más elevado que antes de ello. Resultados: la muestra de estudio contenía 193 casos, con una media de edad de 65,5 años. En la cohorte no expuesta habían 71 casos (36,6%) y en la cohorte expuesta 122 casos (63,4%). Entre ellos un 46,1% presentaban un estadio avanzado de la enfermedad. Un total de 53 casos fueron diagnosticados desde el cribado poblacional, de los cuales 35 fueron estadio precoz. No se encontró relación estadísticamente significativa entre el periodo expuesto a la pandemia y estadio tumoral avanzado. Conclusiones: las medidas implantadas durante la COVID-19 no han llevado a un diagnóstico más tardío de la enfernedad en nuestro hospital. (AU)

Introduction: With the situation created by COVID-19 pandemic, hospitals assumed protocols that could lead to a delay in the oncological process, adding to this, the fear of patients to go to medical consultations due to certain discomforts. Methods: Retrospective, observational and analytical study carried out in patients diagnosed with breast cancer. Two cohorts were determined according to the pandemic period, one prior to the rise of COVID-19, between January 2019 and February 2020, and another exposed to the emergency situation, between March 2020 and December 2021. The main objective was to determine the tumor stage during the pandemic to verify that it was higher than before. Results: The study sample contained 193 cases, with a mean age of 65.5 years. In the unexposed cohort there were 71 cases (36.6%) and in the exposed cohort 122 cases (63.4%). Among them, 46.1% had an advanced stage of the disease. 53 cases were diadnosed from the population screening, of which 35 were early stage. No statistically significant relationship was found between the period exposed to the pandemic and advanced tumor stage. Conclusions: The measures implemented during COVID-19 have not led to a later diagnosis of the disease in our hospital. (AU)

Características clínicas y riesgo de agudizaciones asociados con diferentes criterios diagnósticos del solapamiento asma-EPOC / Clinical Characteristics and Risk of Exacerbations Associated With Different Diagnostic Criteria of Asthma-COPD Overlap

INTRODUCCIÓN: En la actualidad no disponemos de una definición de solapamiento asma-EPOC (ACO) universalmente aceptada. OBJETIVO: Comparar la prevalencia del ACO en pacientes con asma o EPOC, valorar sus características clínicas y la capacidad predictiva de riesgo de agudización de las diferentes definiciones. MÉTODO: Estudio prospectivo observacional con seguimiento de 12 meses sobre una cohorte de asma y otra con EPOC. Se comparan 4 criterios diagnósticos: A) el consenso español del 2012; B) el consenso internacional del 2016; C) el consenso entre la guía española de la EPOC (GesEPOC) y la del asma (GEMA) del 2017; y D) el criterio único de ≥ 300 eosinófilos/μl, propuesto por GOLD 2019. En cada grupo se evaluó el riesgo de agudizaciones. RESULTADOS: Se incluyeron 345 pacientes, 233 (67,5%) con EPOC y 112 (32,5%) con asma, con una edad de 63 ± 14 años; el 70,4% eran hombres. Quince (4,3%) pacientes cumplían criterios de ACO con criterios A; 30 (8,7%) con los B; 118 (34,2%) con los C; y 97 (28,1%) con el criterio D. El subtipo ACO-EPOC presentó más edad, peor función pulmonar y mayor riesgo de agudización que los ACO-asma. De todas las definiciones evaluadas, las que presentaron mayor riesgo de agudizaciones fueron la del consenso GesEPOC-GEMA y la propuesta de GOLD. CONCLUSIONES: La prevalencia de ACO varía enormemente en función del criterio diagnóstico utilizado. La población de ACO es heterogénea, con un subtipo ACO-EPOC muy diferente al ACO-asma. Las definiciones que incluyen la eosinofilia identifican a los ACO de más riesgo de agudización

INTRODUCTION: There is currently no universally accepted definition of asthma-COPD overlap (ACO). OBJECTIVE: To compare the prevalence of ACO in patients with asthma or COPD, and to assess their clinical characteristics and the capacity of the different definitions to predict the risk of exacerbation. METHOD: Prospective observational study with a 12-month follow-up in an asthma cohort and a COPD cohort. Four diagnostic criteria were compared: A) the Spanish 2012 consensus; B) the 2016 international consensus; C) the 2017 consensus between the Spanish COPD guidelines (GesEPOC) and GEMA asthma guidelines; and D) the single criterion of ≥ 300 eosinophils/μL, proposed by GOLD 2019. The risk of exacerbations was evaluated in each group. RESULTS: A total of 345 patients were included, 233 (67.5%) with COPD and 112 (32.5%) with asthma, aged 63 ± 14 years, 70.4% men. Fifteen (4.3%) patients met the criteria for ACO according to the criteria described under A above; 30 (8.7%) with the criteria of B; 118 (34.2%) with the criteria of C; and 97 (28.1%), with the D criterion. The ACO-COPD subtype were older, had worse lung function, and an increased risk of exacerbation compared with the ACO-asthma group. Of all the definitions evaluated, those which distinguished a higher risk of exacerbations were the GesEPOC-GEMA consensus and the GOLD proposal. CONCLUSIONS: The prevalence of ACO varies enormously depending on the diagnostic criteria used. The ACO population is heterogeneous, and the ACO-COPD subtype is very different from the ACO-asthma subtype. The definitions that include eosinophilia identify ACO patients with a greater risk of exacerbation

Clinical Characteristics and Risk of Exacerbations Associated With Different Diagnostic Criteria of Asthma-COPD Overlap. / Características clínicas y riesgo de agudizaciones asociados con diferentes criterios diagnósticos del solapamiento asma-EPOC.

INTRODUCTION: There is currently no universally accepted definition of asthma-COPD overlap (ACO). OBJECTIVE: To compare the prevalence of ACO in patients with asthma or COPD, and to assess their clinical characteristics and the capacity of the different definitions to predict the risk of exacerbation. METHOD: Prospective observational study with a 12-month follow-up in an asthma cohort and a COPD cohort. Four diagnostic criteria were compared: A) the Spanish 2012 consensus; B) the 2016 international consensus; C) the 2017 consensus between the Spanish COPD guidelines (GesEPOC) and GEMA asthma guidelines; and D) the single criterion of ≥300eosinophils/µL, proposed by GOLD 2019. The risk of exacerbations was evaluated in each group. RESULTS: A total of 345 patients were included, 233 (67.5%) with COPD and 112 (32.5%) with asthma, aged 63±14 years, 70.4% men. Fifteen (4.3%) patients met the criteria for ACO according to the criteria described under A above; 30 (8.7%) with the criteria of B; 118 (34.2%) with the criteria of C; and 97 (28.1%), with the D criterion. The ACO-COPD subtype were older, had worse lung function, and an increased risk of exacerbation compared with the ACO-asthma group. Of all the definitions evaluated, those which distinguished a higher risk of exacerbations were the GesEPOC-GEMA consensus and the GOLD proposal. CONCLUSIONS: The prevalence of ACO varies enormously depending on the diagnostic criteria used. The ACO population is heterogeneous, and the ACO-COPD subtype is very different from the ACO-asthma subtype. The definitions that include eosinophilia identify ACO patients with a greater risk of exacerbation.

Comparación de costes y resultados clínicos entre la administración hospitalaria o ambulatoria de omalizumab, en pacientes con asma grave no controlada / Comparison of Costs and Clinical Outcomes Between Hospital and Outpatient Administration of Omalizumab in Patients With Severe Uncontrolled Asthma

Objetivos: Evaluar los resultados clínicos y los costes de 2 estrategias de administración de omalizumab. Método: Se compararon, de forma retrospectiva, 2 cohortes de pacientes con asma grave no controlada: una, procedente del hospital A, en la que el tratamiento se administró en un centro de salud, y otra, procedente del Hospital B, con administración hospitalaria convencional. Resultados: Se estudió a 130 pacientes, 86 en A y 44 en B, 30 hombres (24%) y 100 mujeres (76%), edad 50 ± 15 años, FEV1% 67 ± 22%, índice de masa corporal (IMC) 28 ± 6 kg/m2, IgE 639 ± 747 UI/mL, seguimiento de 24 ± 11 meses (12-45), Asthma Control Test (ACT) 12 ± 4 y Asthma Control Questionnaire (ACQ) 3 ± 2, sin diferencias significativas basales entre ambas cohortes en ingresos hospitalarios ni visitas a urgencias en el año previo, ni en número de pacientes con esteroides orales. Al comparar la situación basal y tras los 12 meses de tratamiento, se observaron diferencias significativas en ACT (p < 0,001), ACQ (p < 0,001) y mejoría en el FEV1% (p < 0,001), reducción en número de ingresos (p < 0,001), días de hospitalización (p < 0,001), visitas a urgencias (p < 0,001), ciclos y dosis de esteroides p < 0,001) respecto al año previo, tanto individualmente como en conjunto. Los costes de hospitalización, visitas a urgencias, visitas no programadas a Primaria y al neumólogo se redujeron significativamente en ambos hospitales, pero los costes de administración y desplazamiento fueron un 35% inferiores con la pauta ambulatoria en A. Conclusión: La administración ambulatoria de omalizumab en los centros de salud consigue los mismos resultados clínicos que una pauta de administración hospitalaria, con menores costes

Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28±6kg/m2, 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P < 0.001), ACQ (P<0.001), improvement in FEV1% (P < 0.001), reduction in total admissions (P < 0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P < 0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A

Comparison of Costs and Clinical Outcomes Between Hospital and Outpatient Administration of Omalizumab in Patients With Severe Uncontrolled Asthma.

OBJECTIVES: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. METHOD: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. RESULTS: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28 ± 6 kg/m(2), 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3 ± 2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<0.001), ACQ (P<0.001), improvement in FEV1% (P<0.001), reduction in total admissions (P<0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P<0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. CONCLUSION: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?

BACKGROUND AND OBJECTIVE: Severity assessment is made at the time of the initial clinical presentation in patients with community-acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP. METHODS: This was a prospective, multicentre study of CAP in Spain. The primary outcomes were the clinical factors associated with POS defined as days from symptoms onset to pneumonia diagnosis >7 days. The secondary outcomes were intensive care unit (ICU) admission, the presence of suppurative complications, septic shock and 30-day mortality. RESULTS: We enrolled 1038 patients diagnosed of CAP: 152 (14.6%) patients had a POS. In multivariate analysis, the presence of prior corticosteroid therapy, alcohol abuse, prior antibiotic therapy, and confusion, urea, respiratory rate, blood pressure and age 65 years or older score 0-1 was independently associated with POS. Patients with POS had a higher incidence of suppurative complications, but not of 30-day mortality when compared with a shorter onset of symptoms. CONCLUSIONS: Approximately 15% of patients diagnosed with CAP had POS. Risk factors associated with POS were previous corticosteroids and antibiotic therapy, alcoholism and less severe pneumonia. POS was associated with a higher rate of suppurative complications and less need for ICU admission.

Manejo de la amiloidosis traqueobronquial mediante técnicas broncoscópicas terapéuticas / Management of Tracheobronchial Amyloidosis With Therapeutic Bronchoscopic Techniques

La amiloidosis es una enfermedad sistémica producida por el depósito anómalo de material amiloide; tiene la peculiaridad de detectarse con la tinción rojo Congo y es de difícil diagnóstico. La afectación del árbol traqueobronquial es muy poco frecuente y constituye un reto para el neumólogo debido al amplio diagnóstico diferencial de esta enfermedad. Se presentan 2 casos en los que se ha objetivado la afectación traqueobronquial: en uno de ellos como enfermedad primaria y en otro como afectación secundaria. El uso de técnicas broncoscópicas es primordial para el diagnóstico de la afectación traqueobronquial. En ausencia de un tratamiento médico eficaz, el manejo local de esta enfermedad con técnicas endoscópicas de repermeabilización bronquial consigue una mejoría clínica y amplía las opciones terapéuticas y pronósticas en esta enfermedad (AU)

Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease (AU)

Management of tracheobronchial amyloidosis with therapeutic bronchoscopic techniques.

Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease.

[Fournier gangrene: presentation of 6 cases with no mortality]. / Gangrena de Fournier: presentación de 6 casos sin mortalidad.

INTRODUCTION: Fournier's gangrene is a serious and potentially lethal rare infection of perineal and external genital that must be treated as a medical and surgical emergency. The aim of this study is to share our experience over the last 10 years in the management of this disease. PATIENTS AND METHOD: We carried out a descriptive and retrospective chart review of patients diagnosed and treated for this pathology in our Hospital over the last 10 years. The patient age, sex, risk factors, urgent laboratory investigations, presenting symptoms, duration of hospital stay, microbiological findings, and number of debridements were recorded. RESULTS: Six patients had this pathology, all males, with a mean age of 58.5 years. Half of them (50%) showed predisposing factors, but none of them showed a clear aetiology. The initial symptomatology was perineal or perianal phlegmon-abscess with a torpid evolution and gangrene. The treatment was intravenous antibiotics and debridement, which was repeated in 4 patients. The most commonly isolated microorganism was Escherichia coli followed by Acinetobacter and Bacteroides. The mean hospital stay was 32 days. There were no deaths recorded in this study. CONCLUSIONS: Fournier's gangrene is a serious disease that occurs in patients with risk factors. Early surgical treatment and broad-spectrum antibiotics are important.

Gangrena de fournier: presentación de 6 casos sin mortalidad / Fournier gangrene: presentation of 6 cases with no mortality

Introducción. La gangrena de Fournier es una infección poco frecuente del periné y los genitales externos grave y potencialmente mortal que debe ser tratada médica y quirúrgicamente de forma precoz. Nuestro objetivo es realizar una revisión de nuestra casuística de los últimos 10 años y de la enfermedad y su tratamiento. Pacientes y método. Realizamos un estudio descriptivo retrospectivo de los pacientes diagnosticados y tratados por esta enfermedad en nuestro hospital durante los últimos 10 años. De ellos recogemos edad, sexo, antecedentes patológicos, analítica de urgencias, cuadro clínico de presentación, estancia hospitalaria, cultivo microbiológico y número de intervenciones quirúrgicas. Resultados. Seis pacientes han presentado esta enfermedad, todos ellos varones, con una media de edad de 58,5 años. El 50% tenía factores de riesgo, pero en ninguno se encontró una etiología clara. La clínica de inicio varía entre flemón-absceso perineal o perianal de evolución tórpida y gangrena. El tratamiento fue antibioterapia intravenosa y desbridamientos, que se repitió en 4 pacientes. El germen aislado más frecuentemente fue Escherichia coli, seguido de Acinetobacter y Bacteroides. La estancia media fue 32 días. No hubo fallecimientos en nuestra serie. Conclusiones. La gangrena de Fournier es una enfermedad infecciosa grave que se presenta generalmente en pacientes con factores de riesgo, por lo que son importantes el tratamiento quirúrgico precoz y la antibioterapia de amplio espectro (AU)

Introduction. Fournier’s gangrene is a serious and potentially lethal rare infection of perineal and external genital that must be treated as a medical and surgical emergency. The aim of this study is to share our experience over the last 10 years in the management of this disease. Patients and method. We carried out a descriptive and retrospective chart review of patients diagnosed and treated for this pathology in our Hospital over the last 10 years. The patient age, sex, risk factors, urgent laboratory investigations, presenting symptoms, duration of hospital stay, microbiological findings, and number of debridements were recorded. Results. Six patients had this pathology, all males, with a mean age of 58.5 years. Half of them (50%) showed predisposing factors, but none of them showed a clear aetiology. The initial symptomatology was perineal or perianal phlegmon-abscess with a torpid evolution and gangrene. The treatment was intravenous antibiotics and debridement, which was repeated in 4 patients. The most commonly isolated microorganism was Escherichia coli followed by Acinetobacter and Bacteroides. The mean hospital stay was 32 days. There were no deaths recorded in this study. Conclusions. Fournier’s gangrene is a serious disease that occurs in patients with risk factors. Early surgical treatment and broad-spectrum antibiotics are important (AU)

El toro: el gran peligro de las fiestas de verano / The bull: the great danger of summer festivals

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