[Sarcopenia index in hospitalized patients with chronic obstructive pulmonary disease exacerbation]. / Índice de sarcopenia en pacientes hospitalizados por agudización de la enfermedad pulmonar obstructiva crónica.

Sarcopenia (loss of muscle mass and function) implies a worse prognosis. However, its diagnosis is complex and is not made in routine clinical care. A biomarker has been proposed as a surrogate estimator of skeletal muscle mass, the so-called sarcopenia index ([serum creatinine/cystatine C] x100) which is associated with prognostic features in various diseases including patients with stable chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate the potential clinical and prognostic information of this biomarker in COPD exacerbation. This is a one-year prospective study of consecutive patients admitted for COPD exacerbation. A total of 89 patients, 70 men (79%) and 19 women (21%) were included. Those with lower values of the sarcopenia index had a higher level of dyspnoea and a longer hospitalization. In the correlation analysis, the index had statistically significant values with FEV1 (r = 0.23), PaCO2 (r = -0.30), bicarbonate (r = -0.31), dyspnoea (r = -0.25) and length of admission (r = -0.30). In patients admitted for COPD exacerbation, the sarcopenia index was related to prognostic characteristics, so that lower values were associated with longer duration of hospital admission, more dyspnoea and greater functional impairment. As this is an index associated with muscle mass, its determination may identify patients who could be the subject of a differentiated therapeutic plan.

La presencia de sarcopenia (pérdida de masa y función muscular) implica peor pronóstico. Sin embargo, su diagnóstico es complejo y no se realiza en la atención clínica habitual. Se ha propuesto un biomarcador como estimador subrogado de la masa muscular esquelética, el denominado índice de sarcopenia ([creatinina sérica/cistatina C] x100) que se asocia a características pronósticas en diversas enfermedades incluyendo pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. El objetivo de nuestro estudio ha sido evaluar de forma prospectiva la potencial información clínica y pronóstica de este biomarcador en agudización de la EPOC. Se trata de un estudio prospectivo, durante un año, de los pacientes consecutivos que ingresan por agudización de su EPOC. Se incluyeron 89 pacientes, 70 varones (79%) y 19 mujeres (21%). Aquellos con valores disminuidos del índice de sarcopenia tenían más disnea y requerían una internación más prolongada. En el análisis de correlación se obtuvo valores con significación estadística del índice con FEV1 (r = 0.23), PaCO2 (r = -0.30) y bicarbonato (r = -0.31), y con la disnea (r = -0.25) y la duración del ingreso (r =- 0.30). En los ingresados por agudización de la EPOC el índice de sarcopenia se relacionó con características pronósticas, de modo que los valores inferiores se asociaron a mayor duración de la internación, más disnea y mayor afectación funcional. Al tratarse de un índice asociado a la masa muscular, su determinación podría identificar a pacientes a incluir en un plan terapéutico diferenciado.

Symptoms in patients with asthma infected by SARS-CoV-2.

INTRODUCTION: Organ tropism of SARS-CoV-2 to the respiratory tract could potentially aggravate asthma. The susceptibility of patients with asthma to develop an exacerbation when they are infected with SARS-CoV-2 is unknown. We aimed to investigate the symptoms presented in patients with asthma who became infected with SARS-CoV-2. METHODS AND RESULTS: All patients over 14 years of age who tested positive for SARS-CoV-2 (by RT-PCR) were included (n = 2995). In patients with asthma (n = 77, 2.6%; 44 females), symptoms, therapy and phenotype were recorded. Seventeen (22%) patients had mild asthma, 55 (71%) moderate and five severe (6%). Twenty-six patients with asthma (34%) were asymptomatic, 34 (44%) developed symptoms but did not require hospital admission, and 17 (22%) were hospitalised. One patient was admitted because of asthma exacerbation without pneumonia or other symptoms. Ten patients (13%) had wheezes (six with pneumonia). Comparison of wheezing between patients with non-T2 asthma and the rest of the patients was statistically significant, (p < 0.001). CONCLUSIONS: SARS-CoV-2 infection is not a significant cause of asthma exacerbation, although some patients may present wheezing, especially in cases of pneumonia. The severity of asthma does not seem to be associated with symptoms of the disease.

Índice de sarcopenia en pacientes hospitalizados por agudización de la enfermedad pulmonar obstructiva crónica / Sarcopenia index in hospitalized patients with chronic obstructive pulmonary disease exacerbation

Resumen La presencia de sarcopenia (pérdida de masa y función muscular) implica peor pronóstico. Sin embargo, su diagnóstico es complejo y no se realiza en la atención clínica habitual. Se ha propuesto un biomarcador como estimador subrogado de la masa muscular esquelética, el denominado índice de sarcopenia ([creatinina sérica/cistatina C] x100) que se asocia a características pronósticas en diversas enfermedades incluyendo pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. El objetivo de nuestro estudio ha sido evaluar de forma prospectiva la potencial información clínica y pronóstica de este biomarcador en agudización de la EPOC. Se trata de un estudio prospectivo, durante un año, de los pacientes consecutivos que ingresan por agudización de su EPOC. Se incluyeron 89 pacientes, 70 varones (79%) y 19 mujeres (21%). Aquellos con valores disminuidos del índice de sarcopenia tenían más disnea y requerían una internación más prolongada. En el análisis de correlación se obtuvo valores con significación estadística del índice con FEV1 (r = 0.23), PaCO (r = -0.30) y bicarbonato (r = -0.31), y con la disnea (r = -0.25) y la duración del ingreso (r =0.30). En los ingresados por agudización de la EPOC el índice de sarcopenia se relacionó con características pronósticas, de modo que los valores inferiores se asociaron a mayor duración de la internación, más disnea y mayor afectación funcional. Al tratarse de un índice asociado a la masa muscular, su determinación podría identificar a pacientes a incluir en un plan terapéutico diferenciado.

Abstract Sarcopenia (loss of muscle mass and function) implies a worse prognosis. However, its diagnosis is complex and is not made in routine clinical care. A biomarker has been proposed as a surrogate estimator of skeletal muscle mass, the so-called sarcopenia index ([serum creatinine/cystatine C] x100) which is associated with prognostic features in various diseases including patients with stable chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate the potential clinical and prognostic information of this biomarker in COPD exacerbation. This is a one-year prospective study of consecutive patients admitted for COPD exacerbation. A total of 89 patients, 70 men (79%) and 19 women (21%) were included. Those with lower values of the sarcopenia index had a higher level of dyspnoea and a longer hospitalization. In the correlation analysis, the index had statistically significant values with FEV1 (r = 0.23), PaCO (r = -0.30), bicarbonate (r = -0.31), dyspnoea (r = -0.25) and length of admission (r = -0.30). In patients admitted for COPD exacerbation, the sarcopenia index was related to prognostic characteristics, so that lower values were associated with longer duration of hospital admission, more dyspnoea and greater functional impairment. As this is an index associated with muscle mass, its determination may identify patients who could be the subject of a differentiated therapeutic plan.

Asma y EPOC en pacientes hospitalizados por COVID-19 / Asthma and COPD in Hospitalized COVID-19 Patients

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Platelet-to-Lymphocyte Ratio and Survival in Malignant Pleural Effusion.

BACKGROUND: Efforts have been made to search for parameters that facilitate the prediction of the 3-month survival for clinical decisions in patients with malignant pleural effusion (MPE). We sought to evaluate whether the platelet-to-lymphocyte ratio (PLR) may be a useful marker of 3-month survival in a series of consecutive patients with MPE. METHODS: A total of 81 patients with MPE were included, 46 (57%) of whom were female. Twenty-six patients (32%) died during the first 3 months according to thoracentesis data. RESULTS: The area under the receiver operating characteristics curve was 0.73 for PLR. Using a cutoff point of 158, patients with higher PLR values experienced higher mortality at 3 months (p = 0.001). CONCLUSIONS: PLR was able to successfully differentiate patients with different survival at 3 months. Outcomes of the PLR (a fast and inexpensive test) could be included among the prognostic factors able to guide the personalized management of MPE.

Asthma prevalence in patients with SARS-CoV-2 infection detected by RT-PCR not requiring hospitalization.

INTRODUCTION: The prevalence of asthma in patients hospitalized with SARS-CoV-2 has been studied and varies widely in the different series. However, the prevalence in SARS-infected patients not requiring hospitalization is not known. The objective of this study was to analyze the presence of asthma in a consecutive series of patients who tested positive in the RT-PCR assay for SARS-CoV-2 and did not require hospital admission. METHODS AND RESULTS: A total of 218 patients (58% of those who tested positive) did not require hospitalization; they had a median age of 45 years (IQR 34-57) and 57% were female. Six patients (2.8%) had a previous diagnosis of asthma. Only one patient developed a mild aggravation of asthma symptoms associated with SARS-CoV-2 infection. CONCLUSIONS: Few patients with asthma were infected by SARS-CoV-2, and this infection was not a significant cause of asthma exacerbation.

Prognostic Value of Hematological Inflammatory Markers in Patients with Pleural Effusion Due to Heart Failure.

BACKGROUND: Pleural effusions due to heart failure are associated with a high 1-year mortality. Several hematological parameters have been shown to provide prognostic information in patients with cardiovascular diseases. The objective was to assess whether hematological markers can also provide prognostic information in patients with pleural effusion caused by heart failure. METHODS: This was a retrospective study of patients with pleural effusion due to heart failure who underwent a diagnostic thoracentesis. The hematological parameters evaluated were as follows: neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio, platelet count, platelet-to-lymphocyte ratio, mean platelet volume (MPV), and MPV-to-platelet ratio. Patients were divided into two groups: those who died within 1 year and survivors of more than 1 year. Differences and possible correlations were analyzed with non-parametric tests. Diagnostic values were estimated. Survival analysis was performed using the Kaplan-Meier method. Cox regression analysis was performed to identify independent variables. RESULTS: Twenty five of 55 (45%) patients died within 1-year from thoracentesis. Patients who died in this period were older, aged 83 years (73 - 87, median and interquartile range, IQR) vs. 74 (65 - 82); with lower platelet count: 181 x 103 (140 - 258 x 103) vs. 241 x 103 (198 - 324 x 103); and higher MPV/platelet: 48.1 (34.9 - 75.6) vs. 35.6 (27.1 - 42.9). In the regression analysis only the MPV/platelet had statistical significance (p = 0.002). MPV/platelet > 50 had a specificity of 87% for 1-year mortality, and a ratio > 30 had a sensitivity of 84%. CONCLUSIONS: Simple hematological parameters such as platelet count and MPV/platelet, may provide useful prognostic information for predicting 1-year mortality in patients with pleural effusion due to heart failure.

Manejo domiciliario del catéter pleural tunelizado permanente: a propósito de un caso / Home management of permanent tunneled pleural catheter: a case report

El derrame pleural maligno representa una entidad frecuente en pacientes con enfermedades neoplásicas. Su aparición representa un estadio avanzado de la enfermedad e indica mal pronóstico, y puede conllevar una elevada carga sintomática con el deterioro de la calidad de vida. Aunque su manejo debe individualizarse, en determinados casos, la utilización de catéteres pleurales tunelizados permanentes puede ser una alternativa segura y eficaz para intentar alcanzar un adecuado control de los síntomas. Presentamos el caso de una paciente diagnosticada en nuestro departamento de un mesotelioma pleural maligno con derrame pleural recidivante, a la que se le colocó un catéter pleural tunelizado puesto que los intentos previos de pleurodesis habían fracasado. Describimos el procedimiento, así como el manejo domiciliario. En este caso, se optó por un abordaje integral con apoyo domiciliario de la Unidad de Hospitalización a Domicilio de nuestro hospital. En definitiva, el catéter pleural permanente tunelizado representa una alternativa eficaz y segura en el manejo ambulatorio de los pacientes con derrame pleural maligno recidivante y sintomático. Este sistema permite la extracción de líquido pleural en el domicilio del paciente y alcanzar un mayor control de los síntomas respiratorios y una mayor calidad de vida en este grupo de pacientes

Malignant pleural effusion represents a frequent entity in patients with neoplastic diseases. Its appearance represents an advanced stage of the disease and indicates a poor prognosis and can lead a high symptomatic burden with the deterioration of the quality of life. Although its management must be individualized, in certain cases, the use of permanent tunneled pleural catheters can be a safe and effective alternative to try to reach an adequate control of symptoms. We present the case of a patient diagnosed in our department of a malignant pleural mesothelioma with recurrent pleural effusion, to which a tunneled pleural catheter was placed because previous pleurodesis attempts had failed. We describe the procedure, as well as home management. In this case, we chose a comprehensive approach with home support from the Hospital at Home of our hospital

Ratio de la longitud de los dedos segundo y cuarto (índice digital) en fumadores / Ratio of the length of the second and fourth fingers (digital index) in smokers

INTRODUCCIÓN: La ratio entre la longitud del segundo y cuarto dedos (2D:4D; índice digital) es diferente en mujeres y hombres, y está relacionada con el grado de exposición a andrógenos en el periodo prenatal. Este índice se ha asociado con rasgos de la conducta y diversas enfermedades, incluido el consumo tóxico de alcohol; sin embargo, no se ha estudiado directamente la relación entre este índice y las características de adicción al tabaco. El objetivo ha sido evaluar en fumadores la relación del índice digital con la intensidad del consumo de tabaco, su nivel de adicción y la motivación para dejar de fumar. MATERIAL Y MÉTODOS: Se incluyeron en el estudio 104 voluntarios fumadores, 51 mujeres (49%) y 53 hombres. Se registró el índice digital de ambas manos. Se analizó su diferencia según sexo (prueba U de Mann-Whitney) y su posible asociación con el consumo de tabaco y puntuaciones de los test de dependencia de Fagerström y de motivación de Richmond (coeficiente Rho de Spearman). RESULTADOS: No se observó correlación estadísticamente significativa entre los índices digitales y las variables analizadas, tanto analizando a todos los participantes en conjunto como en el análisis separado por sexo. La única correlación con un valor de p inferior a 0,10 fue la establecida entre el índice digital derecho en hombres y el test de Fagerström (rho=0,231; p =0,09). CONCLUSIONES: No hay una correlación entre el índice digital 2D:4D (reflejo de la exposición androgénica fetal) y las características del consumo del tabaco

INTRODUCTION: The length of the second and fourth finger ratio (2D:4D; digital index) is different in women and men, and is related to the degree of exposure to androgens in the prenatal period. This index has been associated with behavioural traits and various diseases including toxic alcohol consumption; however, the relationship between this index and tobacco addiction characteristics has not been studied directly. The objective has been to evaluate in smokers the relationship of the digital index with the intensity of tobacco consumption, their level of addiction and the motivation to stop smoking. MATERIAL AND METHODS: A total of 104 volunteer smokers, 51 women (49%) and 53 men were included in the study. The digital index of both hands was recorded. The difference was analysed according to sex (Mann-Whitney U test) and its possible association with tobacco consumption, Fagerström dependence and Richmond motivation test scores (Spearman Rho coefficient). RESULTS: No statistically significant correlation was observed between the digital indices and the variables analysed, both analysing all participants together and, in the sex, -segregated analysis. The only correlation with a p value of less than 0.10 was the one established between the right digital index in men and the Fagerström test (rho=0.231; p = 0.09). CONCLUSIONS: There is no correlation between the 2D:4D digital index (reflection of foetal androgen exposure) and the characteristics of tobacco use

Neumonia lipoidea: causa infrecuente de infiltrados pulmonares / Lipoid pneumonia: an infrequent cause of pulmonary infiltrates

La presencia de infiltrados pulmonares es un hallazgo frecuente que incluye un amplio diagnóstico diferencial basado en muchas ocasiones en la historia clínica. Entre ellas, la neumonía lipoidea exógena representa una entidad poco frecuente y es preciso un elevado índice de sospecha para alcanzar su diagnóstico y evitar su progresión. En estos casos, un contexto clínico adecuado y una TC con opacidades y áreas de baja densidad pueden ser altamente sugestivos de la enfermedad. Se presenta un caso de neumonía lipoidea exógena secundaria a la utilización continuada de sustancias oleosas intranasal, que debido a los antecedentes del paciente y a las posibilidades diagnósticas tras los hallazgos de la TC, precisó confirmación histológica.

The presence of pulmonary infiltrates is a frequent finding that includes a large differential diagnosis based on many occasions in the clinical history. Among them, exogenous lipoid pneumonia represents a rare entity and a high index of suspicion is necessary to reach its diagnosis and prevent its progression. In these cases, an adequate clinical context and a CT with opacities and low density areas are highly suggestive of the disease. We present a case of exogenous lipoid pneumonia secondary to the continued use of oily substances at the nasal level, due to his antecedents and the diagnostic possibilities after the CT findings, histological confirmation was required.