Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial).

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Kidney Transplantation in Patients With Chronic Kidney Disease After a Previous Lung Transplantation.

BACKGROUND: The development of chronic kidney disease is a common complication after a lung transplantation, especially since the introduction of immunosuppressive treatments based on calcineurin inhibitors. Many of these patients reach end-stage renal disease and even need renal replacement therapy. Among the different options of renal replacement therapy, we consider kidney transplantation as a feasible option for these patients. METHODS: A single center, observational retrospective study including 8 lung transplanted patients who have received a kidney transplant in the period between 2013 and 2017 with at least 1 year of follow-up was used. RESULTS: Seven patients maintained an adequate function of the graft 1 year after kidney transplantation, and 1 patient died because of a pulmonary condition in spite of a previous kidney transplant. Two patients presented delayed graft function in the first days after surgery. CONCLUSIONS: The kidney transplantation is a technique of renal replacement therapy that should be considered in patients with previous lung transplantation. Experienced centers in double sequential lung and kidney transplantation should be established to assess and treat these types of patients.

Actinomicosis pulmonar simulando cáncer. Descripción de un caso y revisión de la literatura / Pulmonary actinomycosis mimicking cancer. A case report and literature review

La actinomicosis es una enfermedad crónica granulomatosa infrecuente causada por Actinomyces spp, una bacteria anaerobia gram positiva que normalmente coloniza la boca, genitales y tracto digestivo en humanos1. En la mayor parte de los casos, la enfermedad se manifiesta en la región cervicofacial. Sin embargo, se han descrito varios casos en los que la actinomicosis puede simular procesos malignos en localizaciones no comunes, como en el pulmón. Se presenta el caso de una paciente con un cuadro constitucional de 20 días de evolución con una masa paramediastínica, a la que se le diagnostica de actinomicosis pulmonar tras una lobectomía por sospecha clínica de malignidad

Actinomycosis is a rare chronic granulomatous disease caused by Actinomyces spp, an anaerobic gram positive bacteria that colonizes mouth, large bowel and genitals. Actinomycosis occurs most frequently at oral and cervicofacial region. Less commonly affected areas include thoracic, abdominal, pelvic and central nervous system. We report a case about a patient with constitucional syndrome and a paramediastinal ma ss who was diagnosed with pulmonary actinomycosis after a lobectomy because of clinical suspicion of malingnancy

Resultados de una Consulta de Enfermería de Tabaquismo en un hospital de tercer nivel / Results of a Smoking Habit Nursing Consultations in a tertiary hospital

Objetivo. Analizar resultados de consulta monográfica de enfermería para tratamiento del tabaquismo en un hospital de tercer nivel. Pacientes. Fumadores remitidos del propio centro, atención primaria, Salud Laboral y trabajadores del hospital. Método. Se diseña consulta monográfica con enfermera especializada en tabaquismo. Visitas protocolizadas, presenciales y telefónicas. Seguimiento total durante 12 meses. Apoyo médico para consulta y prescripción de tratamientos. Variables: edad, sexo, cigarrillos/día, edad de inicio, intentos de abandono, tabaquismo en entorno, peso, antecedentes y tratamiento, dependencia con test de Fagërstrom y cooximetría. Análisis estadístico: estudio de cohortes retrospectivo 2010-2013. Comparación entre grupos realizada mediante test de Logrank, y la probabilidad de abstinencia con método de Kaplan-Meier. Resultados. 362 fumadores (53 ± 12 años), test Fagërstrom de 7 ± 2, cooximetría 23,3 ± 14 ppm, media de 36 ± 11 años fumando, edad inicio 16 ± 4 años, e intentos previos abandono en 85% de casos. Tratamientos farmacológicos: vareniclina (65%) y TSN (25%) y solo apoyo en consulta (10%). Tras 12 meses de seguimiento, abstinencia del 33% de los pacientes, ganancia de peso media tras abandono: 2,5 kg en mujer y 3,3 en varón sin diferencias significativas según tratamiento. Conclusiones. La consulta protocolizada de enfermería obtiene resultados similares a los observados en unidades más complejas y de mayor coste, a pesar de ser pacientes reincidentes y con alta dependencia (AU)

Objective. Analyze results of monographic consultation from nursing department for treatment of smoking habit in a tertiary hospital. Patients. Smokers referred from the primary care, occupational health and hospital workers site of the center. Method. A monographic consultation was designed with nurses specialized in smoking habit. On-site protocolized and telephone visits. Total follow-up during 12 months. Medical support for treatment consultation and prescription. Variables: age, gender, cigarettes/day, age of initiation, attempts to quit smoking, smoking in the setting, weight, backgrounds and treatment, dependence with Fagërstrom test and cooximetry. Statistical analysis: 2010-2013 retrospective cohort study. Comparison between groups performed using Log rank Test and the likelihood of abstinence with the Kaplan-Meier method. Results. 362 smokers (53 ± 12 years), Fagërstrom test from 7 ± 2, cooximetry 23.3 ± 14 ppm, mean of 36 ± 11 years smoking, age of initiation 16 ± 4 years, and previous attempts to stop smoking in 85% of the cases. Drug treatments: varenicline (65%) and NRT (25%) and only support in consultation (10%). After 12 months of follow-up, abstinence in 33% of the patients, weight gain after quitting smoking: 2.5 kg in women and 3.3 in men, without significant differences according to the treatment. Conclusions. Protocolized nursing consultation obtains similar results to those observed in more complex units having a higher cost, in spite of being patients with recurrence and high dependence (AU)

Cirugía de reducción de volumen pulmonar en el enfisema: experiencia española / Lung volume reduction surgery for emphysema: the spanish experience

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Estudio de contactos de pacientes tuberculosos en nuestro medio / Study of tuberculosis contacts in our setting

No disponible

[Survival of lung transplant at the Puerta de Hierro Clinic]. / Análisis de la supervivencia del trasplante pulmonar en la Clínica Puerta de Hierro.

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

[Cholesterol in pleural fluid. Its usefulness in differentiating between exudates and transudates]. / Colesterol en líquido pleural. Utilidad en la diferenciación entre exudados y trasudados.

To analyze the usefulness of cholesterol levels in the differentiation of exudates and transudates. A 3.5-year prospective study of 170 patients with pleural discharge. Clinical microbiological and cyto-histological criteria were used for diagnosis. Exudates were classified by Light's criteria, by cholesterol > or = 45 mg/dl in pleural liquid, by a cholesterol in pleural liquid/cholesterol in serum quotient > or = 0.3 and by a finding of both LDH and cholesterol in pleural fluid. These criteria were compared with the final etiological diagnosis. Only pleural discharges with confirmed etiological diagnoses were analyzed. In the 130 pleural discharges for which certain etiological diagnoses were obtained, 33 were transudates and 97 were exudates. Light's criteria allowed accurate classification of 92 (95%) of the 97 exudates and 30 (91%) of the 33 transudates. The cholesterol in pleural liquid/cholesterol in serum quotient was the most productive and useful parameter (96% sensitivity, 97% specificity), better than pleural fluid cholesterol and the Light's criteria. The association of LDH and pleural fluid cholesterol classified 100% of the exudates, with efficacy similar to that of Light's criteria. The cholesterol in pleural fluid/serum quotient was the most useful biochemical variable. Cholesterol levels were about as useful as Light's criteria. The association of LDH and cholesterol allows us to bypass blood analyses for the diagnosis of exudates.