Clinical trial to assess tolerability and subrogate efficacy effects of an abbreviated schedule with house dust mites mixture subcutaneous immunotherapy.

Summary: Objective. To evaluate the tolerability and efficacy of Dermatophagoides pteronyssinus/Dermatophagoides farinae mixture subcutaneous immunotherapy (SCIT). Methods. Patients received an abbreviated build-up schedule. The aims were: number, percentage, and severity of adverse reactions. Secondary outcomes included: changes in immunoglobulin titers and changes in dose-response skin prick tests. Results. Out of 289 administrations, 17% elicited any clinically relevant adverse reaction. Most of them were local reactions (LR) (9.4%) and the rest (7.6%) were systemic. Significant increases in sIgG and sIgG4 were detected in serum samples. Cutaneous reactivity decreased significantly. Conclusions. SCIT with house dust mites mixture of ROXALL Medicina España S.A. seems to have an acceptable tolerability profile, induces blocking IgG and decreases skin reactivity.

Diagnóstico microbiológico de la COVID-19 / Microbiological diagnosis of COVID-19

El diagnóstico microbiológico de la infección por SARS-CoV-2 es de gran importancia por su repercusión clínica a nivel individual y para la elaboración de estrategias de salud pública para intentar frenar su propagación. Actualmente la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) es la técnica de elección para el diagnóstico microbiológico del paciente sintomático por COVID-19, detectando material genético del virus en el organismo. Requiere un adecuado manejo de las muestras y un laboratorio bien equipado. Otros métodos diagnósticos utilizados son la detección de anticuerpos generados por el individuo en contacto con el virus, son útiles para el estudio de infección pasada, estudios de vacunas o estrategias epidemiológicas; y la detección de antígenos del SARS-CoV-2 en muestras biológicas, de mayor rentabilidad, menor coste y gran especificidad, pero con altas tasas de falsos negativos en pacientes con baja carga viral. Es fundamental una correcta indicación e interpretación de las pruebas diagnósticas para su mayor rentabilidad

Microbiological diagnosis of SARS-CoV-2 infection is crucial due to its clinical repercussion at the individual level and for the development of public health strategies to try to stop its spread. Currently, reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard for microbiological diagnosis of symptomatic COVID-19 patients, detecting genetic material of the virus in the body. It requires proper sample handling and a well-equipped laboratory. Other diagnostic methods used are the detection of antibodies generated by the individual in contact with the virus, useful for the study of past infection, vaccine studies or epidemiological strategies; and the detection of SARS-CoV-2 antigens in biological samples, with greater profitability, lower cost and high specificity, but with high rates of false negatives in patients with low viral load. Correct indication and interpretation of diagnostic tests is essential for greater profitability

Tabaquismo en los estudiantes de alto nivel académico en la Comunidad de Madrid y comparación con estudio previo similar realizado en 2014 / High level of student smokers in Madrid compared with a similar previous study of 2014

El tabaquismo es un problema de salud pública que afecta a los jóvenes, influenciado por el entorno y el nivel cultural. OBJETIVOS: Determinar la prevalencia de tabaquismo en estudiantes de bachillerato de excelencia (BE) con alto nivel académico en la Comunidad Autónoma de Madrid, en el curso 2018-2019. Valorar influencias del ambiente sociocultural en la iniciación del tabaquismo. Comparar con estudios previos realizados en alumnos de BE y la población general. POBLACIÓN Y MÉTODOS: Estudio transversal en alumnos de BE de la Comunidad Autónoma de Madrid. Mediante encuesta anónima se interrogó sobre el consumo de tabaco, alcohol y otras sustancias tóxicas; influencia del entorno, amigos y familiares en el inicio. Comparar con estudios previos. RESULTADOS: Se recogieron 740 jóvenes de 16,57±0,61 años; eran 430 (58,1%) mujeres y fumaban 53 (7,18%). Reconocían la influencia inicial de amigos 39 (78%). Consumían alcohol 349 (47,48%); y otras sustancias 109 (15,27%). Ser fumador se relacionó con consumir alcohol y otras drogas, tener madre, hermanos y amigos fumadores. Respecto a estudios previos, no se modificó la prevalencia de tabaquismo. CONCLUSIONES: La prevalencia del tabaquismo en estudiantes de alto nivel académico del BE de la Comunidad Autónoma de Madrid continúa siendo inferior a la de jóvenes de su edad y no existen variaciones respecto a informes previos. El inicio está relacionado con el tabaquismo de amigos, hermanos y de la madre; con el consumo de alcohol y otras drogas. La educación y los programas preventivos son muy importantes en el inicio y prevención del tabaquismo

Smoking is a public health problem that affects young people, and influenced by the environment and cultural level. OBJECTIVES: To determine smoking prevalence among high-level baccalaureate students in the Autonomous Community of Madrid during the 2018-2019 academic year. To assess the influence of the socio-cultural environment on the onset of youth smoking. To compare the results with previous studies conducted on students of baccalaureate of excellence (BE) and the general population. POPULATION AND METHODS: Cross-sectional study on BE students in the Autonomous Community of Madrid. Using an anonymous questionnaire, they were asked about tobacco, alcohol and drug consumption, as well as the influence of the environment, friends, and family in the beginning. To compare with previous studies. RESULTS: A total of 740 valid questionnaires were collected, of which 430 (58.1%) were female, an overall mean age of 16.57±0.61 years, and 53 (7.18%) were smokers. The majority 39 (78%) of smokers acknowledged their friends' influence at its onset. Alcohol was consumed by 349 (47.48%) and other drugs by 109 (15.27%). Being a smoker was related to alcohol, other drugs, a smoking mother, smoking siblings and smoking friends. CONCLUSIONS: Smoking prevalence among students of BE in Autonomous Community of Madrid continues to be lower than the prevalence of adolescents of their age and there are no variations from previous reports. Starting smoking is related to smoking by friends, siblings, and the mother and with the consumption of alcohol and other substances. Education is very important in the beginning and prevention of smoking, and it is necessary to implement prevention programs at early ages in order to promote their effectiveness, and aimed at young people, parents and teachers

[High level of student smokers in Madrid compared with a similar previous study of 2014]. / Tabaquismo en los estudiantes de alto nivel académico en la Comunidad de Madrid y comparación con estudio previo similar realizado en 2014.

Smoking is a public health problem that affects young people, and influenced by the environment and cultural level. OBJECTIVES: To determine smoking prevalence among high-level baccalaureate students in the Autonomous Community of Madrid during the 2018-2019 academic year. To assess the influence of the socio-cultural environment on the onset of youth smoking. To compare the results with previous studies conducted on students of baccalaureate of excellence (BE) and the general population. POPULATION AND METHODS: Cross-sectional study on BE students in the Autonomous Community of Madrid. Using an anonymous questionnaire, they were asked about tobacco, alcohol and drug consumption, as well as the influence of the environment, friends, and family in the beginning. To compare with previous studies. RESULTS: A total of 740 valid questionnaires were collected, of which 430 (58.1%) were female, an overall mean age of 16.57±0.61 years, and 53 (7.18%) were smokers. The majority 39 (78%) of smokers acknowledged their friends' influence at its onset. Alcohol was consumed by 349 (47.48%) and other drugs by 109 (15.27%). Being a smoker was related to alcohol, other drugs, a smoking mother, smoking siblings and smoking friends. CONCLUSIONS: Smoking prevalence among students of BE in Autonomous Community of Madrid continues to be lower than the prevalence of adolescents of their age and there are no variations from previous reports. Starting smoking is related to smoking by friends, siblings, and the mother and with the consumption of alcohol and other substances. Education is very important in the beginning and prevention of smoking, and it is necessary to implement prevention programs at early ages in order to promote their effectiveness, and aimed at young people, parents and teachers.

Clinical assessment of tolerability, immunological and cutaneous reactivity effects of an abbreviated schedule with Olea europaeanative extract of subcutaneous immunotherapy.

Summary: Objectives. To evaluate the tolerability and efficacy of Olea europaea subcutaneous immunotherapy (SCIT) on patients with rhinoconjunctivitis. Methods. In this open clinical trial patients were assigned to an abbreviated build-up scheme. The outcomes were: number, percentage, and severity of adverse reactions. Secondary outcomes included: changes in immunoglobulin titers and changes in dose-response skin prick tests. Results. Only 8 systemic reactions were registered, which represented 7/47 (14.9%) of patients and 8/429 (1.9%) of administered doses. Regarding immunological parameters the significant increases of sIgG and sIgG4 evidenced the changes in the patient immune system. Cutaneous reactivity decreased significantly. Conclusions. Olea europaea SCIT (Allergovac® depot ROXALL Medicina España S.A.) showed a good safety and tolerability profile. Immunological changes with induction of blocking IgG and decreases in cutaneous reactivity were detected in the patients.

Creation and application of voxelised dosimetric models, and a comparison with the current methodology as used for the International Commission on Radiological Protection's Reference Animals and Plants.

Over the past decade, the International Commission on Radiological Protection (ICRP) has developed a comprehensive approach to environmental protection that includes the use of Reference Animals and Plants (RAPs) to assess radiological impacts on the environment. For the purposes of calculating radiation dose, the RAPs are approximated as simple shapes that contain homogeneous distributions of radionuclides. As uncertainties in environmental dose effects are larger than uncertainties in radiation dose calculation, some have argued against more realistic dose calculation methodologies. However, due to the complexity of organism morphology, internal structure, and density, dose rates calculated via a homogenous model may be too simplistic. The purpose of this study is to examine the benefits of a voxelised phantom compared with simple shapes for organism modelling. Both methods typically use Monte Carlo methods to calculate absorbed dose, but voxelised modelling uses an exact three-dimensional replica of an organism with accurate tissue composition and radionuclide source distribution. It is a multi-stage procedure that couples imaging modalities and processing software with Monte Carlo N-Particle. These features increase dosimetric accuracy, and may reduce uncertainty in non-human biota dose-effect studies by providing mechanistic answers regarding where and how population-level dose effects arise.

Las matronas y la detección de la violencia en el embarazo / Midwives and intimate partner violence during pregnancy

La violencia de género es un grave problema social en todo el mundo, por su gravedad y su elevada prevalencia. Puede provocar patologías, incapacidad e incluso la muerte, y tiene repercusiones sobre la salud física, psíquica, social y sexual-reproductiva de la mujer. Si la violencia se ejerce durante el embarazo, puede tener consecuencias no sólo para la mujer, sino también para el feto en desarrollo y el futuro hijo. Existen una serie de funciones mínimas que los profesionales deben desarrollar, como preguntar sobre violencia de género con regularidad, informar y remitir a las mujeres que la sufran a los recursos disponibles de la comunidad, registrar los casos y conocer la legislación vigente del país

Gender violence is a major social problem at global level due to its serious nature and prevalence. It can lead to pathologies, disabilities and even death, and has repercussions for women’s physical, mental, social and sexual/reproductive health. If it occurs during pregnancy it can have consequences not only for the woman but for the developing foetus and the future child. There are a series of minimum functions professionals can perform, such as asking regularly about gender violence, informing women who suffer it about and referring them to the resources available in the community, recording cases and being familiar with current legislation in the country

Validación de técnicas de segmentación para la tomografía por emisión de positrones mediante imágenes ex-vivo de piezas quirúrgicas oncológicas / Validation of segmentation techniques for positron emission tomography using ex-vivo images of oncological surgical specimens

Objetivo: Diseñar una técnica novedosa de adquisición ex-vivo para establecer un marco común de validación de diferentes técnicas de segmentación para imágenes PET oncológicas. Evaluar sobre estas imágenes el funcionamiento de varios algoritmos de segmentación automática. Material y métodos: En 15 pacientes oncológicos se realizaron estudios PET ex-vivo de las piezas quirúrgicas extraídas durante la cirugía, previa inyección de 18F-FDG, adquiriéndose imágenes en 2 tomógrafos: un PET/CT clínico y un tomógrafo PET de alta resolución. Se determinó el volumen tumoral real en cada paciente, generándose una imagen de referencia para la segmentación de cada tumor. Las imágenes se segmentaron con 12 algoritmos automáticos y con un método estándar para PET (umbral relativo del 42%) y se evaluaron los resultados mediante parámetros cuantitativos. Resultados: La segmentación de imágenes PET de piezas quirúrgicas ha demostrado que para imágenes PET de alta resolución 8 de las 12 técnicas de segmentación evaluadas superan al método estándar del 42%. Sin embargo, ninguno de los algoritmos superó al método estándar en las imágenes procedentes del PET/CT clínico. Debido al gran interés de este conjunto de imágenes PET, todos los estudios se han publicado a través de Internet con el fin de servir de marco común de validación y comparación de diferentes técnicas de segmentación. Conclusiones: Se ha propuesto una técnica novedosa para validar técnicas de segmentación para imágenes PET oncológicas, adquiriéndose estudios ex-vivo de piezas quirúrgicas. Se ha demostrado la utilidad de este conjunto de imágenes PET mediante la evaluación de varios algoritmos automáticos (AU)

Objective: To design a novel ex-vivo acquisition technique to establish a common framework to validate different segmentation techniques for oncological PET images. To evaluate several automatic segmentation algorithms on this set of images. Material and methods: In 15 patients with cancer, ex-vivo PET studies of surgical specimens removed during surgery were performed after injection of 18F-FDG. Images were acquired in two scanners: a clinical PET/CT and a high-resolution PET scanner. Real tumor volume was determined in each patient, and a reference image was generated for segmentation of each tumor. Images were segmented with 12 automatic algorithms and with a standard method for PET (relative threshold at 42%) and results were evaluated by quantitative parameters. Results: It has been possible to demonstrate by segmentation of PET images of surgical specimens that on high resolution PET images, 8 out of 12 evaluated segmentation techniques outperformed the standard method, whose value is 42%. However, none of the algorithms outperformed the standard method when applied on images from the clinical PET/CT. Due to the great interest of this set of PET images, all studies have been published on the Internet in order to provide a common framework for validation and comparison of different segmentation techniques. Conclusions: We have proposed a novel technique to validate segmentation techniques for oncological PET images, acquiring ex-vivo PET studies of surgical specimens. We have demonstrated the usefulness of this set of PET images by evaluating several automatic segmentation algorithms (AU)

Bronquio traqueal: complicaciones tras la cirugía / No disponible

El bronquio traqueal (BT) se incluye dentro de las anomalías congénitas del árbol traqueobronquial y consiste en un bronquio que se origina en la tráquea por encima de la carina. Tiene una incidencia del 0,5-3%. Lo más frecuente es que no produzca síntomas y cuando existen manifestaciones clínicas, están causadas por alteración en el drenaje de secreciones, con tos persistente, neumonía y atelectasia recurrentes, entre otras. Su importancia clínica viene dada por el manejo de la vía aérea cuando es necesario intubar a estos pacientes. En ventilaciones unipulmonares debe descartarse previamente la presencia de anomalías bronquiales, realizando una broncoscopia. Las complicaciones ventilatorias secundarias a la presencia de un BT exigen la realización de una broncoscopia para su diagnóstico y manejo. Presentamos el caso de una paciente de 39 años que tras ser sometida a una intubación, presentó complicaciones respiratorias secundarias a la presencia de un BT

Tracheal bronchus is a congenital anomaly in which a bronchus has its origin in the trachea, above the carina. It has an incidence of 0,5-3%. Often, it is asymptomatic, but when clinical manifestations exist, they are caused by difficulties in elimination of secretions with chronic cough, pneumonia and recurrent atelectasis. The clinical importance of tracheal bronchus is related to the airway management when is necessary to intubate these patients. The presence of a tracheal bronchus should be rule out before one-lung ventilation performing a broncoscope. Ventilatory complications should be diagnosed and treated also with broncoscope. We present the case of a woman of 39 years old with respiratory complications after an airway intubation secondary to the presence of a tracheal bronchus

[Validation of segmentation techniques for positron emission tomography using ex-vivo images of oncological surgical specimens]. / Validación de técnicas de segmentación para la tomografía por emisión de positrones mediante imágenes ex-vivo de piezas quirúrgicas oncológicas.

OBJECTIVE: To design a novel ex-vivo acquisition technique to establish a common framework to validate different segmentation techniques for oncological PET images. To evaluate several automatic segmentation algorithms on this set of images. MATERIAL AND METHODS: In 15 patients with cancer, ex-vivo PET studies of surgical specimens removed during surgery were performed after injection of (18)F-FDG. Images were acquired in two scanners: a clinical PET/CT and a high-resolution PET scanner. Real tumor volume was determined in each patient, and a reference image was generated for segmentation of each tumor. Images were segmented with 12 automatic algorithms and with a standard method for PET (relative threshold at 42%) and results were evaluated by quantitative parameters. RESULTS: It has been possible to demonstrate by segmentation of PET images of surgical specimens that on high resolution PET images, 8 out of 12 evaluated segmentation techniques outperformed the standard method, whose value is 42%. However, none of the algorithms outperformed the standard method when applied on images from the clinical PET/CT. Due to the great interest of this set of PET images, all studies have been published on the Internet in order to provide a common framework for validation and comparison of different segmentation techniques. CONCLUSIONS: We have proposed a novel technique to validate segmentation techniques for oncological PET images, acquiring ex-vivo PET studies of surgical specimens. We have demonstrated the usefulness of this set of PET images by evaluating several automatic segmentation algorithms.

Actualización en técnicas broncoscópicas / No disponible

No disponible

Disfunción sexual femenina en el climaterio / Female sexual dysfunction during menopause

Los años en que se presenta la menopausia constituyen una etapa dela vida en la que se experimentan muchos cambios: fisiológicos, psicológicos,ginecológicos, sexuales y sociales. Estos cambios, en algunas ocasiones, pueden interferir en la habilidad para disfrutar de la sexualidady llegar a tener consecuencias negativas en la pareja o en la propia persona; a este trastorno se lo denomina disfunción sexual femenina.Esta revisión bibliográfica tiene como objetivo definir los cambios acontecidos en el climaterio que influyen en la sexualidad de la mujer, así como determinar posibles alternativas, recomendaciones y terapias con el fin de mejorar la vida sexual de las parejas en esta etapa (AU)

The years in which menopause appear represent a stage of life which is accompanied of many changes: physiological, physiological, gynecological,sexual and social. These changes in some occasions might interferein the ability of enjoying the sexuality, being a reason of negative consequences in the couple and the person going through it, this disorder is called female sexual dysfunction. This bibliographical review has as objective,define the changes that occur during the menopause that influence the sexuality of the women, also to determine certain possible alternatives, recommendations and therapies with the end of improving the couples sexual live during this stage (AU)

Evaluation of spatial resolution of a PET scanner through the simulation and experimental measurement of the recovery coefficient.

PURPOSE: In order to measure spatial resolution of a PET tomograph in clinical conditions, this study describes and validates a method based on the recovery coefficient, a factor required to compensate underestimation in measured radioactivity concentration for small structures. METHODS: In a PET image, the recovery factors of radioactive spheres were measured and their comparison with simulated recovery coefficients yielded the tomographic spatial resolution. Following this methodology, resolution was determined in different surrounding media and several conditions for reconstruction, including clinical conditions for brain PET studies. All spatial resolution values were compared with those obtained using classical methods with point and line sources. RESULTS: In each considered condition, spatial resolution of the PET image estimated using the recovery coefficient showed good agreement with classical methods measurements, validating the procedure. CONCLUSION: Measurement of the recovery coefficient provides an assessment of tomographic spatial resolution, particularly in clinical studies conditions.

Análisis retrospectivo de las complicaciones asociadas a los dispositivos implantables intravasculares / Retrospective analysis of complications associated with implantable intravascular devices

Objetivos: Presentar nuestra serie de pacientes a los que se ha implantado un reservorio subcutáneo permanente, el sistema elegido, la técnica y las complicaciones. Material y métodos: Entre el 1 de enero de 2005 y el 31 de diciembre de 2006, se colocaron 66 dispositivos. Los pacientes provenían desde los servicios de oncología médica y hematología. La colocación del reservorio se hizo en quirófano, bajo estrictas medidas de asepsia. Se canalizó la vena subclavia por vía infraclavicular, según la técnica de Seldinger. Una vez canalizada la vena, se realizó una incisión a unos 5 cm del punto de punción para permitir a un tunelizador guiar el catéter hasta el lugar donde se colocaría el reservorio de titanio. Posteriormente, se disecó el tejido celular subcutáneo en la zona infraclavicular hasta crear un lecho donde se deposita un pequeño depósito con una membrana de silicona que permite las inyecciones, perfusiones y extracciones sanguíneas. Se fijó el depósito y se cerraron las incisiones por planos anatómicos. Se diseñó un protocolo para la recogida de datos y seguimiento que incluía: datos de filiación, diagnóstico, indicación, tipo de catéter, vía de acceso venoso, profilaxis antibiótica, complicaciones tempranas y tardías, eventual retirada del catéter y motivo, y días de uso sin complicaciones. El seguimiento de los pacientes de realizó de forma retrospectiva hasta cierre del estudio (junio de 2007). El análisis estadístico se realizó con el programa SPSS 11.0. Resultados: La indicación fue la administración de quimioterapia; la patología predominante fue el carcinoma de mama. Los catéteres utilizados fueron del tipo Celsite ST201.La vía de acceso elegida mayoritariamente fue la vena subclavia derecha (60,6%). Aparecieron complicaciones tempranas (menos de un mes de la colocación) en 2 (3%) pacientes, consistentes en funcionamiento anómalo del catéter y un neumotórax, que se resolvió con medidas conservadoras (...) (AU)

Objectives: To present our series of patients with a permanent subcutaneous reservoir and describe the system chosen, the technique used, and complications. Material and methods: Between January 1, 2005 and December 31, 2006, 66 devices were placed in patients from the Medical Oncology and Hematology Services. There servoir was placed in the operating room, under strict aseptic conditions. The subclavian vein was canalized through the infraclavicular route, following Seldinger’s technique. After the vein was canalized, an incision was made approximately 5 cm from the puncture point to allow a tunneler to guide the catheter to the area where the titanium reservoir would be placed. Subsequently, the subcutaneous cellular tissue of the infraclavicular area was dissected to create a bed where a small deposit was placed with a silicone membrane to allow injections, perfusions and blood extraction. The deposit was fixed and the incisions were closed by anatomical planes. A protocol was designed for data collection and follow-up, which included the following: affiliation, diagnosis, indication, catheter type, route of venous access, antibiotic prophylaxis, early and late complications, eventual catheter withdrawal and reason, days of use without complications. Patient follow-up was performed retrospectively until the end of the study (June 2007). The statistical analysis was performed with the SPSS 11.0 statistical package. Results: The indication was chemotherapy administration and the main disease was breast carcinoma. The type of catheter used was Celsite ST201. The most frequently chosen route of access was the right subclavian vein (60.6%). Early complications (less than 1month after placement) occurred in two patients (3%) and consisted of catheter malfunction and pneumothorax, which were resolved with conservative measures. Late complications occurred in 12 patients (18.2%) (…) (AU)

Principio de un final: trazabilidad en desinfección / The begining of an end: traceability in desinfection

No disponible

No disponible

[Pneumonia in the patient with chronic obstructive pulmonary disease. Levels of severity and risk classification]. / Neumonía en el paciente con enfermedad pulmonar obstructiva crónica. Niveles de gravedad y clases de riesgo.

OBJECTIVES: To analyze the severity, clinical course and mortality in patients with community-acquired pneumonia and COPD. METHOD: Retrospective study of patients admitted with pneumonia over a period of 12 months. From records, we gathered information related to patient characteristics, signs and symptoms and concomitant disease and classified each patient according to risk. RESULTS: One hundred twenty-nine patients with a mean age of 71.13 (SD 17) were identified; 43 (33.3%) had COPD with severe airflow obstruction (FEV1 937 mL, SD 309), although there were no differences from one risk classification to another. No significant differences were found in mortality, as 8 patients (18.6%) with COPD died and 9 patients (10.7%) without COPD. The length of hospital stay was similar in both groups. Patients with COPD suffered more severe pneumonia and were at higher risk (classes IV and V). The percentage of COPD patients using chronic domiciliary oxygen therapy who died (75%) was different from the percentage of such patients who lived (37%); percent mortality also differed by level of risk. Patients receiving oxygen therapy had greater obstruction and greater respiratory insufficiency upon admission (PaO2/FiO2: 216.9, SD 41.92). CONCLUSIONS: The mortality rates and mean hospital stays of patients with and without COPD who are admitted with community-acquired pneumonia are similar, but patients with COPD suffer more severe pneumonia. Mortality is higher in patients with community-acquired pneumonia and COPD who are receiving domiciliary oxygen therapy and have greater airflow obstruction and respiratory deterioration upon admission.

Neumonía en el paciente con enfermedad pulmonar obstructiva crónica. Niveles de gravedad y clases de riesgo / Pneumonia in the patient with chronic obstructive pulmonary disease. Levels of severity and risk classification

Fundamento: La enfermedad pulmonar obstructiva crónica (EPOC) en los pacientes con neumonía adquirida en la comunidad (NAC) puede incrementar la gravedad y la mortalidad. Objetivos: Analizar la gravedad, evolución y mortalidad de los pacientes con NAC que asocian EPOC. Método: Estudio retrospectivo de pacientes ingresados con neumonía durante 12 meses. Se recogieron datos demográficos, clínicos y de las enfermedades coexistentes, asignando a cada paciente una clase de riesgo. Resultados: Se estudió a 129 pacientes con una edad media de 71,13 (DE, 17) años; 43 asociaban EPOC (33,3 per cent) con una obstrucción al flujo aéreo grave -FEV1, 937 (309) ml-, aunque sin diferencias entre las diversas clases de riesgo. No se observaron diferencias significativas de mortalidad entre el grupo de pacientes con EPOC (8 pacientes; 18,6 per cent) y sin EPOC (9 pacientes; 10,7 per cent). La estancia hospitalaria fue similar en los dos subgrupos. Los pacientes con EPOC presentaron NAC de mayor gravedad y riesgo (clases IV y V).Se observaron diferencias en la proporción de pacientes con EPOC que utilizaban oxigenoterapia crónica domiciliaria (OCD) entre los que fallecieron (75 per cent) y los que no fallecieron (37 per cent), así como en las diferentes clases de riesgo. Los pacientes con OCD tenían mayor obstrucción y presentaban mayor insuficiencia respiratoria al ingresar: PaO2/FiO2, 216,9 (41,92).Conclusiones: Los pacientes con NAC y EPOC asociada tienen una mortalidad y estancia hospitalaria similares a las de los que no la asocian, y presentan NAC de mayor gravedad. Los pacientes con NAC y EPOC fallecen en mayor proporción cuando antes del ingreso están en OCD, en cuyo caso tienen una mayor obstrucción al flujo aéreo y un mayor deterioro respiratorio cuando ingresan en el hospital (AU)