Análisis de la proteína C reactiva en la población fumadora sana y con EPOC e influencia de las comorbilidades y del tiempo de abandono del tabaco / Analysis of the C reactive protein as scoreboard of the inflammation bronchopulmonary in the smoking healthy population and with COPD and influence of the comorbidities and of the time of abandonment

Objetivo: El consumo de tabaco incrementa la proteína C reactiva (PCR) en suero. Se estudian sus valores en diferentes poblaciones: sanas (exfumadoras, fumadoras y no fumadoras), bronquitis crónica y enfermedad pulmonar obstructiva crónica (EPOC) en diferentes estadios; además su variación relacionada con tiempo de abandono del tabaco y comorbilidades asociadas. Material y métodos: Análisis descriptivo‑transversal. Se estudiaron 401 personas: 106 sanas no fumadoras (SNF), 104 sanas fumadoras (SF), 95 sanas exfumadoras (SE), 30 con bronquitis crónica, 30 con EPOC incipiente (EPOCi) y 36 con EPOC avanzada (EPOCa), edades entre 45 y 80 años, determinándose PCR y comorbilidades asociadas. Resultados: Valores de PCR: 1,98 (2,1) mg/l SNF; 3,35 (4,39) mg/l SF; 2 (2,2) mg/l SE; 3 (3,8) mg/l bronquitis crónica; 3,40 (2,23) EPOCi y 5,94 (1,76) EPOCa. PCR en bronquitis crónica y EPOC disminuye a 2,7 (6,8) mg/l tras cinco años de abandono, permaneciendo constante después. Existen diferencias significativas entre SF y SNF; y tras cinco años de abandono entre bronquitis crónica y EPOC con SNF (p = 0,003). Sin diferencias significativas entre SE y SNF (p > 0,05) y entre SF y bronquitis crónica o EPOCi (p > 0,05) y entre diferentes estadios de EPOC e índices de comorbilidad. Conclusiones: PCR en SF es superior a SNF y similar a bronquitis crónica y EPOCi. En SF tras el abandono PCR retorna al valor de SNF. En las poblaciones con patología está significativamente elevada respecto a SNF y no regresa al nivel del SNF tras cinco años de abandono. Su nivel es independiente del índice de comorbilidad. El nivel de detección de enfermedad inflamatoria se sitúa en un valor de PCR: 3 mg/l (AU)

Objective: The smoking habit increases the C reactive protein in the serum. Values are studied in different populations: healthy (exsmokers, smokers and nonsmokers), chronic bronchitis and chronic obstructive pulmonary disease (COPD) in different stages; in addition the influence according to the time of abandonment of the tobacco and the associate comorbidities. Material and methods: Descriptive‑transversal analysis. 401 persons we studied: 106 healthy not smokers (HNS), 104 healthy smokers (HS), 95 healthy nonsmoker (HN), 30 with chronic bronchitis, 30 with incipient COPD (COPDi) and 36 with advanced COPD (COPDa), with ages included between 45 and 80 years old, being detrmined CRP and the associate comorbidities. Results: CRP’s values were: 1.98 (2.1) mg/l in HN; 3.35 (4.39) mg/l in HS; 2 (2.2) mg/l in HE; 3 (3.8) mg/l in chronic bronchitis; 3.40 (2.23) in COPDi and 5.94 (1.76) in COPDa. The CRP in chronic bronchitis and COPD falls to 2.7 (6.8) after five years of abandonment of the tobacco, remaining constant after. There exist significant differences between the HS and HN populations, and between chronic bronchitis and COPD after five years of abstinence with the population HN (p=0.003). There are not significant differences between HE and HN (p>0.05); between population HS and the population with chronic bronchitis and COPDi (p>0.05), and between COPD’s different stages and the indexes of comorbiditie. Conclusions: The value of the CRP in the HS population is similar to that on the chronic bronchitis and COPDi population, but higher to that of the HN. After the abandon of the smoking habit, in HS the CRP returns to the value of the HN population. In the populations with pathologies is significantly elevated as compared to HN and not return to the HN level after five years of abstinence. Their level is independent of comorbidity index. The detection level of inflammatory disease is at a value of PCR: 3 mg/l (AU)

[C-reactive protein value related to a smoking history and composition of nicotine and tobacco tar]. / Valor de la proteína C reactiva según historia de tabaquismo y composición de nicotina y alquitrán.

INTRODUCTION: The CRP is known to be an acute phase reactant, but with new high sensitivity assay methods it appears that CRP is also a marker of chronic inflammation. This study was to investigate whether smoking acts as a systemic disease and to see if there is a relation between CRP values and smoking. MATERIAL AND METHODS: 762 persons were studied, with a mean age of 41.74+/-10.03 years. 200 were smokers, 344 were non-smokers and 218 were ex-smokers. The following details were noted in the smoking history: cigarette brand, number of cigarettes/day, number of years smoking and milligrams of nicotine and tar. In the case of ex-smokers, the number of years since giving up smoking was noted. The CRP was determined using the high sensitive Tina-Quant assay. Windows SPSS version 11.0 software was used. RESULTS: The CRP values showed statistically significant differences between the smoking and non-smoking groups. A statistically significant increase in CRP was observed in relation to number of cigarettes/day (p=0.001), mg of nicotine (p=0.017), mg of tar (p=0.020) and number of years of smoking (p=0.0001). However, when analysing the relation between CRP and the number of years since giving up smoking, there was a negative curve of 0.02 in the equation, but this was not of statistical significance. CONCLUSIONS: CRP levels rise when there is an increase in number of cigarettes/day, mg of nicotine and tar and years smoking.

Descripción del valor de la proteína C reactiva según dislipemia e historia de tabaquismo / Description of C-reactive protein according to dyslipidemia and smoking background

Introducción: La Proteína C Reactiva (PCR) es sintetizada en respuesta al daño tisular o a la infección. Se considera factor de riesgo cardiovascular emergente pues es un importante predictor del desarrollo de arteriopatía periférica y de eventos coronarios agudos. El objetivo de este estudio es describir el perfil lipídico de nuestra muestra, comprobar si existe relación entre PCR y valores de triglicéridos, colesterol y sus fracciones, según el hábito tabáquico y entre carga tabáquica y cifras de lípidos y PCR. Material y métodos: Se trata de un estudio observacional y transversal realizado en 762 varones. La PCR se determinó mediante ensayo Tina-Quant ultrasensible. Rangos de normalidad: PCR < 4 mg/l, colesterol 110-220 mg/dl, HDL< 35 mg/dl, LDL < 130 mg/dl, triglicéridos 50-180 mg/dl. La carga tabáquica se analizó a través del número de cigarrillos fumados al día y el índice paquetes/año (nº de cigarrillos diarios x nº de años de fumador/ 20). Los datos fueron analizados mediante el programa informático SPSS windows versión 12.0. Resultados: La edad media era de 41,74 (10,03) años. Doscientos(26,2%) eran fumadores, 344 (45,1%) no fumadores y 218 (28,2%) exfumadores. La media de la PCR fue significativamente mayor en los fumadores que en los no fumadores (2,097 ± 1,7 vs 1,57 ± 1,41; p =0,004). La cifra media de triglicéridos, colesterol y LDL fue mayor en los fumadores que en los no fumadores (p < 0,001, 0,3 y 0,14), respectivamente. La fracción HDL, como factor protector se encontraba aumentada en los no fumadores (p < 0,001). Existe una correlación positiva débil, tanto en fumadores como en no fumadores, entre PCR y cifras de triglicéridos (r = 0,285 y r = 0,2),y negativa con HDL (r = -0,45 y r = -0,182), estadísticamente significativa en ambos casos (p < 0,001 y p = 0,001). La correlación entre PCRy colesterol y LDL es débil. Es significativa en fumadores (p = 0,037), no siendo así en los no fumadores (p = 0,167). Hallamos una correlación débil entre el índice paquetes/año y los lípidos, que es más elevada para los triglicéridos (r = 0,3), con significación estadística (p < 0,001). La hallada para la fracción HDL es débil, negativa (r = -0,15) y estadísticamente significativa (p = 0,03). No hemos hallado correlación entre este índice y las cifras de PCR (r = 0,008). La correlación lineal entre nº de cigarrillos fumados al día y las variables lipídicas y PCR es prácticamente inexistente, siendo significativa solamente para los triglicéridos (p = 0,02). Conclusión: Las cifras de colesterol, cLDL, triglicéridos y PCR, se encuentran más elevadas en los fumadores que en los no fumadores. Las cifras de cHDL disminuyen en fumadores. Los niveles de PCR aumentan al incrementarse las cifras de lípidos, sobre todo en los sujetos fumadores varones estudiados. Al aumentar la carga tabáquica del fumador aumentan los valores de triglicéridos, colesterol, cLDL y disminuyen los de cHDL (AU)

Introduction: C-Reactive Protein (CRP) is synthesized in response to tissue damage or infection. It is considered to be an emergent cardiovascular risk factor since it is an important predictor of the development of peripheral arteriopathy and acute coronary events. This study aims to describe the lipid profile of our sample, verify if there is a relationship between CRP and triglycerides values, cholesterol and its fractions, according to the smoking habit and between smoking load and lipid and CRP values. Material and methods: This is an observational, cross-sectional study conducted in 762 men.The CRP was determined with the ultrasensitive Tina-Quant assay. Normality ranges: CRP35 mg/dl, LDL < 130 mg/dl, triglycerides 50-180 mg/dl. Smoking load was analyzed through the number of cigarettes smoked per day and the package/year index (no. of cigarettes daily x no. of years of smoker/20). The data were analyzed with the windows SPSS program, version12.0. Results: Mean age was 41.74 (10.03) years. Two hundred (26.2%) were smokers, 344 (45.1%) non-smokers and 218 (28.2%) ex-smokers. Mean CRP was significantly greater in smokers than in non-smokers(2,097 ± 1.7 vs 1.57 ± 1.41; p = 0.004). Mean value of triglycerides, cholesterol and LDL was greater in smokers than in non-smokers (p <0.001, 0.3 and 0.14), respectively. HDL fraction, as protector factor, was increased in the non-smokers (p < 0.001).There is a weak positive correlation both in smokers and non-smokers between CRP and triglycerides values (r = 0.285 and r = 0.2), and negative one with HDL (r = -0.45 and r = -0.182), that is statistically significant in both cases (p < 0.001 and p = 0.001). Correlation between CRP and cholesterol and LDL is weak. It is significant in smokers (p = 0.037), not being so in non-smokers (p = 0.167). We find a week correlation between packages/year index and lipids, which is higher for triglycerides (r = 0.3), with statistical significance(p < 0.001). That found for the HDL fraction is weak, negative (r = -0.15) and statistically significant (p = 0.03). We have not found a correlation between this index and the CRP values (r = 0.008). The linear correlation between no. of cigarettes smoked per day and lipid variables and CRP is practically non-existent, it only be significant for triglycerides(p = 0.02). Conclusion: Cholesterol, cLDL, triglycerides and CRP values are higher in smokers than in non-smokers. The cHDL values decrease insmokers. CRP levels increase as the lipid values increase, above all in the male smokers studied. When the tobacco load of the smoker is increased, triglycerides, cholesterol, cLDL values increase and cHDL ones decrease (AU)

Valor de la proteína C reactiva según historia de tabaquismo y composición de nicotina y alquitrán / C-reactive protein value related to a smoking history and composition of nicotine and tobacco tar

Introducción: La PCR se conoce como reactante de fase aguda, pero con los nuevos métodos de análisis ultrasensibles, aparece el concepto de PCR como marcador de inflamación crónica. En este estudio vamos a investigar si el tabaquismo se comporta como una enfermedad sistémica, ver si existe relación entre los valores de la PCR y el tabaquismo. Material y métodos: Se estudian 762 personas de edad media 41,74 (d.s.10,03) años. 200 eran fumadoras, 344 no fumadoras y 218 exfumadoras. En la historia de tabaquismo se recoge: marca de tabaco, número de cigarrillos/ día, duración en años del hábito y milígramos de nicotina y alquitrán. En los exfumadores el número de años de abandono tabáquico. La PCR se determina mediante ensayo Tina – Quant ultrasensible. Se aplica el programa informático SPSS windows versión 11.0 Resultados: Aparecen valores de PCR con diferencias estadísticamente significativas entre los grupos de fumadores y de no fumadores. Se observa un aumento estadísticamente significativo de la PCR en relación con el número de cigarrillos/ día (p = 0,001), con los mg de nicotina (p = 0,017), con los mg de alquitrán (p = 0,020) y con los años de duración del hábito tabáquico (p = 0,001). Sin embargo, al estudiar la relación entre PCR y años de abandono tabáquico se observa una pendiente negativa de la ecuación de 0,02, pero no es estadísticamente significativa. Conclusiones: Los niveles de PCR aumentan al incrementarse el consumo de cigarrillos/día, los mg de nicotina, de alquitrán y la duración del hábito

Introduction: The CRP is known to be an acute phase reactant, but with new high sensitivity assay methods it appears that CRP is also a marker of chronic inflammation. This study was to investigate whether smoking acts as a systemic disease and to see if there is a relation between CRP values and smoking. Material and methods: 762 persons were studied, with a mean age of 41.74 ± 10.03 years. 200 were smokers, 344 were non-smokers and 218 were ex-smokers. The following details were noted in the smoking history: cigarette brand, number of cigarettes/day, number of years’ smoking and milligrams of nicotine and tar. In the case of ex-smokers, the number of years since giving up smoking was noted. The CRP was determined using the high sensitive Tina – Quant assay. Windows SPSS version 11.0 software was used. Results: The CRP values showed statistically significant differences between the smoking and non-smoking groups. A statistically significant increase in CRP was observed in relation to number of cigarettes/day (p = 0.001), mg of nicotine (p = 0.017), mg of tar (p=0.020) and number of years of smoking (p = 0.0001). However, when analysing the relation between CRP and the number of years since giving up smoking, there was a negative curve of 0.02 in the equation, but this was not of statistical significance. Conclusions: CRP levels rise when there is an increase in number of cigarettes/day, mg of nicotine and tar and years’ smoking

An evaluation of tissue polypeptide antigen (TPA) in the two bronchoalveolar lavage fractions of lung cancer patients.

BACKGROUND: It has been proven that cytokeratins (CKs) are useful tumor markers for the follow-up, treatment monitoring and prognosis evaluation of lung cancer and among these, tissue polypeptide antigen (TPA) plays an important role. Nevertheless, only a small number of studies have been reported about their diagnostic capacity. Bronchoalveolar lavage (BAL) can be divided into two fractions: bronchiolar (BF) and alveolar (AF). For the above reasons, our aims were (1) to analyze the diagnostic usefulness of TPA in the BAL of lung cancer patients and (2) to observe if, in lung cancer patients, TPA levels in the two BAL fractions are different. This should mean that the study of tumor markers in the BAL should be carried out in both fractions to increase their diagnostic capacity. METHODS: We studied 289 BALs divided into two phases. In phase I, TPA was analyzed in the BAL of six groups of subjects (healthy persons, chronic bronchitis, asthma, respiratory infections, diffuse interstitial pulmonary diseases and lung cancer). In phase II, TPA was studied in both BAL fractions of a group of patients with lung cancer. RESULTS: We observed that TPA levels were significantly higher in the BAL of patients with bronchogenic neoplasias. In these patients, TPA was increased in the BF of the lavage in relation to the AF. In smoker patients with pulmonary carcinomas, TPA was higher in the AF of the BAL than in the lavage of non-smokers. This did not occur in the BF. We found no relation between the TPA concentrations and cancer histology. CONCLUSIONS: We believe that TPA is a useful tumor marker with diagnostic capacity and this capacity is increased when it is studied in the two BAL fractions. Smoking habit may play a role in the secretion of tumor markers by the tumor cells.

[An evaluation of new prevention programs for tuberculous infection. II. BCG vaccination]. / Evaluación de los nuevos programas de prevención de la infección tuberculosa. II: Vacunación con BCG.

Tuberculosis is an infectious disease produced by Mycobacterium tuberculosis in a 98-99% of the cases and by Mycobacterium bovis in a 1-2%. Its early diagnosis is of a great importance because permits to reduce the transmission of the infection. Until now, the diagnostic techniques used to discover the dissemination of the disease are indirect. We have the PPD skin test and, among them, Mantoux is the most common. Correctly used it has a great diagnostic and epidemiological value, because it permits to evaluate those patients who can obtain a benefit with the chemoprophylaxis when the skin test is positive. We analyse the actual via of chemoprophylaxis, when and how it must be used. We study not only the drugs for the prophylaxis, but also the good and bad utilisation of the BCG vaccine, that it starts to have its indications in other countries.

Evaluación de los nuevos programas de prevención de la infección tuberculosa. II: vacunación con BCG / Evaluation of the new prevention programs for tuberculous infection (II): BCG vaccination

La tuberculosis es una enfermedad infecto-contagiosa producida, en el 98-99 % de los casos por el Mycobacterium tuberculosis y, en 1-2 porciento, por el Mycobacterium bovis. El diagnóstico precoz de esta enfermedad es de gran importancia porque permite reducir la transmisión de la infección. Los medios de diagnóstico que tenemos para descubrir la propagación de la enfermedad son, hasta ahora, indirectos. Contamos con las pruebas cutáneas con tuberculina, de las que la más conocida es el Mantoux. Correctamente utilizada tiene gran valor diagnóstico y epidemiológico, ya que permite evaluar aquellos pacientes que se pueden beneficiar del tratamiento quimioprofiláctico cuando su prueba ha sido positiva. Igualmente, en este artículo se analizan los medios actuales de quimioprofilaxis, cuándo deben emplearse y cómo se administrarán. Se repasa, no sólo los fármacos empleados en la profilaxis sino que también se recuerda el uso y mal uso de la vacuna con BCG, que empieza a tener sus indicaciones en otros países (AU)

[Idiopathic pulmonary hemosiderosis in a patient of advanced age]. / Hemosiderosis pulmonar idiopática en paciente de edad avanzada.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology characterized by hemoptysis, diffuse pulmonary infiltrates and iron-deficiency anemia. It is typically found in children and young adults. Finding that the concentration of siderophages exceeds 20% in bronchoalveolar lavage indicates a diagnosis of IPH. We report the case of a 72-year-old man with repeated diagnoses of respiratory infection, bronchiectasis and melena. Because such a clinical picture is rare for IPH, the final diagnosis was obtained by open lung biopsy.

[Evaluation of new programs to prevent tuberculosis infection. I. Chemoprophylaxis]. / Evaluación de los nuevos programas de prevención de la infección tuberculosa. I: quimioprofilaxis.

Tuberculosis is an infectious disease produced by Mycobacterium tuberculosis in a 98-99% of the cases and by Mycobacterium bovis in a 1-2%. Its early diagnosis is of a great importance because permits to reduce the transmission of the infection. Until now, the diagnostic techniques used to discover the dissemination of the disease are indirect. We have the PPD skin test and, among them, Mantoux is the most common. Correctly used it has a great diagnostic and epidemiological value, because it permits to evaluate those patients who can obtain a benefit with the chemoprophylaxis when the skin test is positive. We analyse the actual via of chemoprophylaxis, when and how it must be used. We study not only the drugs for the prophylaxis, but also the good and bad utilisation of the BCG vaccine, that it starts to have its indications in other countries.

The use of mouth occlusion pressure to evaluate the effect of an initial inhalation of nebulized saline in methacholine challenge.

BACKGROUND: In spite of standardization of bronchial provocation tests, some methodological aspects yet are controversial. The role of saline solution inhalation is questionable. The measurement of mouth occlusion pressure 0.1 seconds after the onset of inspiration (P0.1) is a good means of detecting a response from bronchoprovocation tests. OBJECTIVE: We investigated the value of an initial challenge with nebulized saline in subjects undergoing methacholine challenge. METHODOLOGY: Eighty-four consecutive patients clinically suspected of bronchial asthma were studied. Bronchial methacholine challenge was performed by Chatham method. P0.1 before and three minutes after saline solution inhalation were determined by the method of Whitelaw. RESULTS: There was no significant P0.1 change following the inhalation of the initial dose of nebulized saline either in those subjects who went on to produce a 20% decrement in FEV1 following a standardised methacholine challenge test, or in those subjects who proved to be non-reactors. CONCLUSIONS: We shown that no modifications are present in respiratory center function when it is assessed by measurement of mouth occlusion pressure after saline solution inhalation in methacholine challenge. This may be another reason why saline solution challenge should be omitted from bronchoprovocation challenge.