Efectividad de un programa de rehabilitación respiratoria en pacientes con síndrome de apnea obstructiva del sueño: estudio cuasi-experimental / Effectiveness of a respiratory rehabilitation programme in patients with sleep obstructive apnoea syndrome: Quasi experimental study

OBJETIVOS: El objetivo del estudio fue analizar la efectividad de un programa de rehabilitación respiratoria en pacientes obesos sedentarios con síndrome de apnea obstructiva del sueño (SAOS) en el que se incluyó la realización de ejercicio físico terapéutico. Participantes y métodos: Estudio cuasi-experimental de 2 grupos, grupo intervención y grupo control, no aleatorizados con evaluación pre/post. Se seleccionaron 47 pacientes del hospital diagnosticados de SAOS con obesidad y en tratamiento médico, los cuales fueron tratados por el mismo equipo y siguiendo los mismos criterios diagnósticos. Se registraron las siguientes variables: índice de masa corporal, poligrafía respiratoria, capacidad de ejercicio, patrón de comportamiento sedentario y calidad de vida. Se realizó una comparación pre/post a los 3 meses. RESULTADOS: Se analizaron 38 pacientes y los resultados obtenidos al comparar los valores pre/post de todos los individuos muestran diferencias significativas en forma de mejora en todas las variables analizadas a excepción del comportamiento sedentario. En la comparación pre/post entre los grupos se aprecia una diferencia significativa (p = 0,049) en la percepción de la calidad de vida, concretamente, en la dimensión de los síntomas diurnos (0,42; IC 95%: 0,48-1,33), indicando una tendencia a la mejora en el grupo que ha realizado el programa de ejercicio propuesto. CONCLUSIÓN: La combinación del tratamiento médico de los pacientes durante un mínimo de 6 meses junto con la realización del programa de rehabilitación respiratoria en el que se incluye el ejercicio físico terapéutico genera una tendencia a la mejora clínica de estos, aumentando su calidad de vida, pero sin ningún tipo de cambio en su comportamiento sedentario

OBJECTIVES: The objective of the study was to analyse the effectiveness of a respiratory rehabilitation programme in sedentary, obese patients with Obstructive Sleep Apnoea Syndrome (OSAS) which included therapeutic physical exercise. Participants and methods: A quasi-experimental study of two groups, an intervention group and a control group, not randomised and with pre/post evaluation. Forty-seven hospital patients diagnosed with obesity and under medical treatment were selected and treated by the same team, following the same diagnostic criteria. The following variables were recorded: body mass index, respiratory polygraph, exercise capacity, sedentary behaviour pattern and quality of life. A pre/post comparison was made at 3 months. RESULTS: 38 patients were analysed, and the results obtained when comparing the pre/post values of all the individuals show significant differences in the form of improvement in all variables analysed except for sedentary behaviour. In the pre/post comparison between the groups, a significant difference (p=.049) was observed in perception of quality of life, specifically in the daytime symptom dimension (.42; 95% CI: .48-1.33), indicating a trend towards improvement in the group that undertook the proposed exercise programme. CONCLUSION: The combination of the patients' medical treatment over a minimum of 6 months together with completion of the respiratory rehabilitation programme which included therapeutic physical exercise resulted in a tendency to clinical improvement for the patients, increasing their quality of life, but with no change in their sedentary behaviour

Fibrosis quística: aumento de la sobrevida en un centro especializado a 10 años de seguimiento / Improving cystic fibrosis survival as a result of management in a specialized center with 10-year follow-up

Introducción: La Fibrosis Quística (FQ), la enfermedad genética más frecuente de la raza blanca, es una patología multisistémica y como tal requiere un abordaje multidisciplinario coordinado para obtener mejores resultados de sobrevida y calidad de vida. Con este propósito se organizó un Centro de Fibrosis Quística (CDFQ) en Mendoza, Argentina, y se diseñó este estudio con el objetivo de evaluar la hipótesis de que la organización y tratamiento de la FQ de acuerdo con normas internacionales, mejora la sobrevida. Pacientes y método: Se evaluaron 106 pacientes con FQ a partir del año 1975 en el CDFQ. Los pacientes se agruparon para su seguimiento como cohortes de los años 1999, 2002, 2005 y 2008. Para comparar tasas de sobrevida se usó el test de x² y para edad mediana de la población se usó el test no paramétrico de Mann-Whitney. Resultados: En el año 2008 la sobrevida a los 17 años fue de 80 por ciento comparado con el año 1999 donde esta cifra alcanzó 45 por ciento a la misma edad (p < 0,001). La mediana de edad de la población con FQ total aumentó de 4 años (1985) a 12 años (2008) (p < 0,003). Conclusiones: Un enfoque multidisciplinario y normatizado en un CDFQ puede aumentar la sobrevida significativamente.

Introduction: Cystic fibrosis (CF), the most common genetic disease among whites, is a multisystem disease that requires a coordinated multidisciplinary approach to get better results regarding survival and quality of life. This is why a Cystic Fibrosis Center (CFC) was held in Mendoza, Argentina, with the assumption that the organization and management of CF, according to international standards would improve survival. Patients and Method: 106 patients with CF have been evaluated since 1975 in this Center. Patients were grouped for follow-up monitoring as the 1999, 2002, 2005 and 2008 cohort studies. The chi-square test was used to compare survival rates and the nonparametric Mann-Whitney test was used to calculate the median age of the population. Results: In 2008, survival at 17 years old was 80 percent compared with 45 percent for the same age in 1999 (p < 0,001). The median age of the total CF population increased from 4 (1985) to 12 years old (2008) (p < 0,003). Conclusions: A multidisciplinary standardized approach of this condition in a CF Center can significantly increase survival.

[Improving cystic fibrosis survival as a result of management in a specialized center with 10-year follow-up]. / Fibrosis quística: aumento de la sobrevida en un centro especializado a 10 años de seguimiento.

INTRODUCTION: Cystic fibrosis (CF), the most common genetic disease among whites, is a multisystem disease that requires a coordinated multidisciplinary approach to get better results regarding survival and quality of life. This is why a Cystic Fibrosis Center (CFC) was held in Mendoza, Argentina, with the assumption that the organization and management of CF, according to international standards would improve survival. PATIENTS AND METHOD: 106 patients with CF have been evaluated since 1975 in this Center. Patients were grouped for follow-up monitoring as the 1999, 2002, 2005 and 2008 cohort studies. The chi-square test was used to compare survival rates and the nonparametric Mann-Whitney test was used to calculate the median age of the population. RESULTS: In 2008, survival at 17 years old was 80% compared with 45% for the same age in 1999 (p < 0,001). The median age of the total CF population increased from 4 (1985) to 12 years old (2008) (p < 0,003). CONCLUSIONS: A multidisciplinary standardized approach of this condition in a CF Center can significantly increase survival.

Aplicación de las guías de práctica clínica en la enfermedad pulmonar obstructiva crónica / Application of clinical practice guidelines in chronic obstructive pulmonary disease

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Persistence of Streptococcus pneumoniae urinary antigen excretion after pneumococcal pneumonia.

The aim of this study was to determine the duration of Streptococcus pneumoniae antigen excretion in urine after pneumococcal pneumonia. Urinary antigen detection remained positive in nonconcentrated urine in 18 (52.9%) of the 34 patients in the first month after pneumonia diagnosis. In 12 of these positive cases, the test was still positive in the second month, in six patients after 4 months, and in two cases 6 months after the diagnosis of pneumonia. Using concentrated urine, antigenuria remained positive in all patients for at least 3 months, with antigen detected in three cases more than one year later. We did not observe a relation between age, gender, immunosuppression, underlying diseases, pneumonia severity, positive blood culture, or X-ray presentation and longer-term antigenuria excretion. However, the small number of patients evaluated is a limitation for statistical analysis. In order to correctly analyse a positive urinary antigen test result in patients with pneumonia, it is necessary to know which patients have recently had a previous episode of pneumonia.

Usefulness of pneumococcal antigen detection in pleural fluid samples by immunochromatographic assay for diagnosis of pneumococcal pneumonia.

This study investigated the utility of an immunochromatographic test (ICT) for the detection of Streptococcus pneumoniae antigens in pleural fluid. Antigen was detected in 15 of 19 (79%) patients with pneumococcal pneumonia. The ICT was always negative in patients with non-pneumococcal pneumonia, but was positive in three cases with a non-infectious aetiology. In patients with pneumonia for which no pathogen was identified, antigen was detected in one of 24 pleural fluids tested. The ICT can be a valuable tool for the management of pneumonia because it can detect pneumococcal antigen in pleural effusion samples.

Predictive factors in smoking cessation with combined therapy with bupropion and nicotine patches.

UNLABELLED: The association of bupropion and nicotine is a good choice in the treatment of smoking cessation. However, not all patients actually give up smoking. STUDY OBJECTIVES: This work was undertaken with the aim of finding out the functional or clinical variables that could be associated with the success of the cessation therapy. DESIGN: In one year, 88 patients who were treated with bupropion 300 mg/day and nicotine patches were followed-up, for 1 month and 3 months, respectively. They were all questioned about the number of cigarettes per day, the years they have been smoking, the number of quitting attempts, and concurrent pulmonary conditions were sought for. The Fageström Test, forced spirometry (FVC, FEV-1, FEF25-75), and exhaled carbon monoxide (by co-oxymetry) were also assessed. For the statistical analysis, a logistic regression model allowing to predict the response of new subjects to the treatment, with the lowest error possible, was applied. To choose the working model, the highest and lowest value of each variable were found, drawing the correlation matrix between dependent and independent variables, by means of the box-plot procedure. Then, the model's application conditions were analysed: linearity, homoscedasticity, independence of the applications, and normality of the distributions. To assess the discrimination of the model, a ROC curve was used. RESULTS: Showed that at the end of the follow-up year, 59.1% of the patients quitted smoking. The multivariate analysis with logistic regression showed that no previous history of chronic obstructive pulmonary disease (COPD), a FEF25-75 value and effectively quit after the first week of treatment were independent prognostic factors of treatment success. When the diagnosis precision of our model was analysed by means of the ROC curve, it showed a 78% value, with the 95% confidence interval ranging from 68.5% to 86.9%. At the optimal cut-off point of our model, sensitivity and specificity for quitting smoking were found to be 66.7% and 80%, respectively. CONCLUSIONS: We conclude that with a diagnosis precision of 78.8% patients with no history of COPD, who quitted at the first week of therapy with bupropion and with low FEF25-75, will remain non-smokers after one year follow-up. Contrarily, COPD patients who still smoke after one week of therapy, will not achieve quitting smoking.

[Smoking cessation and bupropion: anxiety and depression as predictors of therapeutic efficacy]. / Deshabituación tabáquica y bupropión: la ansiedad y la depresión como índices de eficacia terapéutica.

UNLABELLED: Smoking and depression are related. Bupropion, the first non-nicotinic drug that is an effective treatment in smoking cessation, is a tricyclic antidepressant that inhibits neuronal uptake of serotonin, dopamine and norepinephrine in the thalamic nuclei. OBJECTIVE: To assess if certain personality factors (anxiety or depression) might predict the efficacy of bupropion for smoking cessation. METHOD: The study was carried out in two smoking cessation clinics in Madrid and Barcelona. Fifty patients (21 men) declaring the desire to quit smoking were enrolled. Their mean age was 43.6 years (SD 8.75). The patients were treated with 300 mg of bupropion per day for one month and expired CO was monitored for 6 months. Personality factors were assessed on a hospital anxiety and depression scale (HADS). We evaluated whether there was a significant difference in HADS scores for patients who were still not smoking after 6 months and those who had not managed to quit. RESULTS: The 50 patients were smokers of a mean 39 packs per year (SD 17.82) and had mean scores of 7.4 (SD 4.15) for anxiety and 5.8 (SD 3.93) for depression. Four patients (8%) were unable to complete the study. After one month, 28% of the patients smoked, after 3 months 56% smoked and after 6 months 58% still smoked. The patients who smoked during the first month had higher depression scores than did the non-smokers (p = 0.03). After 3 and 6 months the patients who had managed to continue not smoking were those who had higher anxiety scores than did those who still smoked (p = 0.0052 at 3 months and p = 0.017 at 6 months). CONCLUSION: Patients who responded better to treatment with bupropion after 6 months of follow-up were those with higher anxiety scores on the HADS. Depression levels influenced outcome only during the first month.

Deshabituación tabáquica y bupropión: la ansiedad y la depresión como índices de eficacia terapéutica / Smoking cessation and bupropion: anxiety and depression as predictors of therapeutic efficacy

Existe una relación entre tabaquismo y enfermedad depresiva. Bupropión es el primer fármaco no nicotínico eficaz en la deshabituación tabáquica. Se trata de un antidepresivo que inhibe la recaptación neuronal de la serotonina, la dopamina y la noradrenalina en los nucleos talámicos. OBJETIVO: Valorar si existen algunas variables dentro del área de la personalidad (ansiedad o depresión) que pudiesen servir como índices predictivos en el tratamiento deshabituador con bupropión. MÉTODO: Estudio realizado en dos consultas de tabaquismo (Madrid y Barcelona). Se incluyó a 50 pacientes (21 varones) con una edad media de 43,6 años (desviación estándar [DE], 8,75) que manifestaban la voluntad en querer dejar de fumar. Fueron tratados con 300 mg/día de bupropión durante un mes y seguidos durante 6 meses con controles de CO espirado. Las variables de personalidad fueron evaluadas con el test de HADS, test psicométrico que puntúa trastornos de personalidad ansiosodepresivos. Se valoró si existía alguna diferencia significativa en los valores de puntuación del HADS entre los pacientes que seguían sin fumar a los 6 meses y los que no. RESULTADOS: Los 50 pacientes incluidos eran fumadores con una media de 39 paquetes/año (DE, 17,82) y con un valor medio de ansiedad de 7,4 (DE, 4,15) y de depresión de 5,8 (DE, 3,93). Un total de 4 pacientes (8 per cent) no pudo completar el estudio. Al primer mes de tratamiento un 28 per cent de los pacientes fumaba, al tercer mes era un 56 per cent de fumadores y a los 6 meses un 58 per cent de los pacientes incluidos seguía fumando. Al analizar las variables de personalidad, observamos que los pacientes que durante el primer mes fumaban tenían unas puntuaciones más elevadas de depresión que los no fumadores (p = 0,03). Al tercero y el sexto mes los pacientes que siguen sin fumar presentan unas puntuaciones más elevadas de ansiedad que la de aquellos pacientes que siguen fumando (p = 0,0052 a los 3 meses y p = 0,017 a los 6 meses). CONCLUSIÓN: Los pacientes que responden mejor al tratamiento con bupropión y después de 6 meses de seguimiento son aquellos que tienen niveles de ansiedad más elevados según el HADS test. Los niveles de depresión sólo influyen negativamente durante el primer mes (AU)

[Bupropion combined with nicotine patches in smoking cessation]. / Asociación de bupropión y parches de nicotina como terapia para dejar de fumar.

Smoking cessation is a first-line treatment for patients with bronchial and pulmonary diseases. Various strategies have been developed to help patients quit. Bupropion, a drug initially developed as an antidepressant, has recently been shown to have effects that increase the ability of a smoker to quit. This descriptive study, enrolling 86 patients who volunteered for a smoking cessation program, assesses the use of 300 mg of bupropion over a 4-week period combined with 12 weeks of nicotine patch application at doses that were lowered every 4 weeks. Abstinence was achieved by 69% of patients after 6 months of follow-up and no significant side effects were described. The percentage decreased to 58.6% after one year of follow-up. No significant differences were found between success in quitting in this study and either the number of prior attempts to quit or concomitant respiratory disease. We conclude that bupropion combined with transdermal nicotine is a good option to aid patients to achieve smoking cessation.

Asociación de bupropion y parches de nicotina como terapia para dejar de fumar / Combining nicotine patches and bupropion in smoking cessation therapy

El abandono del consumo de tabaco es una medida terapéutica de primer orden para todos los pacientes afectados de bronconeumopatías. A lo largo del tiempo, van apareciendo diferentes estrategias para ayudar a nuestros pacientes a dejar su hábito tabáquico. El bupropión es un fármaco que fue desarrollado inicialmente como agente antidepresivo; recientemente se ha descrito la acción por la cual aumenta la capacidad del fumador de abstenerse de fumar. Estudio descriptivo que valora a un grupo de 86 pacientes que voluntariamente quiso someterse a un programa de deshabituación tabáquica utilizando como tratamiento 300 mg de bupropión durante 4 semanas, asociado a los parches de nicotina, dosis decrecientes cada 4 semanas, durante 12 semanas. Los resultados obtenidos fueron que un 69 por ciento de nuestros pacientes consiguió abstenerse de fumar después de 6 meses de seguimiento, sin describirse efectos secundarios significativos. Este porcentaje disminuyó al 58,6 por ciento al cabo de un año de seguimiento. Al analizar si existía alguna relación entre el número de veces que el paciente había intentado previamente dejar de fumar y el éxito en este intento, no se observaron diferencias significativas. Tampoco se encontraron al valorar si existía enfermedad pulmonar concomitante y abandono tabáquico. Concluimos afirmando que la asociación de bupropión y nicotina transdérmica es una buena alternativa para ayudar a nuestros pacientes a dejar de fumar. (AU)

Analysis of tracheal sounds during forced exhalation in asthma patients and normal subjects: bronchodilator response effect.

PURPOSE: During the past 10 years, the acoustic analysis of breath sounds has been used as a diagnostic tool in patients suffering from obstructive respiratory diseases. Acoustic analysis might be able to monitor the response to bronchodilator therapy in a clinical setting. So far, few studies have been carried out in asthmatic patients. To assess the responses of a sampling of asthma patients to an inhaled bronchodilator (terbutaline) by means of spectral analysis of the tracheal sound performed during forced expiratory maneuvers. MATERIAL AND METHODS: Seventeen nonsmoking asthma patients (9 were male, 8 were female) who had been suffering from the disease for > or = 15 years were included in the study, as were 15 normal subjects (7 were male, 8 were female). The average age (+/- SD) was 56.5 +/- 15.2 years (FVC, 2.7 +/- 0.9 L [63.4%]; FEV1, 1.5 +/- 0.6 L [53.0%]). The tracheal sounds were collected during three forced expiratory maneuvers with a sampling frequency of 5,000 Hz and were analyzed by applying a 16-parameter autoregressive model. RESULTS: The centroid frequency decreased after the bronchodilator was given at different flow segments between 1.2 and 0.4 L/s, with significant changes between 0.6 and 0.4 L/s. CONCLUSIONS: Patients with asthma showed changes in the spectral acoustic analysis frequencies after the administration of a bronchodilator drug (terbutaline) during forced expiratory maneuvers.

Cytology of bronchial biopsy rinse fluid to improve the diagnostic yield for lung cancer.

Sampling techniques are combined during bronchoscopy to increase the diagnostic yield for endobronchial malignant tumours. Bronchial biopsy provides the definitive histological diagnosis in most cases, but accompanying cytological procedures such as washing, brushing, needle aspiration or imprint cytology can increase diagnostic yield. In this prospective study, a different cytological technique, that could enhance the diagnostic yield of bronchoscopy without increasing its time or cost, was tested. Flexible bronchoscopy was performed in 93 patients suspected of having pulmonary neoplasms. Bronchial biopsies were initially placed in a balanced salt solution. When bronchoscopy was finished, all visible tissue fragments were removed and placed in formalin to undergo histopathological examination and the rinse fluid was sent for cytological examination. Washing was performed routinely but no cytological brushing was employed. Eighty-two patients had final diagnoses of malignant neoplasm. In four (4.8%) of these patients, the only positive result came from the cytological examination of the bronchial biopsy rinse fluid. No false-positive results were found. The agreement with the histological results was 81.8%. The addition of bronchial biopsy rinse-fluid examination increased the sensitivity of bronchoscopy from 65.8% to 70.7% (McNemar's p=0.009). The cytological study of bronchial biopsy rinse fluid offers reliable positive results in an additional 4.8% of cases, thus enhancing bronchoscopic diagnostic yield for malignant endobronchial tumours while neither prolonging the procedure nor increasing costs.

Pancoast's syndrome due to chronic pneumonia by Pasteurella multocida.

Infectious causes of Pancoast's syndrome are extremely rare. We describe the case of a patient with Pancoast's syndrome due to chronic pneumonia resulting from Pasteurella multocida. The patient was not immunosuppressed and had had no contact with animals. The diagnosis was made by transthoracic needle aspiration and institution of therapy with cefuroxime-axetil resulted in resolution of his symptoms.

[Acute lipoid pneumonia. Report of 2 cases]. / Neumonía lipoidea aguda. Presentación de dos casos.

Lipoid pneumonia is a chronic infiltrative pulmonary process secondary to continued aspiration of exogenous lipids (laxatives and nasal drops). On occasions, an acute form of lipoid pneumonia which may lead to respiratory failure may be observed coinciding with accidental massive aspirations of lipidic material. Two cases of acute lipoid pneumonia secondary to paraffin aspiration in << fire eaters >> are presented.