Proximal ileitis secondary to anisakiasis.

Intestinal anisakiasis is a disease caused by human infection by Anisakis larva that can be found in undercooked fish that is increasing worldwide. The symptoms, typically abdominal pain, develop within 5-7 days after the fish intake. The diagnosis may be suspected based on common anamnesis (unfrozen fish intake) with abdominal pain or bowel obstruction and confirmed by blood serology. Resective surgery is only used in severe cases.

Development of a decision tree to assess the severity and prognosis of stable COPD.

The aim of this study was to develop and validate a new method: a classification and regression tree (CART) based on easily accessible measures to predict mortality in patients with stable chronic obstructive pulmonary disease (COPD). This was a prospective study of two independent prospective cohorts: a derivation cohort with 611 recruited patients and a validation cohort with 348 patients, all followed for 5 yrs. CART analysis was used to predict 5-yr mortality risk using the following covariates from the derivation cohort: age, % predicted forced expiratory volume in 1 s (FEV(1)), dyspnoea, physical activity, general health and number of hospital admissions for COPD exacerbations in the previous 2 yrs. Age (≥ 75 or <75 yrs) provided the first branch of the COPD-CART. The highest mortality risk (0.74) was seen in patients >75 yrs of age with higher levels of dyspnoea and FEV(1) <50% pred. Patients with the lowest risk of 5-yr mortality (0.04) were <55 yrs of age with FEV(1) >35% pred and one or no recent hospitalisations for COPD exacerbations. A simple decision tree that uses variables commonly gathered by physicians can provide a quick assessment of the severity of the disease, as measured by the risk of 5-yr mortality.

Impact of changes in physical activity on health-related quality of life among patients with COPD.

The aim of this study was to evaluate whether changes in regular physical activity (PA) affect health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD). 611 patients (mean age 67.2+/-8.4 yrs; forced expiratory volume in 1 s 49.7+/-14.6) completed the St George's Respiratory Questionnaire (SGRQ), the Chronic Respiratory Questionnaire (CRQ) and the Medical Outcomes Short Form (SF-36) questionnaire. PA, defined as patients' self-reported regular walking times, was classified as low, moderate and high. After 5 yrs, 391 survivors completed these instruments again. After adjustment for relevant confounders, patients who reported low PA at baseline and who increased their PA over the study period improved their SGRQ and CRQ scores by 15.9 and 8.7 points, respectively. Patients who moved from moderate to high PA improved their SGRQ scores by 18.4 and their CRQ scores by 14.8. Slightly smaller increases were observed for patients who maintained a high level of PA throughout the study period. Maintaining a low level of PA or decreasing PA over the study period was associated with a significant HRQoL decline. Among COPD patients, a reduction in time spent engaging in PA or maintaining a low level may impair HRQoL, whereas an increase in PA can improve HRQoL parameters.

Classifying the severity of COPD: are the new severity scales better than the old?

BACKGROUND: Forced expiratory volume in 1 second cut-off points establish the severity of chronic obstructive pulmonary disease (COPD). OBJECTIVES: To compare how the American Thoracic Society (ATS), the British Thoracic Society (BTS), the Global Initiative for COPD (GOLD) and the ATS-European Respiratory Society (ATS-ERS) guidelines for rating COPD severity predict several significant outcomes. DESIGN: Five-year prospective cohort study. Spirometry was performed and health-related quality of life (HRQoL) assessed using the Short Form 36 Health Survey and the Saint George's Respiratory Questionnaire. Hospital admissions resulting from COPD exacerbation and mortality during a 5-year follow-up period were recorded. RESULTS: In all guidelines, the number of admissions was directly associated with COPD severity. The sensitivity and specificity for 5-year respiratory mortality were respectively 0.21 and 0.97 for the GOLD/ATS-ERS, 0.51 and 0.79 for the BTS, and 0.37 and 0.89 for the ATS guidelines. A similar pattern was seen for all-cause mortality. For HRQoL, statistically significant differences between guidelines were seen only for the BTS and ATS scales. CONCLUSIONS: These guidelines did not consistently stratify patients with regard to 5-year mortality and HRQoL. Although the BTS system was slightly superior, none of the guidelines were closely related to these outcomes. Other instruments are needed for a better determination of the severity of COPD.

Crioglobulinemia asociada a primoinfección por citomegalovirus / Cryoglobulinemia associated to cytomegalovirus primoinfection

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A simple score for assessing stable chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is usually assessed using FEV(1) to establish the diagnosis and the severity of the disease. However, COPD is now considered a systemic disease. AIM: To evaluate the utility of the Health-Activity-Dyspnoea-Obstruction (HADO) score for classifying the severity of COPD and predicting outcomes. DESIGN: Prospective longitudinal clinical study. METHODS: We studied 611 consecutive patients with stable COPD in five out-patient clinics of a teaching hospital. We measured dyspnoea degree, pulmonary function (by spirometry), self-reported level of daily physical activity and overall health condition. Outcome measures included health-related quality of life (HRQoL) parameters (as measured by the generic SF-36 Health Survey and by two specific questionnaires, the St George Respiratory Questionnaire and the Chronic Respiratory Questionnaire) and mortality at 3 years follow-up. RESULTS: Based on the HADO score, COPD was classified as mild in 26.7% of patients, moderate in 53.3%, and severe in 20%. There were statistically significant correlations between these three levels of severity and HRQoL parameters and vital status. After adjustment for relevant covariates, the HADO score reliably predicted survival and vital status. DISCUSSION: The HADO score can be easily obtained in an out-patient clinic, and distinguishes groups of COPD patients by their disease severity. The HADO score is better than FEV(1%) alone for predicting mortality at 3 years.

Dolor e impotencia funcional de extremidad inferior derecha / Pain and functional impotence inthe lower right extremity

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Masa inguinal como forma de presentación de la enfermedad por arañazo de gato / Inguinal mass as presentation of cat-scratch disease

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Rabdomiólisis asociada al uso de simvastatina / Rhabdomyolisis associated with the use of simvastatin

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[Description of a sample of patients with chronic obstructive pulmonary disease treated at hospital-supervised respiratory clinics at primary care centers]. / Descripción de una muestra de pacientes con enfermedad pulmonar obstructiva crónica atendidos en las consultas del área de neumología dependientes de un hospital.

OBJECTIVE: To study the general characteristics, health perception and limitations of patients with chronic obstructive pulmonary disease (COPD) treated at respiratory clinics at primary care centers staffed by pulmonologists from our hospital service. METHOD: The study was carried out at 5 primary care centers that enrolled the patients consecutively. Questionnaires were used to collect information on sociodemographic aspects, perception of health, and limitations to activities of daily living. We also collected information on the treatments patients were receiving and comorbidities. Spirometry was also performed. RESULTS: Six hundred eleven patients with a mean age of 67.2 years were included in the study; 97.7% were male. The most common comorbidities were spinal column pathology (43%) and osteoarthritis (37%). The mean forced expiratory volume in 1 second (FEV1) was 1.37 L and FEV1% was 49.7% of predicted. Medications taken for COPD were mainly beta-adrenergics and anticholinergics; 66% of patients used inhaled steroids. The majority of patients (52.7%) referred to their health as fair and 59.9% declared having some degree of limitation to their activities of daily living which they attributed to their respiratory disease. Statistical differences were found between the degree of limitation and the degree of dyspnea (P<.0001), perception of health (P<.0001), and FEV1 (P=.001). CONCLUSIONS: Our study outlines the general characteristics of COPD patients and shows that dyspnea is closely related to the perception patients have of their degree of limitation.

Descripción de una muestra de pacientes con enfermedadpulmonar obstructiva crónica atendidos en las consultas del área de neumología dependientes de un hospital / Description of a sample of patients with chronic obstructive pulmonary disease treated at hospital-supervised respiratory clinics at primary care centers

OBJETIVO: Conocer las características generales, la percepción de salud y las limitaciones de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) atendidos en las consultas de área dependientes de nuestro servicio. MÉTODO: El estudio se llevó a cabo en 5 consultas de área en las que, de forma consecutiva, se fue incluyendo a los pacientes. Mediante cuestionarios se recabó información sobre diversos aspectos sociodemográficos, percepción de salud y limitación en la vida habitual. Asimismo se recogió información sobre los tratamientos que realizaban los pacientes y las enfermedades asociadas que padecían, y se practicó una espirometría. RESULTADOS: Se estudió a 611 pacientes con una edad media de 67,2 años; de ellos, el 97,7 por ciento eran varones. Las enfermedades asociadas más frecuentes fueron la patología de columna y la osteoartrosis (el 43 y el 37 por ciento, respectivamente).La media del volumen espiratorio forzado en el primer segundo (FEV1) fue del 1,37 l respecto al valor teórico, y el FEV1 medio fue del 49,7 por ciento. Los fármacos más utilizados en relación con la EPOC fueron los -adrenérgicos y los anticolinérgicos, el 66 por ciento de los pacientes recibía tratamiento con esteroides inhalados. La mayoría de los pacientes (52,7 por ciento) refería su salud como regular y el 59,9 por ciento manifestaba presentar algún grado de limitación en sus actividades habituales que atribuía a su enfermedad respiratoria. Se encontraron diferencias estadísticamente significativas entre el grado de limitación y el grado de disnea (p < 0,0001), el grado de percepción de salud (p < 0,0001) y el FEV1 (p = 0,001). CONCLUSIONES: Los datos de nuestro estudio dibujan las características generales de los pacientes con EPOC e indican que la disnea se relaciona íntimamente con la percepción de limitación que presentan los pacientes (AU)

[Reference figures for pulmonary artery pressures after effective treatment of Graves' disease]. / Normalización de las cifras de presión en la arteria pulmonar tras tratamiento efectivo de la enfermedad de Graves.

We report the case of a 48-year-old woman with a diagnosis of pulmonary hypertension and hyperthyroidism (Graves' disease) in whom pulmonary artery pressures became normal after treatment of thyroid disease. The possible pathogenic mechanisms involved in this association include the presence of hyperdynamic heart failure and/or the presence of immune alterations underlying both conditions.

Normalización de las cifras de presión en la arteria pulmonar tras tratamiento efectivo de la enfermedad de Graves / Reference figures for pulmonary artery pressures after effective treatment of Graves' disease

Presentamos el caso de una paciente de 48 años de edad con diagnóstico de hipertensión pulmonar e hipertiroidismo (enfermedad de Graves) en la que se objetivó la normalización de las cifras de presión en la arteria pulmonar tras el tratamiento de su enfermedad tiroidea. Los posibles mecanismos etiopatogénicos involucrados en esta asociación incluirían la presencia de un fallo cardíaco hiperdinámico y/o la existencia de una alteración de la inmunidad subyacente y común a ambos (AU)