Large-scale real-life analysis of survival and usage of therapies in multiple myeloma.

Survival in multiple myeloma has improved significantly in recent years, especially in young patients. We reviewed the evolution of the survival of patients with MM in three groups based on age at MM diagnosis over three time periods between 1999 and 2020 at our 12 de Octubre Hospital institution (H12O). Then, to confirm our results, we used data from TriNetx, a global health research platform that includes patients from Europe to US. Finally, we analysed differences in the patterns of treatment between networks across the world. Kaplan‒Meier analysis was used to estimate survival probabilities, and between-group differences were tested using the log-rank test and hazard ratio. For patients from H12O, the median OS was 35.61, 55.59 and 68.67 months for the 1999-2009, 2010-2014 and 2015-2020 cohorts, respectively (p = 0.0001). Among all patients included in the EMEA network, the median OS was 20.32 months versus 34.75 months from 1999-2009 versus 2010-2014. The median OS from the 2010-2014 versus 2015-2020 time cohorts was 34.75 months versus 54.43 months, respectively. In relation to the US cohort, the median OS from before 2010 versus 2010-2014 was not reached in either time cohort and neither when comparing the 2010-2014 versus 2015-2019 time cohorts. Bortezomib is the most commonly used drug in the EMEA cohort, while lenalidomide is the most commonly used drug in the US cohort. This large-scale study based on real-world data confirms the previous finding that MM patients have increased their survival in the last two decades.

Impact of COVID-19 in patients with multiple myeloma based on a global data network.

The COVID-19 pandemic has represented a major cause of morbidity/mortality worldwide, overstressing health systems. Multiple myeloma (MM) patients show an increased risk for infections and they are expected to be particularly vulnerable to SARS-CoV-2 infection. Here we have obtained a comprehensive picture of the impact of COVID-19 in MM patients on a local and a global scale using a federated data research network (TriNetX) that provided access to Electronic Medical Records (EMR) from Health Care Organizations (HCO) all over the world. Through propensity score matched analyses we found that the number of new diagnoses of MM was reduced in 2020 compared to 2019 (RR 0.86, 95%CI 0.76-0.96) and the survival of newly diagnosed MM cases decreased similarly (HR 0.61, 0.38-0.81). MM patients showed higher risk of SARS-CoV-2 infection (RR 2.09, 1.58-2.76) and a higher excess mortality in 2020 (difference in excess mortality 9%, 4.4-13.2) than non-MM patients. By interrogating large EMR datasets from HCO in Europe and globally, we confirmed that MM patients have been more severely impacted by COVID-19 pandemic than non-MM patients. This study highlights the necessity of extending preventive measures worlwide to protect vulnerable patients from SARS-CoV-2 infection by promoting social distancing and an intensive vaccination strategies.

Atención del paciente con EPOC mediante un programa de e-salud / E-health for copd patients

La e-salud, apoyada en el uso de las nuevas tecnologías, nos da las herramientas necesarias para innovar en la asistencia a nuestros pacientes y ha permitido evolucionar el concepto de la relación profesional sanitario-paciente. Sus aplicaciones son prácticamente ilimitadas y los estudios avalan su eficacia, si bien, existen una serie de cuestiones que limitan su implementación real (dificultad para la comparación metodológica, factores asociados al profesional o al paciente, aspectos éticos y legales, etc.). Una de las aplicaciones más interesantes desde el punto de vista clínico es la tele-consulta, especialmente en la actual situación de pandemia por la COVID-19. En este trabajo revisamos las posibilidades de implementación de un programa de tele-consultas en pacientes con EPOC, la selección de candidatos, las posibles herramientas tecnológicas y las limitaciones de este tipo de programas (AU)

E-health using new technologies is a new way to attend our patients and creates a new scenario in the relation between patients and their health carers. Their applications are uncontable and many articles support their efficacy, although some questions still make difficult its implementation. One of the most interesting applications for clinicians is teleconsultation, specially nowadays with COVID pandemic. We review the possible implementation of a tele-consultation program for COPD patients, the right selection of patients, technological tools and its limitations (AU)

Smoking in tuberculosis patients increases the risk of infection in their contacts.

OBJECTIVE: To determine the risk of latent tuberculous infection (LTBI) among contacts of smokers with tuberculosis (TB). METHODS: A study was conducted to determine the prevalence of LTBI among contacts of TB cases aged >14 years in Catalonia, Spain. A survey was carried out for each TB case and their contacts. LTBI was diagnosed using the tuberculin skin test (≥5 mm). The risk of LTBI associated with smoking was determined by multi-variate logistic regression analysis, with adjusted odds ratio (aOR) and their 95% confidence intervals (CI). RESULTS: The smoking prevalence among TB cases was 40.7% (439/1079). The prevalence of LTBI among their contacts was 29.7% (2281/7673). It was higher among contacts of smoking index cases (35.3%) than among those of non-smokers (25.7%). Smoking was independently associated with an increased risk of LTBI among contacts (aOR 1.5, 95%CI 1.3-1.7), and was estimated to be responsible for 12.8% of infections. CONCLUSIONS: Index case smoking increases the risk of LTBI and should be systematically investigated. A reduction in smoking could lower the risk of infection substantially.

Cost-effectiveness of rifampin for 4 months and isoniazid for 9 months in the treatment of tuberculosis infection.

The purpose of this study was to evaluate the cost-effectiveness of the strategy of controlling the contacts of tuberculosis patients with latent tuberculosis infection by means of treatment with rifampin for 4 months or isoniazid for 9 months. The cost was the sum of the cost of treating latent tuberculosis infection in all contacts plus the cost of treating tuberculosis in whom the disease was not avoided. The effectiveness was expressed as cases avoided. The efficacy adopted was 90 % for rifampin for 4 months and 93 % for isoniazid for 9 months. We carried out a sensitivity analysis for efficacies of rifampin for 4 months of 80 %, 75 %, 69 % and 65 %. Of the 1,002 patients studied, 139 were treated with rifampin for 4 months and 863 were treated with isoniazid for 9 months. The cost-effectiveness was 436,842.83/50 cases avoided with rifampin for 4 months and 692,164.42/40 cases avoided with isoniazid for 9 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies of 75 % or greater. The cost-effectiveness analysis favoured the use of rifampin for 4 months when its efficacy was 75 % or greater.

Is isoniazid for 6 months more cost-effective than isoniazid for 9 months?

SETTING: The optimal treatment for latent tuberculosis infection consists of isoniazid (H, INH) for 9-12 months. Although INH for 6 months (6H) is more cost-effective than the 12-month regimen, the cost-effectiveness of the 6H regimen and that of INH for 9 months (9H) have not been compared. OBJECTIVE: To compare the cost-effectiveness of treatment with 6H and 9H. METHODS: Cost-effectiveness was evaluated using the ratio of the cost of preventing one tuberculosis case using 6H vs. 9H. The cost was estimated as the product of the number of patients to be treated to prevent one case using 6H or 9H × the cost of 6H or 9H. RESULTS: A total of 1039 patients were studied. The number of patients that needed to be treated to prevent one case was 33 (95%CI 21-83) using 6H and 26 (95%CI 18-50) using 9H. The cost of 6H and 9H was respectively €444.34 and €578.26, and the cost ratio of preventing one case with 6H/9H was 0.98 (95%CI 0.6-1.5). CONCLUSIONS: The cost-effectiveness of treatment with 6H and 9H is similar.

Edad pulmonar espirométrica: antes y después del abandono del tabaco / Spirometry lung age: before and after quitting smoking

Resumen. Objetivos: Calcular la edad pulmonar espirométrica del fumador. Conocer las diferencias entre la edad cronológica y la edad pulmonar espirométrica antes y un año tras el abandono del tabaco. Averiguar si los datos de consumo de tabaco influyen en dichas diferencias. Analizar estos datos en el subgrupo de pacientes EPOC. Material y métodos: Pacientes que acuden a nuestra consulta de deshabituación tabáquica; se les realiza una espirometría antes y un año tras dejar de fumar. Cálculo de la edad pulmonar espirométrica basal y al año del abandono. Análisis estadístico con SPSS 11.0. Resultados: 117 pacientes, 58,10% mujeres; edad media 47,10 años, edad inicio consumo 16,45 años, consumo medio diario 26,40 cigarrillos. Las cifras de consumo de tabaco no mostraban diferencias significativas entre ambos sexos. La edad media pulmonar del fumador era superior a la cronológica, tanto en varones como en mujeres (12,58 y 1,13 años, respectivamente). Tras un año de abstinencia, el pulmón de los varones tenía 10,97 años más que el propio paciente, mientras que en mujeres la edad pulmonar estaba por debajo de la edad cronológica en 3,67 años. Los datos de consumo de tabaco mostraban correlación con la edad pulmonar antes y después del abandono en ambos sexos. Los fumadores que tenían valores de función pulmonar de EPOC eran 18 (55,6% varones). Estos pacientes presentaban mayores diferencias entre las edades pulmonares final e inicial en ambos sexos frente a la serie global. Conclusión: el pulmón del fumador está “envejecido”. Tras el abandono del tabaco se consigue un rejuvenecimiento del pulmón del fumador. Los pulmones femeninos se benefician más del abandono. La carga tabáquica tiene clara influencia sobre la edad pulmonar inicial y sobre el beneficio tras el abandono. Los pulmones de pacientes EPOC se benefician más del abandono del tabaco (AU)

Abstract. Objectives: To calculate the spirometry lung age of the smoker. To know the differences between chronological age and spirometric lung age before and at one year of quitting smoking. To find out if the tobacco consumption data influence in these differences. To analyze these data in the COPD patient subgroup. Material and methods: Patients who come to our smoking cessation clinic: a spirometry is performed before and one year after they quit smoking. The baseline spirometric lung age and age at one year of smoking cessation is calculated. Statistical analysis is performed with the SPSS 11.0. Results: 117 patients, 58.10% women; mean age 47.10 years, age of onset consumption 16.45 years, mean daily consumption 26.40 cigarettes. There were no significant differences between both genders for tobacco consumption levels. Mean lung age of the smoker is greater than the chronological one, both in men and women (12.58 and 1.13 years, respectively). After one year of abstinence, the lung of the men had 10.97 years more than the real age of the patient, while the lung age in the woman was 3.67 years below the chronological age. The tobacco consumption data showed a correlation with the lung age before and after cessation in both genders. Eighteen (55.6% men) of the smokers had lung function levels of COPD. These patients showed greater differences between the final and initial lung ages in both genders compared to the global series. Conclusion: The lung of the smoker is "aged." After smoking cessation, the smoker's lung was rejuvenated. Female lungs benefit more from the cessation. The tobacco load has a clear influence on the initial lung age and on benefit after cessation. The lungs of COPD patients benefit more from smoking cessation (AU)

Cambios en la función pulmonar tras el abandono del tabaco / Changes in pulmonary function after smoking cessation

Objetivos. Valorar los cambios en la función pulmonar tras un año de abstinencia de los fumadores que son seguidos en la consulta de deshabituación tabáquica. Conocer la influencia de las características del consumo en la pérdida y posterior variación en los parámetros funcionales respiratorios. Pacientes y métodos. Estudio prospectivo longitudinal de fumadores que realizan un intento de deshabituación. Historia clínica general y de tabaquismo en la primera visita. Espirometría con test broncodilatador previo y al año tras la deshabituación. Resultados. Se han estudiado 68 pacientes (56,1% mujeres), con una edad media de 47,46 años. Fumaban 23,54 cigarrillos/ día desde los 17,02 años. Tras un año sin fumar existían diferencias significativas en todos los parámetros funcionales respiratorios estudiados (FEV1, FVC y FEV1/FVC). No existían diferencias tras un año según sexo, edad ni parámetros de consumo (edad inicio y cigarros/día). Aquellos que no tenían parámetros funcionales de EPOC obtenían una mayor diferencia anual. Las mujeres con EPOC que fumaban más de un paquete al día y que se iniciaron en el consumo antes de los 17 años se beneficiaban más del abandono. Conclusiones. Existe una ganancia en los parámetros funcionales respiratorios tras la cesación del consumo de tabaco. Esta ganancia se hace más evidente si se abandona el hábito antes de que se afecten los parámetros funcionales. Las mujeres EPOC con mayor carga acumulada de tabaco son las que más se benefician del abandono (AU)

Objective. Evaluate the changes in pulmonary function after one year of abstinence of smokers who are followed-up in the smoking cessation consultation. Know the influence of the usage characteristics in the loss and subsequent variation in the respiratory functional parameters. Patients and methods. Prospective, longitudinal study of smokers who made an attempt to quick smoking. General clinical history and smoking history on the first visit. Spirometry with previous bronchodilator test and at one year after cessation. Results. A total of 68 patients (56,1% women) with a mean age of 47, 46 years were studied. They smoked 23,54 cigarettes/ day since 17,02 years of age. After one year without smoking, there were significant differences in all the respiratory functional parameters studied (FEV1, FVC and FEV1/FVC). There were no differences after one year according to gender, age or consumption parameters (onset age and cigarettes/day). Those who had no functional parameters of COPD obtained a greater annual difference. COPD women who smoked more than one pack a day and who initiated smoking before 17 years of age benefited the most from quitting. Conclusions. There is an improvement gain in the respiratory functional parameters after smoking cessation. This improvement is clearer if the habit is discontinued before the functional parameters are affected. COPD women with greater accumulated burden of tobacco are those who benefit the most from quitting (AU)

Factores asociados a la ganancia de peso en la deshabituación tabáquica / Factors associated to weight gain in tobacco dehabituation

Objetivo: evaluar la ganancia ponderal en un grupo de fumadores abstinentes 6 meses después de dejar de fumar y valorar qué factores influyen en dicha ganancia. Pacientes y métodos: estudio observacional de una cohorte prospectiva concurrente. Población diana: fumadores atendidos en una unidad especializada de tabaquismo abstinentes a los 6 meses. Variables: edad, sexo, motivación (Richmond), dependencia a la nicotina (Fagerström), cigarrillos/día, tratamiento farmacológico (parches de nicotina, bupropión y chicles de nicotina), abandonos previos, incremento del peso en kilogramos (kg) y del índice de masa corporal (IMC). Se consideró éxito abstinencia mantenida según el paciente con cooximetría de confirmación. Se valoraron 4 momentos: antes del abandono, al mes, a los 3 y 6 meses. Los resultados se expresan como medias (desviación estándar) en las variables cuantitativas y como proporciones en las cualitativas. Resultados: de los 111 pacientes que iniciaron el programa, 43 permanecieron abstinentes a los 6 meses (38,73%). El peso medio basal fue de 70,73 kg (DE 14,28) y el IMC medio, de 25,49 (DE, 4,42). El incremento de peso a los 6 meses fue de 4,25 kg (DE, 3,25) y el de IMC,1,02 (DE 1,01), sin diferencias por sexo. Dicho incremento fue significativamente mayor que a los 3 meses. Ningún paciente ganó más de 8,8kg, y dos pacientes, ambas mujeres, perdieron peso a los 6 meses. La ganancia ponderal se correlacionó significativamente con el número de cigarrillos día y la dependencia física. Conclusiones: la ganancia ponderal al dejar de fumar es moderada, ocurriendo el mayor incremento en el segundo trimestre. Los pacientes que consumen más nicotina presentan una mayor ganancia ponderal, lo que puede relacionarse con los efectos metabólicos de la nicotina (AU)

Objective: Evaluate weight gain in a group of abstinent smokers6 months after they have stopped smoking and evaluate the factors that influence in this weight gain. Patients and methods: Observational study of a concurrent prospective cohort. Target population: smokers seen in a specialized unit for abstinent smokers at 6 months. Variables: age, gender, motivation (Richmond),nicotine dependence (Fagerström), cigarettes/day, drug treatment(nicotine patches, bupropion and nicotine gum), previous abandonments, weight gain in kilograms (kg) and body mass index (BMI). Successful maintenance of abstinence is considered when the patient has a cooximetry of confirmation. Four different times were evaluated: before abandonment, at one month, at 3 and 6 months. The results are expressed as means (standard deviation) in the quantitative variables and proportions in the qualitative ones. Results: of the 111 patients who initiated the program, 43 remained abstinent at 6 months (38.73%). Mean baseline weight was 70.73kg (SD 14.28) and mean BMI of 25.49 (SD, 4.42). Weight increase at 6months was 4.25 kg (SD, 3.25) and BMI 1.02 (SD 1.01), without differences by gender. Said increase was significantly greater than at 3months. No patient gained more than 8.8 kg, and two patients, both women, had lost weight at 6 months. Weight gain significantly correlated with the number of cigarettes per day and physical dependence. Conclusions: Weight gain when the patient stops smoking is moderate, the greatest increase occurring in the second quarter. The patients who consume the most nicotine have the greatest weight gain, which could be related with the metabolic effects of nicotine (AU)

Estudio descriptivo de una serie de pacientes traqueotomizados por ventilación mecánica prolongada que llegan a una planta de neumología / Descriptive study of a series of tracheotomized patients from prolonged mechanical ventilation who arrive to the pneumology ward

Objetivo: Análisis descriptivo de las características de un grupo de pacientes derivados a la planta de hospitalización de un servicio de neumología desde las unidades de críticos del hospital, tras haber sido traqueotomizados por precisar ventilación mecánica de larga duración.Diseño: Estudio prospectivo, observacional, descriptivo de una cohorte consecutiva.Ámbito: Pacientes derivados a la planta de hospitalización de un servicio de neumología desde las unidades de críticos del hospital.Resultados: Entre enero de 1994 y diciembre de 2001 fueron incluidos 100 pacientes (72 varones y 28 mujeres) con una edad media de 59 (DE 12,98) años. El 92% procedía de una UCI médica y el 8% de una UCI quirúrgica. El 59% eran fumadores activos. Los diagnósticos fueron: esclerosis lateral amiotrófica (5); enfermedades de la caja torácica (16); EPOC(29); síndrome hipoventilación-obesidad (11); complicaciones postoperatorias de diversas cirugías (postquirúrgicos) (9); enfermedades neuromusculares (14); síndrome de apnea del sueño (15) y bronquiectasias (1). El tiempo hasta la realización de la traqueotomía fue 9,8 (DE 2,9) días y el tiempo desde la realización de la traqueotomía hasta el traslado a planta de neumología fue de 28,6 (DE 36,2 días). Las gasometrías en la unidad de críticos fueron: pH: 7,24 (DE 0,11);PaO2: 41 (DE 8,1) mm Hg y PaCO2: 79 (DE 18,1) mm Hg. Asu llegada a planta: pH: 7,36 (DE 0,03), PaO2: 53 (DE 10,1)mm Hg y PaCO2: 55 (DE 9,5) mm Hg. No hubo diferencias en el tiempo que se tardó en realizar la traqueotomía entrelos distintos grupos diagnósticos.Conclusiones: El prototipo de paciente traqueotomizado en la UCI por ventilación mecánica prolongada que llega a planta de neumología es muy variado, predominando un varón con diagnóstico de EPOC, fumador, de unos 60 años de edad, que ha permanecido 38 días en la UCI y al que se le ha realizado una traqueotomía tras 10 días de ingreso

Objetive: A prospective, observational, descriptive study.Methods: Descriptive analysis of the characteristics of a group of tracheostomized patients admitted in a pneumological ward coming from the intensive care units of our hospital. All of them with prolonged mechanical ventilation.Results: One hundred patients were studied between January 1994 and December 2001 (72 males, 28 females). Age: 59.26 (DE 12.98) years old. 92% were coming from medical ICUS and 8% from surgical ICUS. 59% of patients were smokers. The diagnoses were: ALS (5); Thoracic cage defects (16); COPD (29); Obesity hypoventilation syndrome(11); Postsurgical complications (9); NMD (14); Sleep apnea syndrome (15); Bronchiestasis (1). Time to tracheotomy: 9.8 (DE 2.9) days. Time to arrival to pneumological ward: 28.6 (DE 36.2) days. Gasometry results in ICU: pH: 7.24 (DE 0.11); PaO2: 41 (DE 8.1) mmHg y PaCO2: 79 (DE 18.1) mmHg. Gasometry results in pneumological ward: pH: 7.36 (DE 0.03), PaO2: 53 (DE 10.1) mmHg y PaCO2: 55 (DE 9.5) mmHg. There were no differences in the diagnoses groups in relationto time to tracheostomy.Conclusions: The patient prototype admitted in our pneumological ward is a smoker COPD man, about 60 years old, coming from a medical ICU where he was tracheostomized at 10 days, remaining there for 38 dayss=&Camp (AU)

[LASIK results of IntraLase femtosecond laser to correct myopia: efficacy, security and predictability]. / Resultados de LASIK realizado con láser de femtosegundo (IntraLase) para corrección de miopía: eficacia, predictibilidad y seguridad.

PURPOSE: To evaluate LASIK results obtained with the IntraLase femtosecond laser to correct myopia. METHODS: This was a prospective, single masked observer study. Flaps were created with the IntraLase femtosecond laser (FS). All laser procedures were performed by the same surgeon using the Technolas 217 excimer laser (Bausch & Lomb). We have analysed the uncorrected visual acuity (UCVA) at 1 day, 1 week, 1 month and 3 months after surgery and best spectacle-corrected visual acuity (BSCVA) after 3 months. RESULTS: 485 eyes with myopia were treated and their results evaluated. The mean preoperative sphere was of -3.9 D (SD 2.0) and a mean astigmatism of -0.9 D (SD 0.9) with BSCVA 1.1 (SD 0.1). The UCVA results were 0.94 (SD 0.1) at the first day postoperatively visit, 0.96 (SD 0.1) at first week, 1.00 (SD 0.1) at one month and 1.00 (SD 0.2) at 3 months. The refractive error at 3 months was -0.02 D (SD 0.3) and -0.1 D (SD 0.3) of myopia and astigmatism respectively. At 3 months 96.9% of eyes were within +/-1.00D and 93.6% of the eyes were within + 0.50 D. CONCLUSIONS: LASIK to correct myopia is a safe, effective and predictable procedure using IntraLase FS to create the flap.

Ozone-induced foliar injury in saplings of Psidium guajava 'Paluma' in São Paulo, Brazil.

Psidium guajava 'Paluma' was evaluated under field conditions as a tropical bioindicator species of ozone (O(3)). Three exposures of 90 days each were performed (June 21, 2004-March 19, 2005). In each one of them, saplings of 'Paluma' (n=30) were exposed to ambient air at a site in São Paulo (Brazil) with high ozone concentrations, and in a greenhouse with charcoal-filtered air. Ozone-like visible foliar injuries were observed during the winter, spring and summer exposures, when AOT40 reached 6166ppbh, 3504ppbh and 4828ppbh, respectively. No injuries were observed in the plants kept under filtered air. The injuries consisted in red stippling on adaxial leaf surfaces. They did not cover the veins and appeared first in older leaves, becoming more intense as the exposure period increased. Injury incidence, severity, and the cumulative exposure threshold at injury onset varied among the exposure periods. AOT40 explained partly the incidence, severity and leaf injury index LII (r(2)=0.52, 0.39, 0.38, respectively, p=0.002). The results confirm the potential of the species as an O(3)-sensitive bioindicator.

Consumo de tabaco y actitud ante el inicio del hospital sin humo en el Hospital de Móstoles / Tobacco consumption and attitude towards the onset of the smokeless hospital in the Hospital de Móstoles

Objetivos: Conocer en los trabajadores de nuestro Hospital el número de exfumadores, no fumadores y fumadores activos, profundizando en las características del consumo de tabaco de estos últimos. Saber su predisposición al abandono y si precisarían de ayuda. Evaluar la opinión de los mismos con respecto al cumplimiento de la prohibición vigente del consumo de tabaco en centros sanitarios, el papel modélico del personal sanitario, si creen necesario realizar acciones para que no se fume en el hospital y si estarían dispuestos a colaborar con ellas. Material y métodos: Encuesta distribuida en los meses de julio y septiembre de 2004 a todos los trabajadores de las distintas categorías profesionales de nuestro centro hospitalario. Resultados: 411 encuestas válidas (20,30% participación). Se declaraban fumadores 25,9%, exfumadores 16% y nunca habían fumado 58,1%. De los fumadores 20,2% eran hombres y 79,8% mujeres, mediana de edad de inicio de 16 años. Los colectivos de mayor prevalencia de consumo fueron enfermería (37,2%) y auxiliares de clínica (24,4%). La mediana del test de Fagerström obtenida fue de 4. El 89,4% de los fumadores se encontraban en fase de contemplación y el 86,8% en fase de preparación. El 81% de los fumadores expresaba la necesidad de ayuda para lograr el abandono. El 91,2% consideraba importante el papel del profesional sanitario como ejemplo para el resto de la sociedad en cuanto al consumo del tabaco se refiere; 94,4% opinaba que en nuestro Centro se incumple la ley que actualmente regula el consumo de tabaco en los centros sanitarios; 96,3% creía que se debían iniciar acciones para evitar dicho consumo y 96% estaría dispuesto a colaborar con las mismas. Conclusiones: Menor prevalencia de fumadores que en la población general. Predominio femenino, sobre todo en el colectivo de enfermería y auxiliares. Alta predisposición a realizar un intento serio de abandono, aunque recibiendo ayuda. Importante conciencia del papel modélico que tenemos los sanitarios. Muy elevado porcentaje de incumplimiento de la prohibición de fumar, aunque también elevada creencia de que hay que cambiarlo y gran predisposición a colaborar con las nuevas medidas para lograr un hospital sin humos (AU)

Objectives: Discover the number of ex-smokers, non-smokers and active smokers in the workers of our hospital, thoroughly studying the characteristics of tobacco consumption of the latter. Know the predisposition to stop smoking and if they would require help. Evaluate their opinion in regards to complying with the current ban on smoking in health care sites, the model role of the health care personnel, if they consider it necessary to take actions to stop smoking in the hospital and if they are willing to collaborate with them. Material and methods: Survey distributed in the months of July and September 2004 to all the workers of the different professional categories of our hospital site. Results: 411 valid surveys (20.30% participation). A total of 25.9%declared they smoked, 16% ex-smokers and 58.1% that they had never smoked. Of the smokers, 20.2% were men and 79.8% women, mean onset age 16 years. The group having the greatest prevalence of consumption was nurses (37.2%) and clinical auxiliary workers (24.4%). Median obtained on the Fagerström test was 4. A total of 89.4% of the smokers were in the contemplation phase and 86.8% in the preparation phase. Eighty one percent of the smokers expressed the need for help to stop smoking and 91.2% considered the role of the health care professional important as an example for the rest of society in regards to smoking. A total of 94.4% considered that the law the currently regulates smoking in health care sites is not fulfilled in our site and 96.3% believed that actions should be initiated to avoid this consumption. A total of 96%were willing to collaborate with them. Conclusions: There is a lower prevalence of smokers than in the general population with female predominance, above all in the nursing and auxiliary worker group. High predisposition to make a serious attempt to stop smoking, although receiving help. Important awareness of the model role that the health care professionals have. Very high percentage of non-compliance of the ban on smoking, although also high belief that this must be changed and great predisposition to collaborate with the new measures to achieve a hospital without smoke (AU)

[Excess mortality due to tuberculosis and factors associated to death in and annual cohort of patients diagnosed of tuberculosis]. / Exceso de mortalidad por tuberculosis y factores asociados a la defunción en una cohorte anual de enfermos diagnosticados de tuberculosis.

OBJECTIVE: To calculate excess mortality in an annual cohort of tuberculosis patients and study the factors associated with death. MATERIAL AND METHOD: Cases of tuberculosis reported in Catalonia (May 1996-April 1997). Patients were classified as completed treatment/cured (compliant), non-compliant, failures, transfers out and deaths. Excess mortality was defined as the ratio actual deaths/expected deaths (according to general mortality figures for Catalonia, May 1996-April 1997). Factors associated with death were determined by a comparative study of variables (demographic, substance abuse, comorbidity, tuberculosis-related disease) in deaths after diagnosis and survivors. Time from diagnosis to death was recorded. RESULTS: Patients included: 2,085. Patients classified as: completed treatment/cured (compliant), 1,406 (67.43 %); noncompliant, 165 (7, 91%); failures, 5 (0.24%); transfers out, 25 (1.21%); deaths, 133 (6.38%), 28 of which occurred before diagnosis and 105 after diagnosis. Insufficient data in medical record for classification, 351 (16.83%) patients. Excess mortality: 5.98 (95% CI: 4.96-7.0). Factors associated with death: treatment with non-standardized guidelines, 46%; OR: 10.3 (6.2-17.4); HIV infection, 40%; OR: 13.0 (6.6-25.8); age greater than 64 years, 40%; OR: 14.6 (3.0-69.8); alcoholism, 25%; OR: 2.0 (1.1-3.6); neoplasm, 16%; OR: 3.9 (1.8-8.6; renal failure, 8%; OR: 10.1 (3.1-32.3). The shortest time from diagnosis to death was in patients with only one risk factor, except for HIV infection, where the time passed was the longest observed. CONCLUSIONS: We found substantial excess mortality in tuberculosis patients. Death was associated with the efficacy of treatment, HIV coinfection, advanced age, alcoholism and the coexistence of neoplasms or renal failure.

Situación laboral de los neumólogos formados en el periodo 2000-2003 / Work situation of the pneumologists trained in 2000-2003

OBJETIVOS: Conocer la situación laboral de los residentesextremeños y andaluces de Neumología formados en los últimos 4años.MATERIAL Y MÉTODOS: Encuesta distribuida por correoelectrónico u ordinario a los residentes formados entre los años2000-2003 según listado proporcionado por la secretaría de nuestrasociedad.RESULTADOS: 48 encuestas válidas de 48 residentes formados.Predominio femenino (54,9%) con una media de edad de32,78. Alto porcentaje de becarios (64,58%) y excesiva duración delas becas (14,33 meses de media). 41,77% nunca habían ejercido laNeumología desde el fin de su período de formación y sólo 18.75%trabajaban de forma estable.CONCLUSIONES: Precariedad laboral en el campo de laNeumología en los últimos años. Reclamamos mayor sensibilidadpor parte de nuestros dirigentes ante este tema y mayor presión ala administración. Tratar de adecuar el número de residentes a lasnecesidades reales

OBJECTIVES: To understand the work situation of the residentsof Extremadura and Andalusia trained in Pneumologywithin the past four years.MATERIAL AND METHODS: A survey carried out by electronicor ordinary mail of residents trained in 2000-2003, accordingto a listing provided by the NEUMOSUR society secretary.RESULTS: 48 valid surveys of 48 trained residents. Femalespredominated (54.9%) with an average age of 32.78. There was ahigh percentage of training contracts (64.58%) and the trainingcontract was excessive (an average of 14.33 months). 41.77% hadnever worked in the field of pneumology after having finishedstudying and only 18.75% had found stable work.CONCLUSIONS: In recent years, the job situation within thefield of pneumology is precarious. We demand a greater awarenessfrom governmental leaders with regards to this matter and greateradministrative pressure. The number of residents must be adaptedto the real needs

[Evaluation of the efficacy of long term topical steroid treatment to prevent regression after hyperopic LASIK]. / Valoración de la eficacia de tratamiento corticoideo tópico prolongado para prevenir regresión en LASIK hipermetrópico.

PURPOSE: To evaluate the efficacy of long-term versus short-term steroid treatment in preventing regression after hyperopic LASIK. MATERIAL AND METHODS: This is a prospective single masked study. Hyperopic patients who were candidates for LASIK surgery were randomized to be treated with one week (topical dexametasone) in control group or one month (topical dexametasone the first week and topical fluormetalone the next three weeks) in study group. The three month postoperative manifest refraction was compared between the two groups. RESULTS: 105 eyes were included in each group. The mean preoperative spherical equivalent was 3.17 D SD 2.82 D (standard deviation) and 3.39 D SD 2.65 D in the study and control group, respectively (p=0.6). The final manifest refraction in the three-month postoperative visit was 0.62 D SD 0.68 D and 0.6 D SD 0.3 D in the study and control group respectively (p=0.6). CONCLUSIONS: Long-term topical steroid therapy does not appear to improve the refractive result in hyperopic LASIK.

Valoración de la eficacia de tratamiento corticoideo tópico prolongado para prevenir regresión en LASIK hipermetrópico / Evaluation of the efficacy of long term topical steroid treatment to prevent regression after hyperopic LASIK

Objetivo: Evaluar la eficacia del tratamiento corticoideo tópico prolongado en pacientes operados de LASIK hipermetrópico.Material y métodos: Se realiza un estudio prospectivo observador enmascarado. Pacientes candidatos a cirugía LASIK para la corrección de baja y moderada hipermetropía fueron asignados aleatoriamente a recibir tratamiento tópico corticoideo (dexametasona) una semana (grupo control) o un mes (dexametasona la primera semana y fluorometalona las tres siguientes), en el grupo estudio. Se comparó la refracción final manifiesta en ambos grupos.Resultados: Analizamos 105 ojos en cada grupo (estudio y control). El equivalente esférico medio preoperatorio era 3,17 D DE 2,82 D (desviación estándar) y 3,39 D DE 2,65 D en el grupo estudio y control respectivamente (p=0,6). La refracción final manifiesta a los 3 meses era 0,62 D DE 0,68 D y 0,6 D DE 0,3 D en el grupo estudio y control respectivamente (p=0,6).Conclusión: La regresión refractiva tras LASIK hipermetrópico, no parece ser modulable por el mayor o menor tratamiento corticoideo tópico

Purpose: To evaluate the efficacy of long-term versus short-term steroid treatment in preventing regression after hyperopic LASIK.Material and methods: This is a prospective single masked study. Hyperopic patients who were candidates for LASIK surgery were randomized to be treated with one week (topical dexametasone) in control group or one month (topical dexametasone the first week and topical fluormetalone the next three weeks) in study group.The three month postoperative manifest refraction was compared between the two groups.Results: 105 eyes were included in each group. The mean preoperative spherical equivalent was 3.17 D SD 2.82 D (standard deviation) and 3.39D SD 2.65D in the study and control group, respectively (p=0.6). The final manifest refraction in the three-month postoperative visit was 0.62D SD 0.68D and 0.6D SD 0.3D in the study and control group respectively (p=0.6).Conclusions: Long-term topical steroid therapy does not appear to improve the refractive result in hyperopic LASIK