Irritant-induced Asthma Caused by Aerotoxic Syndrome.

PURPOSE: Case series on respiratory features of Aerotoxic Syndrome (AS). The term AS has been coined to describe the spectrum of clinical manifestations after aircraft fume events. Among these manifestations, neurological and respiratory symptoms are the most frequently reported complaints. METHODS: Three cases of AS with relevant respiratory features are presented. RESULTS: Cough and shortness of breath for 6 to12 months were the predominant symptoms in the first two cases. The first case also developed neurological symptoms affecting his central nervous system. In the third case, the patient complained for nine years about an unbearable cough triggered by odors, smells, and a variety of indoor and outdoor irritants, among other symptoms of multiple chemical sensitivity. In all three cases, the respiratory symptoms resolved after appropriate treatment. CONCLUSION: Our report aims at raising awareness on AS and calls for actions to improve the management of patients suffering from this syndrome.

Prevalencia de la enfermedad y características sociodemográficas y clínicas de la otitis media crónica en el hospital de clínicas / Prevalence of the disease and sociodemographical and clinical characteristics of the chronic media otitis in the clinics hospital

La otitis media crónica es una inflamación crónica del mucoendostio del oído medio y anexos, con o sin perforación de la membrana del tímpano, con o sin exudado. Según los datos obtenidos por la Organización Mundial de la Salud posterior al análisis de trabajos de investigación publicados, la prevalencia para Sudamérica y América Central se encuentra alrededor del 1,5%. El Paraguay no cuenta con un estudio similar al presente que haya sido publicado. Por tal motivo nos propusimos a determinar la carga de la enfermedad y las características sociodemográficas y clínicas de los pacientes con otitis media crónica operados en el Hospital de Clínicas en el período 2015-2019. Se realizó un estudio observacional, descriptivo de corte transverso, retrospectivo. De 41885 pacientes operados (9,42%) fueron pacientes de la Cátedra y Servicio de Otorrinolaringología y de estos, 274 tenían otitis media crónica, lo que representa el 6,94% del total de pacientes operados por la Cátedra y Servicio de Otorrinolaringología y el 0,65% del total de pacientes operados en el Hospital en el mencionado periodo de tiempo. Pudimos concluir que la otitis media crónica es una patología de alta prevalencia para el servicio de otorrinolaringología del Hospital de Clínicas, no obstante, representa una baja carga para la administración hospitalaria total.

Chronic otitis media is a chronic inflammation of the mucoendostium of the middle ear and annexes, with or without perforation of the eardrum, with or without exudate. According to data obtained by the World Health Organization after the analysis of published research papers, the prevalence for South America and Central America is around 1.5%. Paraguay does not have a study similar to this one that has been published. For this reason, we set out to determine the burden of the disease and the sociodemographic and clinical characteristics of patients with chronic otitis media operated at the Hospital of Clinics in the period 2015-2019. An observational, descriptive, cross-sectional, retrospective study was conducted. Of 41885 patients operated 9.42% were patients of the Chair and Department of Otolaryngology and of these, 274 had chronic otitis media, which represents 6.94% of the total of patients operated by the Chair and Department of Otolaryngology and 0,65% of the total of patients operated in the Hospital in the mentioned period of time. We could conclude that chronic otitis media is a pathology of high prevalence for the otolaryngology service of the Hospital of Clinics, however, it represents a low burden for total hospital administration.

Estudio sobre la prevalencia de alteraciones morfo-estructurales de las extremidades inferiores en corredores afectados por el síndrome de la cintilla iliotibial / Study on the prevalence of morphostructural alterations of the lower extremities in runners affected by iliotibial band syndrome

Se practica estudio sobre la prevalencia de alteraciones morfoestructurales de las extremidades inferiores en corredores afectados por el síndrome de la cintilla iliotibia. Participan 19 sujetos diagnosticados por el síndrome de la cintilla iliotibial a los que se les práctica test de confirmación de diagnóstico, exploración goniométrica de la rodilla y del pie, así como un examen baropodométrico. Se realizan también encuestas acerca de la intensidad del dolor y el tiempo que tarda el dolor en aparecer durante la actividad física. Se concluye que el 100% de los sujetos presenta algún tipo de alteración morfoestructural o funcional de las extremidades inferiores (AU)

Study is performed on the prevalence of morphostructural alterations of the lower limbs in runners affected by the syndrome iliotibia streak. Involved 19 subjects diagnosed by iliotibial band syndrome, those who underwent diagnostic confirmation test, goniometer scan of the knee and foot, and a baropodometric review. Surveys about pain intensity, pain takes time to appear during physical activity were made. We conclude that 100% of the subjects have some form of alteration, functional or morphostructural of the lower extremities (AU)

Indacaterol, A Novel Once Daily Inhaled beta2-Adrenoreceptor Agonist.

In this article we will review the role of long acting beta2-adrenoreceptor agonists and long-acting muscarinic agents in the management of airflow obstruction. We will then focus our attention on indacaterol, one of the new once daily inhaled beta2-adrenoreceptor agonists. Pharmacologically this drug is a nearly full beta2-agonist without loss of efficacy after prolonged administration. We will also discuss its dosing, safety and tolerability.

Neglected respiratory toxicity caused by cancer therapy.

When a patient with lung cancer presents non-specific respiratory symptoms there are many diagnostic options. Chemotherapy is the cornerstone of treatment in many stages of lung cancer and its toxicity is well known. The main priority is to prevent life-threatening diseases such as lung infection, which can be treated successfully if a prompt, accurate diagnosis is given. Drug-induced pulmonary disease must be avoided at all costs but it is also important to avoid side-effects of drugs which do not directly interfere with respiratory physiology but may impair gas exchange. This review highlights the risks and characteristics of non-cytostatic-induced lung toxicity caused by agents that have been commonly used to treat cancer in recent decades. Physicians should be alert to the possibility of this neglected non-chemotherapy-induced lung toxicity in cancer patients, since early withdrawal of the offending drug is mandatory.

Calidad de vida en pacientes con osteoartrosis de cadera y rodilla

La Osteoartrosis es la más común de las enfermedades articulares. Es un síndrome anatomoclínico caracterizado por dolor mecánico que con frecuencia se asocia a rigidez y que conduce progresivamente a una pérdida o disminución de la función articular. Siendo una enfermedad que cursa con dolor y limitación funcional progresiva constituye, además de un motivo habitual de consulta médica con los consiguientes elevados costos para su atención y tratamiento, una causa frecuente de deterioro del estilo de vida que influye en la Calidad de Vida del individuo asociada a su salud. Se realizó un estudio prospectivo, descriptivo y observacional para evaluar la Calidad de Vida en pacientes con Osteoartrosis de cadera y rodilla en el Centro Nacional de Rehabilitación Julio Díaz en el período comprendido entre enero de 2004 y enero de 2005. Se aplicaron el Índice WOMAC de valoración funcional y la Escala de evaluación de Calidad de Vida denominada EUROQuol-5D. Se realizó análisis cualitativo de los datos por métodos descriptivos e inferenciales empleándose los paquetes estadísticos SPSS, versión 10,0. Como medida de resumen se emplearon los porcentajes. Se determinó además la existencia de asociación entre las escalas empleadas y las variables sociodemográficas a través de la prueba no paramétrica de independencia Chi cuadrado. El nivel de significación preestablecido fue de 0,05. Las dimensiones más afectadas en cuanto a Calidad de Vida en la Salud fueron movilidad, cuidado personal, actividades cotidianas y dolor. Ningún paciente refirió estado óptimo de salud. Las variables que influyeron en el estado de salud fueron: sexo, edad, estado civil, nivel de estudio, actividad laboral, residencia, tiempo de diagnóstico, ingreso económico y grado de discapacidad. No hubo diferencias entre la evaluación funcional del examinador y la percepción de los pacientes acerca de su estado de salud(AU)

Fluoroquinolones vs macrolides in the treatment of Legionnaires disease.

BACKGROUND: Erythromycin has been the treatment of choice for Legionnaires disease (LD). However, treatment failure and experimental evidence of its bacteriostatic effect have led to evaluation of new drugs such as fluoroquinolones. This study compared the evolution of patients with LD treated with macrolides and fluoroquinolones. METHODS: A prospective observational study was performed, and 130 patients from three centers were included. Diagnoses were made using Legionella urinary antigen assay in all patients. Patients receiving any antibiotic > 36 h before starting the study therapy were excluded. Group 1 included 76 patients who received macrolides (33 patients with erythromycin and 43 patients with clarithromycin), and group 2 included 54 patients treated with fluoroquinolones (50 patients with levofloxacin and 4 patients with ofloxacin). RESULTS: No significant differences were seen between the two groups regarding age, sex, smoking, alcohol intake, underlying diseases, or community/hospital acquisition. The time from onset of LD symptoms until the initiation of antibiotic treatment was 78.5 h and 92.7 h in groups 1 and 2, respectively (p = 0.1). Time to apyrexia was significantly longer in the macrolide group (77.1 h vs 48 h for groups 1 and 2, respectively; p = 0.000). There were no differences according to radiology, clinical complications, or mortality. Nevertheless, a trend to a longer hospital stay was observed in the macrolide group (9.9 days vs 7.6 days in groups 1 and 2, respectively; p = 0.09). CONCLUSIONS: Fluoroquinolones were as effective as erythromycin in the treatment of LD. It is of note that time to apyrexia was significantly shorter and hospital stay tended to be shorter in patients receiving fluoroquinolones.

Legionella spp.: community acquired and nosocomial infections.

PURPOSE OF REVIEW: The key points of this review are the increasingly recognized risk of home-acquired Legionnaires' disease; the significance and potential pathogenic role of other species of Legionella spp., different from L. pneumophila, and of other microorganisms that are phylogenetically close to Legionella and that have been named as Legionella-like amoebal pathogens; the breakthrough in the diagnosis of the disease caused by new commercially available urine antigen detection tests; the controversy over sensitivity and specificity of serological diagnostic methods; the recognition of a variety of possible mixed infections, particularly in the immunocompromised population; and new and controversial aspects of the therapeutic approach to legionellosis. RECENT FINDINGS: During the last year a number of articles have provided clinically relevant insights into our knowledge of Legionnaires' disease. In view of the fact that Legionella spp. have progressively become recognized as relatively common causative agents of both community-acquired and nosocomial legionellosis, this is an opportune moment for this review. SUMMARY: If domestic aquatic reservoirs were eventually confirmed as significant agents of transmission of legionellosis, the adoption of preventive measures would then be crucial. The progressive identification of other species, different from L. pneumophila, as causative agents of pneumonia should both encourage microbiologists and clinicians to improve their diagnostic methodology and increase the awareness of these infections. Finally, the awareness of mixed infections, probably far more severe and perhaps not so uncommon as previously thought, has important clinical connotations for both the diagnostic and the therapeutic approach to legionellosis in the immunosuppressed host, particularly in those cases of delayed clinical resolution.

Legionnaires' disease: a rational approach to therapy.

Optimal therapy against Legionella infection is based on agents with a high intrinsic activity, an appropriate pharmacokinetic and pharmacodynamic profile (including the ability to penetrate phagocytic cells), a low incidence of adverse reactions and an advantageous cost-efficacy relationship. Newer macroazalides and fluoroquinolones are among the first-line therapies and in severe infections, particularly those occurring in immunocompromised patients, azithromycin and later fluoroquinolones are the agents of choice. Delay in the onset of adequate therapy is a key factor associated with a poor outcome. Thus, all patients with pneumonia associated with respiratory failure, shock or underlying disease causing severe immunodeficiency should initially receive an agent active against Legionella spp., at least while the aetiology remains unknown. Adjunctive measures improve outcome in critically ill patients. In intubated patients with delayed resolution, superinfection by Pseudomonas aeruginosa or co-infection caused by other pathogens should be excluded.