Diagnostic performance of the measurement of nitric oxide in exhaled air in the diagnosis of COPD phenotypes.

INTRODUCTION: COPD is a highly heterogeneous disease that has a serious impact on affected populations. Patients share some of the features of bronchial asthma, often summarized under the term ACOS (asthma-COPD overlap syndrome). The objective of this study is to evaluate the utility of the measurement of nitric oxide in exhaled air (FENO50) in the diagnosis of COPD phenotypes. MATERIAL AND METHODS: The study comprised cross-sectional observation of patients receiving assistance during a respiratory outpatient visit. Patient data was collected on lung function, FENO, questionnaires scoring CAT®(COPD Assessment Test), and COPD clinical phenotype. RESULTS: 192 patients were studied: 103 with COPD; 16 healthy non-smokers; 30 healthy smokers; and 43 asthmatics. COPD patients were grouped by phenotype: 34 non exacerbators (33.0%); 22 ACOS (21.3%); 13 frequent exacerbators with emphysema (12.6%); and 34 frequent exacerbators with chronic bronchitis (33.0%). ACOS patients showed significantly higher FENO50 values compared to the others after adjustments for confounding factors. FENO50 demonstrated greater diagnostic accuracy than the bronchodilator test (BT) in the diagnosis of ACOS and COPD phenotypes (AUC 0.79 vs 0.74), with an optimal cut-off value of 19 ppb (sensitivity 0.68, specificity 0.75). CONCLUSIONS: Patients with COPD have different levels of FENO50 depending on the COPD phenotype. FENO50 measurement provides better diagnostic accuracy than BT, with an optimal cut-off value of 19 ppb.

Paciente con disnea progresiva de un mes de evolución / Patient with one-month long progressive dyspnea

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[Study of energy expenditure in anorexia nervosa: agreement between indirect calorimatry and several equations]. / Estudio del gasto energético en la anorexia nerviosa: concordancia entre calorimetria indirecta y diferentes ecuaciones.

UNLABELLED: Nutritional management is essential in anorexia nervosa (AN), although nutrient replenishment must be done progressively to prevent the occurrence of re-alimentation syndrome. OBJECTIVE: to compare resting enengy expenditure (REE) by means of indirect calorimetry and by different equations in AN female patients. MATERIAL AND METHODS: we studied 21 women admitted for AN (DSM-IV), mean age 17 years (SD 5.9), range 12-34 years. Admission stay was 55.1 +/- 20.7 days (21-91). Initial nutritional assessment included anthropometrics (BMJ, TSF, SSE, MAC, MAMC) and tetrapolar bioimpedance (HoltainBC). Indirect calorimetry (IC) was done after overnight fasting (Deltatrac II MBM-200). In 9 patients, the same study was repeated before hospital discharge. We compared REE (Kcal/24 h) measured by IC with that obtained by several equations [Fleish, Harris- Benedict, FAO, Schofield-HW (SHW), Schebendach] through the intraclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS: Nutritional status significantly improved during hospital admission. Fifty percent of the recovered weight was fat mass. REE significantly increased during admission. The equations overestimated REE as compared to IC (p < 0.05), except for the Schebendach equation that underestimated REE. The agreement between direct measurement of REE by IC and its estimation through equations was poor [Fleish (ICC = 0.21); HB (ICC = 0.21), SHW (ICC = 0.19), Schebendach (ICC = 0.15)]. Through the Bland-Altman method, we observed that there was a variable bias between IC and equations, with a clinically acceptable agreement for REW values of around 1200 Kcal/day. CONCLUSIONS: 1) In our study we obtained a poor agreement between REW values measured by indirect calorimetry and those estimated by equations. 2) Through the Bland-Altman method, we observed that all equations present a variable bias as for IC, the agreement being clinically acceptable for REE values of around 1200 Kcal/day. 3) Thus, indirect calorimetry seems to be a very useful tool to calculate the energy requirements of anorexia nervosa patients.

Estudio del gasto energético en la anorexia nerviosa: concordancia entre calorimetría indirecta y diferentes ecuaciones / Study of energy expenditure in anorexia nervosa: agreement between indirect calorimatry and several equations

El tratamiento nutricional es fundamental en la anorexia nerviosa (AN), si bien la reposición de nutrientes debe hacerse de forma progresiva para evitar la aparición del síndrome de realimentación. Objetivo: Comparar el gasto energético en reposo (GER) mediante calorimetría indirecta con el estimado con diferentes fórmulas en mujeres con AN. Material y Métodos: Estudiamos 21 mujeres ingresadas con AN (DSM-IV), edad 17 (DE 5,9) rango 12-34 años. El tiempo de ingreso fue 55,1 ± 20,7 días (21-91). La valoración nutricional inicial incluyó antropometría (IMC, PTC, PSE, CMB,CMMB) y bioimpedancia tetrapolar (HoltainBC). La calorimetría indirecta (CI) se realizó tras ayuno nocturno (Deltatrac TM II MBM-200). En 9 pacientes se repitió el mismo estudio antes del alta. Comparamos el GER (kcal/24 h) medido por CI con el obtenido por diferentes ecuaciones [Fleisch, Harris-Benedict (HB), FAO, Schofield-HW (SHW), Schebendach] mediante el coeficiente de correlación intraclase (CCI) y el método de Bland y Altman. Resultados: El estado nutricional mejoró significativamente durante la hopitalización. El 50% del peso recuperado fue masa grasa. El GER aumentó significativamente durante el ingreso. Las fórmulas sobrestimaron el GER respecto al obtenido por CI (p < 0,05), con excepción de la ecuación de Schebendach que infravaloró el GER. La concordancia entre la medida directa del GER por CI y su estimación por las fórmulas fue mala [Fleish (CCI = 0,21), HB (CCI = 0,21), FAO (CCI = 0,21), SHW (CCI = 0,19), Schebendach (CCI = 0,15)]. Mediante el método de Bland y Altman observamos que existía un sesgo variable entre la medida de la CI y las fórmulas, existiendo una concordancia clínicamente aceptable para valores de GER de aproximadamente 1.200 kcal/día. Conclusiones: 1) En nuestro estudio obtuvimos una baja concordancia entre los valores de GER medidos por calorimetría indirecta y los estimados por las fórmulas. 2) Mediante el método de Bland y Altman observamos que todas las fórmulas presentan un sesgo variable respecto a la CI, siendo la concordancia clínicamente aceptable para valores de GER alrededor de 1200 kcal/día. 3) Por tanto, la calorimetría indirecta parece una herramienta muy útil en el cálculo de los requerimientos energéticos de las pacientes con Anorexia Nerviosa (AU)

Nutritional management is essential in anorexia nervosa (AN), although nutrient replenishment must be done progressively to prevent the occurrence of re-alimentation syndrome. Objective: to compare resting energy expenditure (REE) by means of indirect calorimetry and by different equations in AN female patients. Material and methods: we studied 21 women admitted for AN (DSM-IV), mean age 17 years (SD 5.9), range 12-34 years. Admission stay was 55.1 ± 20.7 days (21-91). Initial nutritional assessment included anthropometrics (BMJ, TSF, SSE, MAC, MAMC) and tetrapolar bioimpedance (HoltainBC). Indirect calorimetry (IC) was done after overnight fasting (DeltatracTM II MBM-200). In 9 patients, the same study was repeated before hospital discharge. We compared REE (Kcal/24 h) measured by IC with that obtained by several equations [Fleish, Harris- Benedict, FAO, Schofield-HW (SHW), Schebendach] through the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results: Nutritional status significantly improved during hospital admission. Fifty percent of the recovered weight was fat mass. REE significantly increased during admission. The equations overestimated REE as compared to IC (p < 0.05), except for the Schebendach equation that underestimated REE. The agreement between direct measurement of REE by IC and its estimation through equations was poor [Fleish (ICC = 0.21); HB (ICC = 0.21), SHW (ICC = 0.19), Schebendach (ICC = 0.15)]. Through the Bland-Altman method, we observed that there was a variable bias between IC and equations, with a clinically acceptable agreement for REW values of around 1200 Kcal/day. Conclusions: 1) In our study we obtained a poor agreement between REW values measured by indirect calorimetry and those estimated by equations. 2) Through the Bland-Altman method, we observed that all equations present a variable bias as for IC, the agreement being clinically acceptable for REE values of around 1200 Kcal/day. 3) Thus, indirect calorimetry seems to be a very useful tool to calculate the energy requirements of anorexia nervosa patients (AU)

Varón con infecciones respiratorias de repetición / Recurrent respiratory infections in man

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Hernia diafragmática como causa de insuficiencia respiratoria / Diaphragmatic hernia presenting respitatory failure

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Nódulo inflamatorio tras picadura de insecto / Inflammatory nodule after insect bite

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An intensive outpatient program for patients with borderline personality disorder.

Intensive outpatient programs are designed to promote patients' functioning in the community by offering a more intensive level of structure and support than was previously available for outpatients. This paper describes the intensive outpatient program at McLean Hospital in Belmont, Massachusetts, which is tailored for patients with borderline personality disorder. These patients are susceptible to control struggles and regressive behaviors in more restrictive treatment settings. Through frequent contact with clinicians and other patients in this group-oriented program, patients with borderline personality disorders appear to feel sufficiently "held" and understood to develop their functional capacities as outpatients.

Families of borderline patients: a psychoeducational approach.

The development of the psychoeducational form of treatment described in this article has been prompted by changes in our understanding of borderline psychopathology and changes in the health care system in which these patients are treated. After reviewing these background changes, the authors describe the treatment itself, its form, its purpose, and the preliminary suggestions of its effectiveness.