[Post-hospital mortality in patients re-admitted due to COPD. Utility of BODE index]. / Mortalidad posthospitalaria en pacientes reingresadores por EPOC. Utilidad del índice BODE.

BACKGROUND: The BODE index can accurately predict mortality in ambulatory patients with COPD, although its utility in hospitalized patients is unknown. MATERIAL AND METHODS: We prospectively evaluated all patients hospitalized during one year for acute exacerbation of COPD with one or more admissions in the previous year. On discharge, previous functional dependence, comorbidity, depression and quality of life, among other variables, were evaluated. Body mass index, 6-minute walking test, dyspnea scale and spirometry with a post-bronchodilator test were performed on the last day of hospitalization and the BODE index was calculated using these data. RESULTS: A total of 66 patients were included, with a mean age of 71.6 +/- 8.9 years. Of these patients, 42 (63.6%) died before the end of the study (median follow-up 1,490 days). A higher mortality was observed among the oldest patients (p < 0.004), those with more comorbidities (p < 0.05), worse score on the BODE index (p < 0.006; OR 1.3; CI 95%: 1.07-1.54) and the dyspnea scale (p < 0.008). Functional dependence (p < 0.02), and pCO2 > 45 mmHg at discharge (p < 0.001) were also significant predictors of mortality. In the multivariate analysis, only hypercapnia (p < 0.004; OR 3.48; CI 95% 1.49-8.14) and the BODE index (p < 0.0005; OR 1.47; CI 95%: 1.18-1.82) were independent predictors of mortality. CONCLUSIONS: The BODE index measured at hospital discharge is an accurate and reliable predictor of mortality in patients who require several admissions for acute exacerbations of COPD.

Mortalidad posthospitalaria en pacientes reingresadores por EPOC. Utilidad del índice BODE / Post-hospital mortality in patients re-admitted due to COPD. Utility of BODE index

Introducción: El índice BODE es un buen predictor de mortalidad en pacientes ambulatorios con enfermedad pulmonar obstructiva crónica (EPOC), aunque no se ha demostrado su utilidad en los pacientes hospitalizados. Material y métodos: Estudiamos prospectivamente los pacientes hospitalizados por exacerbación de la EPOC con uno o más ingresos en el año previo. Al alta se valoró la dependencia funcional previa, la comorbilidad, la depresión y la calidad de vida, entre otras variables. Se realizó una prueba de marcha de 6 minutos, una espirometría con prueba broncodilatadora, se valoró la escala de disnea, el índice de masa corporal y se calculó el índice BODE. Resultados: Se incluyeron 66 pacientes con una edad media de 71,6 ± 8,9 años. Fallecieron 42 pacientes (63,6%) antes del final del estudio (mediana de seguimiento de 1.490 días). La mortalidad fue más elevada en los pacientes más ancianos (p < 0,004), con más comorbilidad (p < 0,05) y con peores puntuaciones en la escala de disnea (p < 0,008) y en el índice BODE (p < 0,006; odds ratio [OR] 1,3; intervalo de confianza [IC] 95%: 1,07-1,54). La dependencia funcional (p < 0,02) y la pCO2 ≥ 45 mmHg al alta (p < 0,001) fueron también predictores de mortalidad. En el análisis multivariante sólo la hipercapnia y el índice BODE fueron variables predictoras independientes de mortalidad. Conclusiones: El índice BODE calculado al alta hospitalaria es una variable útil como predictor de mortalidad posterior en pacientes reingresadores por EPOC. Su capacidad pronóstica es superior al FEV (AU)

Background: The BODE index can accurately predict mortality in ambulatory patients with COPD, although its utility in hospitalized patients is unknown. Material and methods: We prospectively evaluated all patients hospitalized during one year for acute exacerbation of COPD with one or more admissions in the previous year. On discharge, previous functional dependence, comorbidity, depression and quality of life, among other variables, were evaluated. Body mass index, 6-minute walking test, dyspnea scale and spirometry with a post-bronchodilator test were performed on the last day of hospitalization and the BODE index was calculated using these data. Results: A total of 66 patients were included, with a mean age of 71.6 ± 8.9 years. Of these patients, 42 (63.6%) died before the end of the study (median follow-up 1,490 days). A higher mortality was observed among the oldest patients (p < 0.004), those with more comorbidities (p < 0.05), worse score on the BODE index (p < 0.006; OR 1.3; CI 95%: 1.07-1.54) and the dyspnea scale (p < 0.008). Functional dependence (p < 0.02), and pCO2 > 45 mmHg at discharge (p < 0.001) were also significant predictors of mortality. In the multivariate analysis, only hypercapnia (p < 0.004; OR 3.48; CI 95% 1.49-8.14) and the BODE index (p < 0.0005; OR 1.47; CI 95%: 1.18-1.82) were independent predictors of mortality. Conclusions: The BODE index measured at hospital discharge is an accurate and reliable predictor of mortality in patients who require several admissions for acute exacerbations of COPD (AU)

Tuberculosis cutánea, mamaria y ganglionar sin afectación pulmonar en paciente sininmuno depresión aparente / Mammary cutaneous and nodal tuberculosis without pulmonary affectation in a patient

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[Cerebral SPECT with thallium-201 in the differential diagnosis of focal cerebral lesions in patients with AIDS]. / SPECT cerebral con talio-201 en el diagnóstico diferencial de lesiones cerebrales focales en pacientes con SIDA.

BACKGROUND: The aim of this study was to analyze the usefulness of cerebral SPECT with thallium-201 in patients with the acquired human immunodeficiency syndrome (AIDS) and focal cerebral lesions. METHODS: Six patients with AIDS and focal cerebral lesions in whom a cerebral SPECT was performed with thallium-201 are described. Treatment was initiated with antiToxoplasma drugs in all patients. The clinical response, serology for positive toxoplasma and radiologic improvement were criteria for the diagnosis of encephalitis by Toxoplasma. In the remaining cases, cerebral biopsy and/or necropsy study were carried out. RESULTS: In the 2 patients in whom cerebral SPECT demonstrated enhancement of the lesion, the pathologic diagnosis was cerebral lymphoma. Of the 4 remaining cases in whom no enhancement was observed, three corresponded to cerebral toxoplasmosis and one to progressive multifocal leucoencephalopathy. CONCLUSIONS: Cerebral SPECT with thallium-201 is a simple, specific and useful technique for the differentiation of primary cerebral lymphoma from the remaining inflammatory cerebral lesions which may be present in AIDS patients.