Development and validation of a prognostic index (BODEXS90) for mortality in stable chronic obstructive pulmonary disease.

INTRODUCTION: Several multidimensional indices have been proposed to predict mortality in chronic obstructive pulmonary disease (COPD). The BODEX index is simple and easy to use for this purpose in all clinical settings. Only a few prognostic indices have integrated oxygenation variables, with measurement methods that are not practical for real life clinical practice in all settings. OBJECTIVES: To develop and externally validate a new prognostic index (BODEXS90) that combines the variables included in BODEX index with rest peripheral oxygen saturation measured with finger oximetry (SpO2) to predict all-cause mortality in stable COPD. METHOD: Observational, non-intervention, multicenter historic cohort study. The BODEXS90 index was developed in a derivation cohort and externally validated in a validation cohort. Calibration of the index was carried out using Hosmer-Lemeshow test. The discrimination capacity of BODEXS90 and BODEX were compared by means of receiver-operating characteristics curves. Modelling of the index was carried out by crude and adjusted Cox regression analysis. RESULTS: The derivation and validation cohorts included 787 and 1179 subjects, respectively. SpO2 predicted all cause-mortality independently of BODEX index. Discrimination capacity of BODEXS90 to predict the outcome was significantly higher than that of BODEX, particularly for more severely affected patients, both in the derivation and in the validation cohorts. CONCLUSIONS: The new index is potentially useful for designing clinical decision-making algorithms in stable COPD.

In vitro amoebicidal effects of arabinogalactan-based ophthalmic solution.

The main corneal infections reported worldwide are caused by bacteria and viruses but, recently, the number of Acanthamoeba keratitis (AK) cases has increased. Acanthamoeba genus is an opportunistic free living protozoa widely distributed in environmental and clinical sources, with two life-cycle stages: the trophozoite and the cyst. AK presents as primary symptoms eye redness, epithelial defects, photophobia and intense pain. An early diagnosis and an effective treatment are crucial to avoid blindness or eye removal but, so far, there is no established treatment to this corneal infection. Diverse research studies have reported the efficacy of commercialized eye drops and ophthalmic solutions against the two life cycle stages of Acanthamoeba strains, that usually present preservatives such as Propylene Glycol of Benzalkonium chloride (BAK). These compounds present toxic effects in corneal cells, favouring the inflammatory response in the so sensitive eye tissue. In the present work we have evaluated the efficacy of nine proprietary ophthalmic solutions with and without preservatives (ASDA Dry Eyes Eyedrops, Miren®, ODM5®, Ectodol®, Systane® Complete, Ocudox®, Matrix Ocular®, Alins® and Coqun®) against the two life cycle stages of three Acanthamoeba strains. Our work has demonstrated the high anti-Acanthamoeba activity of Matrix Ocular®, which induces the programmed cell death mechanisms in Acanthamoeba spp. trophozoites. The high efficacy and the absence of ocular toxic effects of Matrix Ocular®, evidences the use of the Arabinogalactan derivatives as a new source of anti-AK compounds.

Focal laser for idiopathic macular telangectasia type 1 refractory to ozurdex, ranibizumab and aflibercept. / Láser focal para telangectasia macular idiopática tipo 1 refractario a ozurdex, ranibizumab y aflibercept.

We present a case of a woman with idiopathic macular telangiectasia type 1, characterized by the presence of a capillary macroanaeurysm associated with macular edema with a macular star pattern. Several differential diagnoses were proposed, in which the study with a multimodal image was key to clarify the diagnosis. In addition, the various treatments used and their effectiveness are discussed.

Relación entre la dislipidemia y otros factores de riesgo cardiovasculares conocidos con la presencia de enfermedad cardiovascular en pacientes con enfermedad pulmonar obstructiva crónica de las Islas Canarias / Dyslipidaemia and other cardiovascular risk factors in relation to manifest cardiovascular disease in patients with chronic obstructive pulmonary disease in the Canary Islands

INTRODUCCIÓN: La enfermedad cardiovascular tiene un impacto negativo en el pronóstico vital de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), siendo la dislipidemia (DLP) y la hipertensión arterial (HTA) los factores de riesgo más prevalentes. El objetivo del estudio fue: 1) evaluar la relación existente entre el diagnóstico de DLP y la presencia de enfermedad cardiovascular en pacientes con EPOC, y compararlo con otros factores conocidos de riesgo cardiovascular; y 2) determinar la relación entre las diferentes comorbilidades cardiovasculares y los grupos de gravedad según la clasificación GOLD 2017. MÉTODOS: Estudio observacional transversal de 454 pacientes con EPOC en seguimiento ambulatorio. Se calculó la prevalencia de cada una de las comorbilidades cardiovasculares y el riesgo de que cada uno de los factores de riesgo cardiovascular se presentase conjuntamente con una enfermedad vascular (RRij). RESULTADOS: El 66,7% de los pacientes eran dislipidémicos. La DLP mostró una mayor relación con la presencia de accidentes cerebrovasculares (ACV) (RRij 1.36; p = 0,0054), enfermedad renal crónica (ERC) (RRij 1.34; p = 0,00023) y arteriopatía periférica (AP) (RRij 1.38; p = 0,00015); la HTA se relacionó mayormente con ACV (RRij 1,41; p = 0,0014) y ERC (RRij 1,42; p < 0,0001); la DMT2 con AP (RRij 1,90; p = 0,0001), insuficiencia cardiaca (IC) (RRij 1,74; p = 0,0002) y ERC (RRij 1,76; p < 0,0001); la obesidad con IC (RRij 1,60; p = 0,0009) y ERC (RRij 1.54; p = 0,0001). CONCLUSIÓN: La DLP se relacionó con la presencia de ACV, ERC y AP. La HTA y DMT2 se relacionaban mayoritariamente con IC y ACV

INTRODUCTION: Cardiovascular disease has a negative impact on the vital prognosis of patients with chronic obstructive pulmonary disease (COPD), where dyslipidaemia (DLP) and arterial hypertension (AHT) are considered the most prevalent risk factors. The objective of this study was 1) to assess the relationship between diagnosed DLP and cardiovascular disease in COPD patients and compare it with other known cardiovascular risk factors and 2) to determine the relationship between the different cardiovascular comorbidities and the severity groups according to the GOLD 2017 classification. METHODS: A cross-sectional, observational study was performed in 454 outpatients with COPD during their follow up. We calculated the prevalence of each of the cardiovascular comorbidities and the probability of each of the cardiovascular risk factors to occur jointly with a vascular disease (RRij). RESULTS: A total of 66.7% of the patients had DLP, whereby DLP was related to cerebrovascular accidents (CVA) (RRij 1.36, P=.0054), chronic kidney disease (CKD) (RRij 1.34, P=.00023), and peripheral arterial disease (PAD) (RRij 1.38, P=.00015). AHT was mostly related to CVA (RRij 1.41, P=.0014) and CKD (RRij 1.42, P<.0001). Type 2 diabetes mellitus (T2DM) correlated with PAD (RRij 1.90, P=.0001), heart failure (HF) (RRij 1,74, P=.0002), and CKD (RRij 1.76, P<.0001), and obesity was associated with HF (RRij 1.60, P=.0009) and CKD (RRij 1.54, P=.0001). CONCLUSION: DLP was related to CVA, CKD, and PAD. AHT and T2DM are the conditions that mostly relate to HF and CVA

Pérdida visual secundaria a intoxicación inhalatoria y cutánea por metanol y tolueno. A propósito de un caso / Secondary visual loss due to inhalation and cutaneous poisoning by methanol and toluene. Presentation of a clinical case

La intoxicación por ingesta de metanol es una entidad frecuentemente descrita en la literatura, no así la intoxicación vía transdérmica o inhalatoria. Suele cursar con daño multiorgánico variable, entre lo que destaca la afectación visual, neurológica y digestiva, así como las alteraciones metabólicas y electrolíticas que pueden llegar a causar la muerte. El contacto con tolueno por inhalación ocupacional o intencional puede producir también alteraciones neurológicas. En este artículo se expone el caso de una paciente mujer que acude al servicio de urgencias por pérdida visual bilateral secundaria a una intoxicación accidental (inhalatoria-transdérmica) con un disolvente que contenía metanol y tolueno, entre otros compuestos, y que durante el ingreso evoluciona favorablemente tras tratamiento con etanol en perfusión y corticoides

Methanol poisoning is often described in the literature, but not transdermal or inhalational poisoning. It usually involves variable multi-organ damage, among which visual, neurological, and gastrointestinal involvement, as well as the metabolic and electrolyte changes that can lead to death. Contact with toluene by occupational or intentional inhalation may also cause neurological abnormalities. This article describes the case of a female patient who was seen in the Emergency Department due to bilateral visual loss secondary to accidental poisoning (inhalation-transdermal) with a solvent containing methanol and toluene. She had a favourable outcome during admission after treatment with ethanol in perfusion and corticosteroids

Secondary visual loss due to inhalation and cutaneous poisoning by methanol and toluene. Presentation of a clinical case. / Pérdida visual secundaria a intoxicación inhalatoria y cutánea por metanol y tolueno. A propósito de un caso.

Methanol poisoning is often described in the literature, but not transdermal or inhalational poisoning. It usually involves variable multi-organ damage, among which visual, neurological, and gastrointestinal involvement, as well as the metabolic and electrolyte changes that can lead to death. Contact with toluene by occupational or intentional inhalation may also cause neurological abnormalities. This article describes the case of a female patient who was seen in the Emergency Department due to bilateral visual loss secondary to accidental poisoning (inhalation-transdermal) with a solvent containing methanol and toluene. She had a favourable outcome during admission after treatment with ethanol in perfusion and corticosteroids.

Dyslipidaemia and other cardiovascular risk factors in relation to manifest cardiovascular disease in patients with chronic obstructive pulmonary disease in the Canary Islands. / Relación entre la dislipidemia y otros factores de riesgo cardiovasculares conocidos con la presencia de enfermedad cardiovascular en pacientes con enfermedad pulmonar obstructiva crónica de las Islas Canarias.

INTRODUCTION: Cardiovascular disease has a negative impact on the vital prognosis of patients with chronic obstructive pulmonary disease (COPD), where dyslipidaemia (DLP) and arterial hypertension (AHT) are considered the most prevalent risk factors. The objective of this study was 1) to assess the relationship between diagnosed DLP and cardiovascular disease in COPD patients and compare it with other known cardiovascular risk factors and 2) to determine the relationship between the different cardiovascular comorbidities and the severity groups according to the GOLD 2017 classification. METHODS: A cross-sectional, observational study was performed in 454 outpatients with COPD during their follow up. We calculated the prevalence of each of the cardiovascular comorbidities and the probability of each of the cardiovascular risk factors to occur jointly with a vascular disease (RRij). RESULTS: A total of 66.7% of the patients had DLP, whereby DLP was related to cerebrovascular accidents (CVA) (RRij 1.36, P=.0054), chronic kidney disease (CKD) (RRij 1.34, P=.00023), and peripheral arterial disease (PAD) (RRij 1.38, P=.00015). AHT was mostly related to CVA (RRij 1.41, P=.0014) and CKD (RRij 1.42, P<.0001). Type 2 diabetes mellitus (T2DM) correlated with PAD (RRij 1.90, P=.0001), heart failure (HF) (RRij 1,74, P=.0002), and CKD (RRij 1.76, P<.0001), and obesity was associated with HF (RRij 1.60, P=.0009) and CKD (RRij 1.54, P=.0001). CONCLUSION: DLP was related to CVA, CKD, and PAD. AHT and T2DM are the conditions that mostly relate to HF and CVA.

Síndrome post-COVID en el paciente con enfermedad pulmonar obstructiva crónica: ¿Un caballo de Troya? / Post-COVID syndrome in the patient with chronic obstructive pulmonary disease: a Trojan horse?

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Aplicabilidad del score COPD-LUCSS-DLCO en pacientes con enfermedad pulmonar obstructiva crónica: análisis en condiciones de práctica clínica habitual / Applicability of the COPD-LUCSS-DLCO score for patients with chronic obstructive pulmonary disease: Analysis in standard clinical practice conditions

Introducción: El score COPD-LUCSS-DLCO ha sido validado como una herramienta predictiva capaz de identificar pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y alto riesgo de fallecer por cáncer de pulmón (CP). No obstante, hasta la fecha no se han realizado estudios acerca de su uso en la práctica clínica habitual. El objetivo del estudio fue estimar las puntuaciones del score COPD-LUCSS-DLCO en pacientes con EPOC atendidos en consultas de Neumología, así como determinar la incidencia de CP en cada uno de los subgrupos. Material y métodos: Estudio observacional retrospectivo de una cohorte de 159 pacientes con EPOC en seguimiento en consultas ambulatorias de Neumología. Se calculó la puntuación del score COPD-LUCSS-DLCO (puntuación de 0-8) a cada uno de los sujetos, considerando bajo riesgo (BR) entre 0-3 puntos y alto riesgo (AR) ≥ 3,5 puntos. Se estimó la incidencia del CP en cada uno de los subgrupos. Resultados: El 62% presentaban un score de AR. Se estimó una tasa global de CP de 30 por 1.000 pacientes con EPOC-año (IC 95%:16-53), de 44 por 1.000 pacientes con EPOC-año (IC 95%: 18-76) entre los catalogados de AR y de 17 por 1.000 pacientes con EPOC-año (IC 95%: 4-50). Conclusiones: El uso del score COPD-LUCSS-DLCO en la práctica clínica habitual podría permitir detectar pacientes con un mayor riesgo de desarrollar CP, lo cual ayudaría a una mejor gestión de casos en un programa de screening de CP

Introduction: The COPD-LUCSS-DLCO score had been validated as a predictive tool capable of identifying patients with chronic obstructive pulmonary disease (COPD) and a high mortality risk associated with lung cancer (LC); however, studies have not been conducted yet on its use in standard clinical practice. The aim of this study was to estimate the COPD-LUCSS-DLCO scores for patients with COPD treated in Pulmonology consultations and to determine the incidence of LC in each of the subgroups. Material and methods: A retrospective observational study was conducted with a cohort of 159 patients with COPD in Pulmonology outpatient follow-up consultations. We calculated the COPD-LUCSS-DLCO score (0-8) for each patient, with low risk considered at 0-3 points and high risk at ≥3.5 points. We calculated the incidence rate of LC in each of the subgroups. Results: Sixty-two percent of the patients had a high-risk score. We estimated an overall LC rate of 30 per 1000 patients with COPD-year (95% CI: 16-53), 44 per 1000 patients with COPD-year (95% CI: 18-76) among those categorised as high risk and 17 per 1000 patients with COPD-year among those categorised as low risk (95% CI: 4-50). Conclusions: The use of the COPD-LUCSS-DLCO score in standard clinical practice could help detect patients with a greater risk of developing LC, which could help to better manage cases in an LC screening programme

Desprendimiento del epitelio pigmentario de la retina en la retinopatía por malaria / Detachment of retinal pigment epithelium in retinopathy due to malaria

CASO CLÍNICO: Varón de 45 años de edad, acude diagnosticado de paludismo con afectación neurológica. Dos meses más tarde refiere metamorfopsia en el ojo izquierdo. En el fondo de ojo se aprecia retinopatía palúdica bilateral, observándose en la tomografía de coherencia óptica (OCT) macular un desprendimiento del epitelio pigmentario (DEP) parafoveal en el ojo izquierdo. Se inicia tratamiento específico antipalúdico, evidenciándose desaparición de la retinopatía. DISCUSIÓN: El Plasmodium falciparum es responsable de la retinopatía en el paludismo neurológico. Debiéndose realizar en estos pacientes una exploración fundoscópica y OCT macular porque está asociado a una mortalidad mayor cuando existe afectación retiniana

CASE REPORT: A 45-year-old man was diagnosed with malaria with neurological involvement. Two months later he referred metamorphopsia in the left eye. Malarial retinopathy was observed in the fundus examination. The Optic Coherence Tomography (OCT) of the macula showed parafoveal pigment epithelium detachment (DEP). Specific anti-malarial treatment was initiated, with the disappearance of the retinopathy being observed. DISCUSSION: Plasmodium falciparum is responsible for the retinopathy in neurological malaria. A funduscopic examination and macular OCT should be performed in these patients, as it is associated with a higher mortality when there is a retinal involvement

Applicability of the COPD-LUCSS-DLCO score for patients with chronic obstructive pulmonary disease: Analysis in standard clinical practice conditions. / Aplicabilidad del score COPD-LUCSS-DLCO en pacientes con enfermedad pulmonar obstructiva crónica: análisis en condiciones de práctica clínica habitual.

INTRODUCTION: The COPD-LUCSS-DLCO score had been validated as a predictive tool capable of identifying patients with chronic obstructive pulmonary disease (COPD) and a high mortality risk associated with lung cancer (LC); however, studies have not been conducted yet on its use in standard clinical practice. The aim of this study was to estimate the COPD-LUCSS-DLCO scores for patients with COPD treated in Pulmonology consultations and to determine the incidence of LC in each of the subgroups. MATERIAL AND METHODS: A retrospective observational study was conducted with a cohort of 159 patients with COPD in Pulmonology outpatient follow-up consultations. We calculated the COPD-LUCSS-DLCO score (0-8) for each patient, with low risk considered at 0-3 points and high risk at ≥3.5 points. We calculated the incidence rate of LC in each of the subgroups. RESULTS: Sixty-two percent of the patients had a high-risk score. We estimated an overall LC rate of 30 per 1000 patients with COPD-year (95% CI: 16-53), 44 per 1000 patients with COPD-year (95% CI: 18-76) among those categorised as high risk and 17 per 1000 patients with COPD-year among those categorised as low risk (95% CI: 4-50). CONCLUSIONS: The use of the COPD-LUCSS-DLCO score in standard clinical practice could help detect patients with a greater risk of developing LC, which could help to better manage cases in an LC screening programme.

Clinical characteristics of COPD patients with early-onset desaturation in the 6-minute walk test.

BACKGROUND: Exercise-induced desaturation in chronic obstructive pulmonary disease (COPD) frequently has prognostic implications. Desaturation within the first minute of the walk 6-minute walk test will probably also occur in daily life activities and translate into hypoxaemic respiratory failure at rest in later years. This study aimed at comparing these patients with those who desaturate after the first minute and determine potential markers. METHODS: We conducted a cross-sectional, retrospective study collecting data on respiratory function tests, cardiovascular comorbidity, body mass index, pack-year index, 6-minute walk test outcomes, BODE index, and Charlson comorbidity index. Patients who desaturated during the first minute of the test were referred to as early desaturators compared to the non-early ones. RESULTS: We observed a higher mean body mass index in early desaturating patients, and an inverse relation as to the body mass index categories <25, 25-29, and ≥30. Early desaturators had a lower FEV1/FVC index. The mean distance walked in the test was shorter in early than in non-early desaturators, and they desaturated more deeply. CONCLUSION: Overweight and obesity, as determined by body mass index, seem to behave like markers for early desaturation. This simple anthropometric measure might indicate point to potential early desaturation in COPD patients.

Propuesta de confirmación espirométrica de la enfermedad pulmonar obstructiva crónica / Proposal confirmation by spirometry of chronic obstructive pulmonary disease

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Estudio de la eficacia de la botella NKD POD+: seguridad de su sistema de filtrado para el combatiente / Study of the NKD POD+ bottle efficacy: analysis of its safety filtering system

ANTECEDENTES Y OBJETIVOS: Actualmente, los miembros de las Fuerzas Armadas utilizan desinfectantes en forma de pastillas para potabilizar el agua. Recientemente, se estudió la posibilidad de introducir en el material de dotación del combatiente un tipo de botella con un sistema de filtrado novedoso, la botella Nkd POD+. El objetivo principal de este estudio es analizar la eficacia del sistema de filtrado de dicha botella para valorar su uso en las Fuerzas Armadas Españolas, de tal manera que, cualquier agua contaminada que sea filtrada y consumida, no suponga ningún riesgo para la salud. Para ello, en el Laboratorio de Análisis de Aguas del Instituto de Toxicología de la Defensa se realizaron ensayos químicos y microbiológicos de diferentes muestras de agua para determinar la eficacia del filtro para eliminar metales pesados, plaguicidas, nitratos y microorganismos del agua. MATERIAL Y MÉTODOS: Para realizar los ensayos se han preparado muestras utilizando agua destilada y disoluciones patrón certificadas de los contaminantes. Posteriormente las muestras fueron filtradas con la botella. Se analizaron las muestras antes y después del filtrado, para los nitritos el análisis se realizó mediante espectroscopía Ultravioleta-Visible (UV-Vis), los metales pesados mediante plasma de acoplamiento inductivo acoplado a espectrometría de masas (ICP-MS) y los plaguicidas mediante cromatografía gaseosa acoplada a espectrometría de masas (CG/MS). RESULTADOS: Se comprobó que el filtro apenas elimina metales pesados. Los pesticidas en concentraciones de 1 mig/L son retenidos adecuadamente por la botella, pero a concentraciones de 10 mig/L, lo son en menor medida. Respecto a los nitratos se observó un aumento respecto a la concentración inicial en la muestra filtrada. En el ensayo microbiológico, el sistema de filtrado únicamente retiene las bacterias grandes con un tamaño superior a 0.45 mim, siendo totalmente ineficaz para las pequeñas como enterococos. CONCLUSIONES: la botella Nkd POD+ genera una falsa sensación de seguridad, ya que no cumple con los requisitos ofrecidos y pone en riesgo la salud del combatiente

BACKGROUND AND OBJECTIVES: Nowadays, the Army uses disinfectant tablets to purify water. Recently, it was hinted the possibility of including in our combatants' equipment a special kind of bottle with a new filtering system, the NKD POD+ The main objective of this research is to analyse the efficacy of this bottle filtering system in order to assess its possible use by Spanish Army so as to allow the filtering of any type of water which, once drunk, implies no health risk. In order to do so, the Laboratorio de Análisis de Aguas (Water Analysis Lab) of the Instituto de Toxicología de la Defensa (Defence Toxicology Institute) performed chemical and microbiological tests on different water samples to assess the degree of efficacy of the filter in order to eliminate heavy metals, pesticides, nitrates and water microorganisms. MATERIALS AND METHOD: In order to conduct the tests, different samples with distilled water and certified patron solutions of the contaminants were used. Later, these samples were filtered through the bottle. The samples were analyses prior and after the filtering process. The analysis of the nitrites was conducted with visible ultraviolet spectroscopy (UV-Vis), heavy metals through inductive coupling plasma, coupled to mass spectrometry (ICP-MS), and pesticides through coupling gas chromatography to mass spectrometry (CG/MS). RESULTS: It was proved that the water filter had hardly eliminated heavy metals. Pesticides in concentration of 1 mig/L were properly filtered by the bottle but to a lesser extent for concentrations of 10 mig/L. Regarding nitrites, it was observed an increase with respect to the original concentration in the filtered sample. In the microbiological test, the filtering system only retained those particles bigger than 0.45 mim, being totally ineffective with the tiniest ones such as enterococcus. CONCLUSIONS: The Nkd POD+ bottle generates a false feeling of safety as it does not meet the necessary requirements and compromises the combatants' health

Detachment of retinal pigment epithelium in retinopathy due to malaria. / Desprendimiento del epitelio pigmentario de la retina en la retinopatía por malaria.

CASE REPORT: A 45-year-old man was diagnosed with malaria with neurological involvement. Two months later he referred metamorphopsia in the left eye. Malarial retinopathy was observed in the fundus examination. The Optic Coherence Tomography (OCT) of the macula showed parafoveal pigment epithelium detachment (DEP). Specific anti-malarial treatment was initiated, with the disappearance of the retinopathy being observed. DISCUSSION: Plasmodium falciparum is responsible for the retinopathy in neurological malaria. A funduscopic examination and macular OCT should be performed in these patients, as it is associated with a higher mortality when there is a retinal involvement.