Utilidad de la valoración ecográfica previa a la realización del primer acceso vascular para hemodiálisis

IntroductionTraditionally, the indication of the type of vascular access (VA) has been based on the surgeon's physical examination, but it is now suggested that imaging methods could provide a clinical benefit. Our aim was to determine whether or not preoperative Doppler ultrasound modifies outcomes of the first VA for haemodialysis.Patients and methodsProspective cohort of patients undergoing a first VA from June 2014 to July 2017 who had a preoperative Doppler ultrasound (ECO group). They were compared to a historical cohort (January 2012-May 2014) of first VA indicated exclusively by clinical assessment (CLN group).ResultsA total of 86 patients from the CLN group were compared to 92 from the ECO group, which was younger (68.4 vs 64.0, P = .038).The primary patency (CLN/ECO) at 1 and 2 years was 59.5%/71.9% and 53.1%/57.8% respectively, marginally better in the ECO group (P = .057). The assisted patency at 1 and 2 years was 63.2%/80.7% and 58.1%/70.2%, respectively, significantly better for the ECO group (P = .010).Due to lack of patency/utility of the initial VA, 26.7% in the CLN group and 7.6% in the ECO group (P < .001) required a new VA during the first 6 months. An average of 1.39 interventions were performed to achieve a useful VA in the CLN group and 1.08 in the ECO group (P < .001), the first VA being useful at the radiocephalic level in 31.0%/45.1% (P = .039).ConclusionThe indication of the first VA according to a preoperative Doppler ultrasound examination could decrease the need for new VA, enable them to be made more distal, and significantly improve patency.     

Comportamiento de la calidad de vida (SGRQ) en pacientes con EPOC según las puntuaciones BODE

IntroductionTo evaluate if the association between the BODE index and deterioration in health-related quality of life is linear. To determine possible associations between the BODE index and health status evaluated by the Saint George's Respiratory Questionnaire (SGRQ) at all levels of disease severity in COPD.MethodsA cross-sectional study was carried out on 253 patients from two Latin American respiratory centers (Brazil and Chile) with a clinical diagnosis of COPD, based on GOLD criteria. Assessment included the BODE index and the SGRQ questionnaire.ResultsPatients had a BODE index of 3.1 ± 2.0; FEV₁ (%) of 49 ± 19.2; BMI (kg/m²) of 24.7 ± 5.1; 6MWT distance (meters) of 444 ± 96. Significant correlations were found between the BODE index and SGRQ total scores (r = 0.5; < 0.001), impact (r = 0.45; < 0.001) and activity (r = 0.5; < 0.001). From BODE score zero, HRQOL was already compromised in all SGRQ domains. SGRQ scores (total and domain) increased progressively for individual components of the BODE index, with the decrease in airflow limitation (< 0.05), BMI (< 0.002) and 6MWT (< 0.05), and with the increase in the Modified Medical Research Council (MMRC) score (< 0.05).ConclusionThere is an association between health-related quality of life, as assessed by the SGRQ and the BODE index within the entire spectrum of COPD severity. Even in early disease stages and BODE index zero, health-related quality of life is already impaired.     

Conocimiento de la población española de las enfermedades músculo-esqueléticas

ObjectiveTo explore knowledge on musculoskeletal-diseases (MSDs) by the Spanish population.MethodsThis was a cross-sectional study of the general population (> 18 years) using a telephone survey of 1,009 subjects stratified by habitat size, age, sex, and geographic area. A structured questionnaire was used to collect information on the subjects, their general knowledge of MSDs (GK), their specific knowledge of particular MSDs (SK), and their knowledge of their social impact (KSI). Synthetic indicators of the level of knowledge were used to analyze, using univariate and multivariate models, variables associated to the level of knowledge.ResultsThe KSI level ranges from medium-high (mean: 0.62 ± 0.16 out of 1), suggesting that most subjects recognize MSDs as disabling conditions which affect the ability to work and have a high personal and social cost. The GK level is intermediate (mean: 0.50 ± 0.17); 60% of subjects know something about MSDs, but 54% state that their information is poor/very poor. The SK level is low (mean: 0.18 ± 0.10), and there are some MSDs that are little known (lupus, spondylitis). Being male or retired or having a MSD is associated to a greater knowledge of MSDs.ConclusionThe Spanish population has a medium level of knowledge of the frequency and extent to which MSDs affect performance of activities by those who suffer them. They identify them adequately and have a GK of their symptoms, but have little information about them. The level of knowledge varies depending on social and demographic factors and on whether or not the subject has direct or indirect experience of what a MSD means.     

Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón

ObjectiveEvaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients.MethodsCase-controlled retrospective analysis. Study population: Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database.ResultsNo statistically significant differences were found in BMI (P=.40), FEV1% (P=.41), postoperative FEV1% (P=.23), FEV1/FVC (P=.23), DLCO (P=.76) and pneumonectomy rate (P=.90). Case mortality was 1.85% and control mortality was 1.26% (OR: 1.48). Cardiorespiratory complications occurred in 12.80% of younger subjects and in 13.21% of patients aged 80 years or older. (OR: 1.03). In the logistic regression, only FEV1% was related to postoperative complications (P<.005).ConclusionSelection criteria for octogenarians are similar to those applied in the rest of the population. Advanced age is not a factor for increased 30-day mortality or postoperative morbidity.     

Aplicación de un modelo de predicción de progresión de artritis reumatoide en pacientes con artritis indiferenciada

IntroductionDifferent prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts.ObjectiveTo apply the LPR to a cohort of patients with UA of northeastern Mexico.MethodsWe included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not.Results43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p = 0.940.ConclusionMost patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease.     

Validación pronóstica según los criterios de la GesEPOC 2017

IntroductionThe Spanish COPD guidelines (GesEPOC) have been recently modified. The aim of this study is to assess this revision and evaluate the prognosis of patients according to the new classification of severity.MethodsA total of 700 COPD patients (83.9% men) were prospectively followed up for a mean period of 5 years in tertiary hospitals in Spain and the USA. Anthropometric data, lung function tests, dyspnea (according to the mMRC scale), BODE and Charlson index were collected. We calculated mortality at 5 years following the risk criteria proposed by the new GesEPOC.ResultsMean age was 66 ± 9.6 years and mean FEV₁% was 59.7 ± 20.2. The proportion of patients in the low-risk group was 40.43%. Patients in the high-risk group had a significantly higher BODE index than those in the low-risk group (2.92 ± 0,66 vs. 0.52 ± 1.91, p < 0.001), while the Charlson index score was similar in both groups. Mortality at 60 months was significantly higher in the high-risk group (31.7% vs. 15.5%, p < 0.001). Dyspnea and FEV₁% were also independent predictors of mortality (p < 0.001), and neither was inferior to the risk classification proposed by GesEPOC.ConclusionsThe new severity index proposed by GesEPOC accurately predicts 5-year mortality. However, dyspnea and FEV₁% have the same strength in predicting mortality.     

Importancia de la imagen en la valoración de la respuesta al tratamiento con inmunoterapia del cáncer de pulmón

Immunotherapy (particularly immune checkpoint inhibitors) in the treatment of patients with lung cancer has aroused great interest in recent years, revolutionized the management of patients with locally advanced/metastatic disease, and given hope to both patients and treating physicians. These drugs, in combination or in monotherapy, have become the standard treatment for many patients with lung cancer, and their use is expected to increase significantly in the near future. In this article, we will review the growing importance of imaging techniques in the evaluation of therapeutic response to immunotherapy in lung cancer patients, with emphasis on the new specific radiological criteria on response to immunotherapy, atypical radiological responses (pseudoprogresion, dissociative responses, hyperprogresion), and the main radiological manifestations of adverse events associated with immunotherapy (sarcoid reactions, pulmonary toxicities, etc.). Pulmonologists must be familiar not only with atypical radiological responses to immunotherapy and their prognostic implications, but also with their effects and the new radiological criteria of response to assess treatment response. In this study, we will address key concepts such as “pseudoprogresion”, “paradoxical response”, “hyperprogresion”, or “unconfirmed progression”, and their significance in the management of patients with lung cancer treated with immunotherapy.     

Planificación en enfermedades reumáticas. Elaboración del Plan director de las enfermedades reumáticas y del aparato locomotor de Cataluña

BackgroundRheumatic diseases (RDs) are among the most common chronic health problems of the Catalan adult population. They cause important problems for individuals, their families and for the society overall, with high direct and indirect economic costs. The Department of Health of Catalonia promoted the creation of a Master Plan for the rheumatic diseases, as a tool for planning an integral approach to these problems.ObjectiveTo present the work methodology that has been used in the development of the Master Plan and its final proposals.MethodsFirst an analysis of the burden caused by these problems in our community was performed and the objectives of the Plan were established. Later, strategic lines were defined and work groups organized to analyze proposals for improvement, which after consensus were accepted.ResultsThe proposals of the Plan comprise actions in the scope of prevention, rationalization in the use of resources and the formation of professionals among others. Changes in the health care model for RDs were proposed in order to improve specialized and primary care coordination with clinics and musculoskeletal functional units.ConclusionsThe Master Plan recommends actions to improve the attention of the population through operative planning and the services to different providers. The Master Plan will establish the health policy action lines directed against these disorders.     

Evaluación de la función de la mano en las enfermedades reumáticas. Validación y utilidad de los cuestionarios AUSCAN,m-SACRAH,DASH y Cochin en Español

IntroductionQuestionnaires to evaluate hand function are variable in the number of items, domains and diseases in which they had been previously used.Objectivesa) To translate to Spanish and validate the m-SACRAH and AUSCAN questionnaires; b) to do a transcultural adaptation of DASHe, previously validated in Spain), and c) to compare them and the Cochin questionnaire (previously validated in México), in rheumatic patients with variable impairment of hand function.Material and methodsm-SACRAH, AUSCAN and DASH were translated/retro-translated and adapted. The final version was revised to determine content validity and them, plus Cochin were applied to 10 healthy subjects (pilot study) with a variable educational level and in 16 rheumatic patients with variable diagnoses and degrees of hand function impairment; all patients answered 4 questionnaires and were evaluated clinically by blinded investigators.ResultsSeventy six percent were women, mean age 45.7 ± 11.4 years. Cronbach?s alpha > 0.90; time to answer went from 2.3 ± 0.087 (AUSCAN) to 3.5 ± 0.36 minutes (DASH). There was good correlation among them (r = 0.0683 AUSCAN-m-SACRAH to r = 0.889 AUSCAN-DASH) and good capability for discrimination between patients with mild VS moderate to severe impairment was also demonstrated; patients with mild impairment needed less time to answer them and there were no significant differences among questionnaire scores. Patients prefered AUSCAN (10/16), Cochin (4/16) and m-SACRAH (2/16).ConclusionThe 4 questionnaires are useful to evaluate hand function in rheumatic patients and have good discrimination capability. More patients preferred AUSCAN.     

Relación de las profesiones y las condiciones laborales con la neumonía adquirida en la comunidad

IntroductionCommunity-acquired pneumonia (CAP) is not considered a professional disease, and the effect of different occupations and working conditions on susceptibility to CAP is unknown. The aim of this study is to determine whether different jobs and certain working conditions are risk factors for CAP.MethodologyOver a 1-year period, all radiologically confirmed cases of CAP (n = 1,336) and age- and sex-matched controls (n = 1,326) were enrolled in a population-based case-control study. A questionnaire on CAP risk factors, including work-related questions, was administered to all participants during an in-person interview.ResultsThe bivariate analysis showed that office work is a protective factor against CAP, while building work, contact with dust and sudden changes of temperature in the workplace were risk factors for CAP. The occupational factor disappeared when the multivariate analysis was adjusted for working conditions. Contact with dust (previous month) and sudden changes of temperature (previous 3 months) were risk factors for CAP, irrespective of the number of years spent working in these conditions, suggesting reversibility.ConclusionSome recent working conditions such as exposure to dust and sudden changes of temperature in the workplace are risk factors for CAP. Both factors are reversible and preventable.