Ventilación mecánica no invasiva en una población anciana que ingresa en una unidad de monitorización respiratoria: causas,complicaciones y evolución al año de seguimiento

Objective

To determine the usefulness of non-invasive ventilation (NIV) in elderly patients (≥75) admitted to a respiratory monitoring unit (RMU) during hospitalization and one year later in comparison with the results from the younger age group (<75).

Material and methods

Ours is a prospective observational study carried out at the Hospital Universitario La Princesa (Madrid, Spain). We recruited all patients who were ≥75 years old and were admitted to our RMU during the period 2008-2009 with respiratory acidosis (pH <7.35 and PaCO₂ >45 mmHg) requiring NIV. We gathered data for basic variables as well as sociodemographics, history of previous pathologies, reason for hospitalization and severity, analysis upon admission and the evolution of blood gases at the start of NIV (within the first hour and after 24 hours), complications and evolution at the one-year follow-up.

Results

Mean age of the sample was 80.6 years. The Charlson index was 3.27. About half of the patients had some limitation for performing daily activities. The main reasons for admission were COPD exacerbation and heart failure. There were complications in 36% of the cases (11 renal failure and 6 atrial fibrillation). The survival rate at the one-year follow-up was 63.21%.

Conclusions

NIV is a good alternative in elderly patients admitted to the hospital with respiratory acidosis. We did not detect differences in mortality during admission between the two groups. The elderly patients were more frequently re-admitted than the younger group in the 6-12 months after hospital discharge. This could be due to their poorer functional state after hospitalization requiring NIV.     

Primera fase de validación del algoritmo europeo de evaluación funcional previa a la resección pulmonar: cuantificación del cumplimiento de las recomendaciones en la práctica clínica real

Objective

To quantify the degree of compliance with the recommendations of the clinical practice guidelines published in 2009 by the ERS and the ESTS regarding the preoperative assessment of risk of lung resection in daily clinical practice at a tertiary hospital.

Method

A prospective, observational study of real-time data collected from consecutive patients who had been referred for evaluation from September 2009 to December 2010. We recorded the presence or absence of the recommended studies included in the algorithm, their results and, when a test was missing, the reasons why it was not performed. Hospital mortality and cardio-respiratory morbidity rates are also presented.

Results

173 patients were evaluated. In 171 cases, lung resection was performed, with a mortality of 1.2% and a cardio-respiratory morbidity of 11.7%. The failure rate of the first level of the algorithm was 4.6% and for the second level (VO_2max test) it was 26%. The absence of exercise tests was mainly due to hospital structural problems and the patients’ inability to perform it. Out of the patients who performed the exercise testing, 31 reached a VO_2max of 20 ml/kg-min or more and underwent surgery without calculation of FEV₁ppo and DCLOppo; 35 patients required the calculation to determine their operability and in 2 cases the intervention was not recommended due to functional inoperability of the patient.

Conclusions

The validation process found lack of compliance with the proposed algorithm in 18.5% of the cases basically due to the absence of the exercise tests. The rate of adherence to the algorithm recommendations should be improved before performing any other validation studies.     

Rapid Wuchereria bancrofti-Specific Antigen Wb123-Based IgG4 Immunoassays as Tools for Surveillance following Mass Drug Administration Programs on Lymphatic Filariasis

The Global Programme to Eliminate Lymphatic Filariasis has an urgent need for rapid assays to detect ongoing transmission of lymphatic filariasis (LF) following multiple rounds of mass drug administration (MDA). Current WHO guidelines support using the antigen card immunochromatographic test (ICT), which detects active filarial infection but does not detect early exposure to LF. Recent studies found that antibody-based assays better serve this function. In the present study, two tests, a rapid IgG4 enzyme-linked immunosorbent assay (ELISA) and a lateral-flow strip immunoassay, were developed based on the highly sensitive and specific Wuchereria bancrofti antigen Wb123. A comparison of W. bancrofti-infected and -uninfected patients (with or without other helminth infections) demonstrated that both tests had high sensitivities and specificities (93 and 97% [ELISA] and 92 and 96% [strips], respectively). When the W. bancrofti-uninfected group was separated into those with other filarial/helminth infections (i.e., onchocerciasis, loiasis, and strongyloidiasis) and those who were parasite uninfected, the specificities of the assays varied between 91 and 100%. In addition, the geometric mean response by ELISA of W. bancrofti-infected patients was significantly higher than the response of those without W. bancrofti infection (P < 0.0001). Furthermore, the Wb123 ELISA and the lateral-flow strips had high positive and negative predictive values, giving valuable information on the size of survey population needed to be reasonably certain whether or not transmission is ongoing. These highly sensitive and specific IgG4 tests to the W. bancrofti Wb123 protein give every indication that they will serve as useful tools for post-MDA monitoring.     

Human Mycobacterium bovis infection in Buenos Aires: epidemiology, microbiology and clinical presentation

We performed a retrospective study of clinical, epidemiological and microbiological characteristics of patients with confirmed Mycobacterium bovis infection treated at Francisco Mu?iz Hospital, Buenos Aires, Argentina, between 1996 and 2008. A total of 39 patients were included, accounting for 0.4% of tuberculosis cases in our hospital. Of these, 93% had at least one risk factor for M. bovis; the most frequent was occupational exposure (65%), followed by history of living in a rural area (31%) and consumption of unpasteurised milk (4%). Pulmonary disease was the most frequent clinical presentation. Rifampicin resistance and multidrug resistance were seen in two patients, both of whom had human immunodeficiency virus infection.     

Place of residence before hospital admission and mortality at 12‐months in Spanish patients aged 70 years or older

Aim: Hospitalization of elderly people is often followed by high mortality rates. The aim of this study was to analyze the influence of prior residence on 1‐year mortality after hospital discharge in patients aged 70 years and over. Methods: This was a prospective observational cohort study. Participants were 426 patients discharged from the Internal Medicine Department at a Spanish Hospital who were followed for a 12‐month period. Data collection was carried out during hospitalization and included sociodemographic characteristics, comorbidity (Charlson index), functional (Barthel index and Lawton scale) and cognitive conditions (Short Portable Mental Status Questionnaire), together with parameters related to the disease causing admission (diagnosis related group, laboratory tests, length of hospital stay). Mortality was carried out using telephone interviews. Results: A total of 420 (98.6%) patients were located at the end of follow up. Of these, 95 patients had died, giving an overall 1‐year mortality of 22.6%. The mortality rate for patients living in their private homes was 15.6% versus 24.7% for those living with relatives and 60% for those living in institutions. After adjustment for potential confounders, prior residence was associated with mortality with a hazard ratio of 3.98 (95% CI 1.94–8.17) for those institutionalized and a hazard ration of 1.68 (95% CI 0.99–2.16) for those living with relatives, as compared with patients living in their private homes. Conclusions: Prior residence is associated with 1‐year‐mortality following discharge after controlling for several multidimensional factors. Geriatr Gerontol Int 2012; ??: ??–??.     

The endophytic mycobiota of Arabidopsis thaliana

Fungal endophytes are receiving increasing attention as resources to improve crop production and ecosystem management. However, the biology and ecological significance of these symbionts remains poorly understood, due to a lack of model systems for more efficient research. In this work, we have analyzed the culturable endophytic mycobiota associated, in the wild, with leaves and siliques of the model plant A. thaliana. We have studied the effect of biotic and abiotic factors in the frequency of fungal endophytes in plant specimens, and in the species composition of the endophytic community. Our results indicate that the frequency of Arabidopsis plants hosting endophytes depends on the time of the year and the phenological stage of the plant, and that the probability of endophyte colonization increases as the life cycle of the plant progresses. The diversity of the endophytic assemblages of natural A. thaliana populations was high, and precipitation and temperature were the two main factors determining the diversity and species composition of the communities. We propose A. thaliana and its endophytes as a model system for an integral approach to the principles governing the endophytic lifestyle, taking advantage of the molecular tools and the abundant knowledge accessible from the host plant.