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OBJECTIVE: The aim of the study was to compare the effectiveness of a telerehabilitation exercise program versus "wait-and-see" on physical exertion, quality of life, dyspnea severity, heart rate, and oxygen saturation in patients with post-COVID fatigue and dyspnea. DESIGN: Sixty-four patients were enrolled in this randomized clinical trial. A telerehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes, and the 6-min walking test were assessed at baseline, after the program and at 1- and 3-mo follow-up periods. RESULTS: The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life, and 6-min walking test (all, P < 0.001). In addition, patients undergoing the telerehabilitation program reported lower exertion scores at rest and after the 6-min walking test (both, P < 0.001). Between-group oxygen saturation differences were found at rest ( P < 0.001), but not after the 6-min walking test ( P = 0.024). Finally, significant between-group differences were found for heart rate after the 6-min walking test ( P < 0.001). CONCLUSIONS: Although both groups showed a significant improvement after 3 mos of follow-up, the group receiving the telerehabilitation program described a greater improvement compared with the group receiving no intervention.
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COVID-19 , Disnea , Terapia por Ejercicio , Fatiga , Terapia Ocupacional , Esfuerzo Físico , Calidad de Vida , Telerrehabilitación , Humanos , Masculino , Femenino , Disnea/rehabilitación , Disnea/etiología , COVID-19/rehabilitación , Persona de Mediana Edad , Terapia por Ejercicio/métodos , Fatiga/rehabilitación , Esfuerzo Físico/fisiología , Terapia Ocupacional/métodos , SARS-CoV-2 , Educación del Paciente como Asunto/métodos , Actividades Cotidianas , AncianoRESUMEN
Objectives. To describe participant characteristics associated with severe acute respiratory syndrome coronavirus 2 infection in Spain's first 2 COVID-19 waves per the Spanish National Seroepidemiological Survey of SARS-CoV-2 Infection (ENE-COVID). Methods. A representative cohort of the noninstitutionalized Spanish population, selected through stratified 2-stage sampling, answered a questionnaire and received point-of-care testing April to June 2020 (first wave: n = 68 287); previously seronegative participants repeated the questionnaire and test November 2020 (second wave: n = 44 451). We estimated seropositivity by wave and participant characteristics, accounting for sampling weights, nonresponse, and design effects. Results. We found that 6.0% (95% confidence interval [CI] = 5.7%, 6.4%) of Spain's population was infected by June and 3.8% (95% CI = 3.5%, 4.1%) more by November 2020. Both genders were equally affected. Seroprevalence decreased with age in adults 20 years and older in the second wave; socioeconomic differences increased. Health care workers were affected at 11.1% (95% CI = 9.0%, 13.6%) and 6.1% (95% CI = 4.4%, 8.5%) in the first and second waves, respectively. Living with an infected person increased infection risk to 22.1% (95% CI = 18.9%, 25.6%) in the first and 35.0% (95% CI = 30.8%, 39.4%) in the second wave. Conclusions. ENE-COVID characterized the first 2 pandemic waves, when information from surveillance systems was incomplete. (Am J Public Health. 2023;113(5):533-544. https://doi.org/10.2105/AJPH.2023.307233).
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COVID-19 , Adulto , Humanos , Femenino , Masculino , Adulto Joven , COVID-19/epidemiología , SARS-CoV-2 , Pandemias , España/epidemiología , Estudios SeroepidemiológicosRESUMEN
Data System. The Spanish National Seroepidemiological Survey of SARS-CoV-2 (or ENE-COVID; SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] is the causative agent of COVID-19) was funded by the Spanish Ministry of Health, the Instituto de Salud Carlos III, and the Spanish National Health System. Data Collection/Processing. A stratified 2-stage probability sampling was used to select a representative cohort of the noninstitutionalized population of Spain. ENE-COVID collected longitudinal data from epidemiological questionnaires and 2 SARS-CoV-2 IgG antibody tests. From April 27 to June 22, 2020, 68 287 participants (77.0% of contacted persons) received a point-of-care test and 61 095 (68.9%) also underwent a laboratory immunoassay. A second follow-up phase was conducted between November 16 and 30, 2020. Data Analysis/Dissemination. Analyses use weights to adjust for oversampling and nonresponse and account for design effects of stratification and clustering. ENE-COVID data for research purposes will be available upon request from the official study Web page. Public Health Implications. ENE-COVID, a nationwide population-based study, allowed monitoring seroprevalence of antibodies against SARS-CoV-2 at the national and regional levels, providing accurate figures by gender, age (from babies to nonagenarians), and selected risk factors; characterizing symptomatic and asymptomatic infections; and estimating the infection fatality risk during the first pandemic wave. (Am J Public Health. 2023;113(5):525-532. https://doi.org/10.2105/AJPH.2022.307167).
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COVID-19 , Anciano de 80 o más Años , Humanos , SARS-CoV-2 , España/epidemiología , Estudios Seroepidemiológicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Current evidence suggests that up to 70% of COVID-19 survivors develop post-COVID symptoms during the following months after infection. Fatigue and dyspnea seem to be the most prevalent post-COVID symptoms. OBJECTIVE: To analyze whether a tele-rehabilitation exercise program is able to improve self-perceived physical exertion in patients with post-COVID fatigue and dyspnea. METHODS: Sixty-eight COVID-19 survivors exhibiting post-COVID fatigue and dyspnea derived to four Primary Health Care centers located in Madrid were enrolled in this quasi-experimental study. A tele-rehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was structured on eighteen sessions (3 sessions/week). Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and distance walked and changes in oxygen saturation and heart rate during the 6-Minute walking test were assessed at baseline, after the program and at 1- and 3-months follow-up periods. RESULTS: Daily living activities, dyspnea severity and quality of life improved significantly at all follow-ups (p<0.001). Additionally, a significant increase in oxygen saturation before and after the 6-Minute Walking test was found when compared with baseline (P<0.001). Heart rate adaptations at rest were found during the follow-up periods (P = 0.012). Lower perceived exertion before and after the 6-Minute Walking test were also observed, even if larger distance were walked (P<0.001). CONCLUSION: Tele-rehabilitation programs could be an effective strategy to reduce post-COVID fatigue and dyspnea in COVID-19 survivors. In addition, it could also reduce the economic burden of acute COVID-19, reaching a greater number of patients and releasing Intensive Unit Care beds for prioritized patients with a severe disease. STUDY REGISTRATION: The international OSF Registry registration link is https://doi.org/10.17605/OSF.IO/T8SYB.
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COVID-19 , Calidad de Vida , COVID-19/epidemiología , Disnea/etiología , Disnea/rehabilitación , Fatiga/etiología , Humanos , Esfuerzo Físico , Atención Primaria de Salud , SobrevivientesRESUMEN
BACKGROUND: The main aims of this study were to analyze trends of SARS-CoV-2 anti-nucleocapsid IgG throughout the four rounds of the seroepidemiologic study ENE-COVID, and compare the fourth-round results of two immunoassays detecting anti-nucleocapsid and anti-RBD IgG. METHODS: ENE-COVID was developed in 2020 (two phases). Phase one included three rounds carried out in April 27-May 11, May 18-June 1, and June 8-June 22. Phase two included a fourth round in the same cohort (November 16-29). A chemiluminescent microparticle immunoassay was offered to participants in the first three rounds (Abbott; anti-nucleocapsid IgG). In the fourth round, we offered this test and a chemiluminescence immunoassay (Beckman; anti-RBD IgG) to i) a randomly selected sub-cohort, ii) participants who were IgG-positive in any of the three first rounds; and iii) participants who were IgG-positive in the fourth round by point-of-care immunochromatography. RESULTS: 10,153 individuals (82.2% of people invited) participated in the fourth round. Of them, 2595 (35.1% of participants with results in the four rounds) were positive for anti-nucleocapsid IgG in at least one round. Anti-nucleocapsid IgG became undetectable in 43.3% of participants with positive first-round results. In fourth round, anti-nucleocapsid and anti-RBD IgG were detected in 5.5% (321/5827) and 5.4% (315/5827) participants of the randomly selected sub-cohort, and in 26.6% (867/3261) and 25.9% (846/3261) participants with at least one previous positive result, respectively. CONCLUSIONS: The IgG response is heterogeneous and conditioned by infection severity. A proportion of SARS-CoV-2 infected population may have negative serologic results in the post-infection months.
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COVID-19 , SARS-CoV-2 , Anticuerpos Antivirales , COVID-19/epidemiología , Humanos , Inmunoglobulina G , Estudios Seroepidemiológicos , España/epidemiologíaRESUMEN
OBJECTIVES: To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare. STUDY DESIGN AND SETTING: Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection. RESULTS: Of all, 28.7% of infections were asymptomatic (95% CI 26.1-31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02-1.40) for men vs. women, 1.82 (1.33-2.50) and 1.45 (0.96-2.18) for individuals <20 and ≥80 years vs. those aged 40-59, 1.27 (1.03-1.55) for smokers vs. nonsmokers, and 1.91 (1.59-2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37-10.3), discrimination index of 0.79 (0.77-0.81), and sensitivity and specificity of 71.4% (68.1-74.4%) and 74.2% (73.1-75.2%) for a score ≥3. CONCLUSION: The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.
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Infecciones Asintomáticas/epidemiología , COVID-19/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Factores de Riesgo , Estudios Seroepidemiológicos , España/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes. DESIGN: Nationwide seroepidemiological study. SETTING: First wave of covid-19 pandemic in Spain. PARTICIPANTS: Community dwelling individuals of all ages. MAIN OUTCOME MEASURES: The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020. RESULTS: The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more. CONCLUSION: The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.
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COVID-19/mortalidad , Estudios Seroepidemiológicos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina G/sangre , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Riesgo , Factores Sexuales , España/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. METHODS: 35â883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61â075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FINDINGS: Seroprevalence was 5·0% (95% CI 4·7-5·4) by the point-of-care test and 4·6% (4·3-5·0) by immunoassay, with a specificity-sensitivity range of 3·7% (3·3-4·0; both tests positive) to 6·2% (5·8-6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1-92·1; both tests positive) to 91·8% (86·3-95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8-16·8) to 19·3% (17·7-21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1-24·9) to 35·8% (33·1-38·5). Only 19·5% (16·3-23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. INTERPRETATION: The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. FUNDING: Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.
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Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anticuerpos Antivirales/sangre , Betacoronavirus/inmunología , COVID-19 , Niño , Preescolar , Femenino , Humanos , Inmunoensayo , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Pruebas en el Punto de Atención , Prevalencia , Factores de Riesgo , SARS-CoV-2 , Estudios Seroepidemiológicos , España/epidemiología , Adulto JovenRESUMEN
Fabry disease (FD) is a rare, X-linked disorder caused by mutations in the GLA gene encoding the enzyme α-galactosidase A. Complete or partial deficiency in this enzyme leads to intracellular accumulation of globotriaosylceramide (Gb3) and other glycosphingolipids in many cell types throughout the body, including the kidney. Progressive accumulation of Gb3 in podocytes, endothelial cells, epithelial cells, and tubular cells contribute to the renal symptoms of FD, which manifest as proteinuria and reduced glomerular filtration rate leading to renal insufficiency. A correct diagnosis of FD, although challenging, has considerable implications regarding treatment, management, and counseling. The diagnosis may be confirmed by demonstrating the enzyme deficiency in males and by identifying the specific GLA gene mutation in male and female patients. Treatment with enzyme replacement therapy, as part of the therapeutic strategy to prevent complications of the disease, may be beneficial in stabilizing renal function or slowing its decline, particularly in the early stages of the disease. Emergent treatments for FD include the recently approved chaperone molecule migalastat for patients with amenable mutations. The objective of this report is to provide an updated overview on Fabry nephropathy, with a focus on the most relevant aspects of its epidemiology, diagnosis, pathophysiology, and treatment options.
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Enfermedad de Fabry/diagnóstico , Enfermedades Renales/diagnóstico , 1-Desoxinojirimicina/análogos & derivados , 1-Desoxinojirimicina/uso terapéutico , Terapia de Reemplazo Enzimático , Enfermedad de Fabry/tratamiento farmacológico , Enfermedad de Fabry/patología , Enfermedad de Fabry/fisiopatología , Femenino , Galactosidasas/genética , Humanos , Enfermedades Renales/patología , Masculino , TrihexosilceramidasRESUMEN
Resumen Antecedentes: Los adenomas hipofisarios no funcionales generalmente tienen un comportamiento benigno y naturaleza no invasiva, sin embargo, pueden mostrar características de agresividad con invasión a tejidos circundantes, alto índice mitótico, un índice de Ki67 > 3%y positividad extensa para la tinción de p53, diferenciándose de los carcinomas hipofisarios por la ausencia de diseminación cerebroespinal o metástasis a distancia. Los adenomas agresivos muestran resistencia al tratamiento guirúrgico, médico y radioterapia, y los agentes guimioterapéuticos como temozolamida son una opción terapéutica prometedora de acuerdo con los reportes de la literatura médica internacional. Caso clínico: Paciente del sexo femenino en la sexta década de la vida con padecimiento caracterizado por síndrome guiasmático progresivo e hipopituitarismo ante la presencia de un macroadenoma hipofisario no funcional, con resistencia a tratamiento neuroguirúrgico inicial, tratamiento médico con un agonista dopaminérgico y análogo de receptor de la somatostatina así como radioterapia convencional fraccionada, y cumple con los criterios de agresividad. Se establece tratamiento guimioterapéutico a base de temozolamida, y durante su vigilancia muestra tanto estabilidad clínica como ausencia de progresión tumoral. Conclusiones: La determinación de agresividad es de crucial importancia para mejorar el tratamiento del paciente y, con ello, ofrecer un mejor pronóstico y efectividad terapéutica. El tratamiento de los adenomas hipofisarios no funcionales con características de agresividad es un reto clínico gue involucra un abordaje multidisciplinario. La resistencia al tratamiento quirúrgico, médico y radioterapéutico han dado lugar a la investigación de opciones terapéuticas con agentes quimioterapéuticos como la temozolamida, con tasas de respuesta prometedoras.
Abstract Background: Non-functional pituitary adenomas generally have a benign and non-invasive nature, however, it may show aggressiveness with invasion of surrounding tissues, high mitotic index, an index of Ki67> 3% and extensive positive staining for the cellular tumor antigen p53, differing from the pituitary carcinomas by the absence of craniospinal dissemination or systemic metastases. Aggressive adenomas show resistance to surgical, medical and radiation therapy, including chemotherapeutic agents such as temozolomide, a promising therapeutic option according to reports in the international literature. Case presentation: This is a woman in her 6th decade of life with a clinical presentation characterized by a progressive chiasm syndrome and hypopituitarism in the presence of non-functional pituitary macroadenoma, with initial resistance of neurosurgical treatment, medical treatment with a dopaminergic agonist plus a somatostatin receptor agonist and conventional fractionated radiotherapy, meeting the criteria of aggressive pituitary adenoma. After the treatment with temozolomide as a chemotherapy regimen, the patient showed clinical stability and absence of tumor progression during her follow-up. Conclusion: Defining aggressiveness is of crucial importance for improving the management of patients by enhancing prognostic predictions and effectiveness of treatment. The treatment of nonfunctioning pituitary adenomas with aggressiveness is a clinical challenge that involves a multidisciplinary approach. Resistance to surgical, medical and radiotherapeutic treatment have resulted in the investigation of therapeutic options with chemotherapeutic agents such as temozolomide, with promising response rates.
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BACKGROUND: Although automated cell separators (apheresis) have undergone a lot of technical refinements, the effect of the procedure on hematological indices of donors is rarely taken into account. The purpose of this study is to identify potential hematologic changes in donors undergoing erythrocytapheresis. METHODS: 30 apparently healthy adult donors were evaluated. Erythrocytapheresis procedure was performed using automated equipment. Hematologic measurements (hemoglobin, hematocrit, white blood cells counts and platelets) were analyzed before and after erythrocytapheresis in all donors. RESULTS: We observed a significant decrease in the donors in hemoglobin (p <0.0001), hematocrit (p <0.0001), leukocytes (p <0.0001), lymphocytes (p = 0.0267), and platelets (p <0.0001). On the other hand, we found no changes in segmented, monocytes, eosinophils and basophils post erythrocytapheresis. CONCLUSION: In this study we found a significant drop in complete blood count in blood donation procedure by erythrocytapheresis; there are hematological changes in both red and white cells in all donors; however, none of donors manifested symptoms of thrombocytopenia or anemia. This study demonstrates hematological changes post-donation and therefore requires larger multicenter studies, in order to establish guidelines for donors' safety in apheresis and also help in assessing donor suitability, especially given the present trend of double product apheresis collections.
Introducción: El efecto del procedimiento en los índices hematológicos del donador rara vez se determina al finalizar una sesión de donación. El propósito de este estudio es identificar las posibles alteraciones hematológicas en los donadores sometidos a eritroféresis. Métodos: Se evaluaron 30 donadores adultos, aparentemente sanos. El procedimiento de eritroféresis se realizó utilizando un equipo automatizado. Las mediciones hematológicas (hemoglobina, hematocrito, células blancas y plaquetas) se realizaron antes y después de la eritroféresis. Resultados: Existe disminución significativa en hemoglobina (p < 0.0001), hematocrito (p < 0.0001), leucocitos totales (p < 0.0001), linfocitos (p = 0.0267), y plaquetas (p < 0.0001) tras el procedimiento de donación. Por otro lado, los segmentados tienen un ligero aumento. No se encontraron cambios en monocitos, eosinófilos ni en basófilos poseritroféresis. Conclusiones: durante el procedimiento de donación sanguínea mediante eritroféresis se producen cambios hematológicos tanto en la formula roja como blanca en los donadores estudiados, a pesar de ello, ninguno de los donadores manifestaron signos de trombocitopenia o anemia. Este trabajo demuestra que existen cambios hematológicos postdonación y por ello se requiere de estudios amplios y multicéntricos, con el fin de establecer directrices para establecer un procedimiento seguro para el donador y mejorar la evaluación de idoneidad de los donadores.
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Eliminación de Componentes Sanguíneos/efectos adversos , Donantes de Sangre , Transfusión de Eritrocitos/efectos adversos , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Estudios Transversales , Femenino , Hematócrito , Hemoglobinas/metabolismo , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Adulto JovenRESUMEN
Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation.
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INTRODUCCIÓN: La resección y las deformidades/defectos de la pared torácica así como las fracturas costales complejas requieren de reconstrucción con diversos materiales protésicos para garantizar las funciones básicas de dicha pared. El titanio aporta múltiples características que lo hacen un material idóneo para esta cirugía. El objetivo es presentar nuestros resultados iniciales con este material en diversas afecciones. Material y métodos De 2008 a 2012 se ha intervenido a 14 pacientes en los que se ha empleado el titanio para la reconstrucción de la pared torácica. Un total de 7 pacientes presentaban tumores de pared torácica, 2 de ellos con resección esternal, 4 con deformidades/defectos de la pared torácica y 3 pacientes con traumatismo costal severo por accidente de tráfico. Resultados La reconstrucción fue satisfactoria en todos los casos, con extubación temprana y sin detectar problemas en la funcionalidad de la pared torácica a nivel respiratorio. Los pacientes con tumores de pared torácica, incluyendo las resecciones esternales, se extubaron en quirófano, así como las deformidades de pared torácica. Los casos de traumatismo torácico se extubaron en menos de 24 h desde la fijación costal interna. No hubo complicaciones en relación con el material utilizado ni con el método de implantación. Conclusiones El titanio es un material ideal para la reconstrucción de la pared torácica en diversas situaciones clínicas, al permitir una gran versatilidad y adaptabilidad en las diferentes reconstrucciones de pared torácica en que se quiera emplear
INTRODUCTION: Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery. The aim is to present our initial results with this material in several diseases. Material and methods From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident. Results The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24 h from internal rib fixation. There were no complications related to the material used and the method of implementation. Conclusions Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions
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Humanos , Titanio/uso terapéutico , Procedimientos de Cirugía Plástica/métodos , Pared Torácica/cirugía , Materiales Biocompatibles/uso terapéutico , Procedimientos Quirúrgicos Torácicos/métodosRESUMEN
INTRODUCTION: Chest wall deformities/defects and chest wall resections, as well as complex rib fractures require reconstruction with various prosthetic materials to ensure the basic functions of the chest wall. Titanium provides many features that make it an ideal material for this surgery. The aim is to present our initial results with this material in several diseases. MATERIAL AND METHODS: From 2008 to 2012, 14 patients were operated on and titanium was used for reconstruction of the chest wall. A total of 7 patients had chest wall tumors, 2 with sternal resection, 4 patients with chest wall deformities/defects and 3 patients with severe rib injury due to traffic accident. RESULTS: The reconstruction was successful in all cases, with early extubation without detecting problems in the functionality of the chest wall at a respiratory level. Patients with chest wall tumors including sternal resections were extubated in the operating room as well as the chest wall deformities. Chest trauma cases were extubated within 24h from internal rib fixation. There were no complications related to the material used and the method of implementation. CONCLUSIONS: Titanium is an ideal material for reconstruction of the chest wall in several clinical situations allowing for great versatility and adaptability in different chest wall reconstructions.
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Procedimientos de Cirugía Plástica , Prótesis e Implantes , Costillas/lesiones , Costillas/cirugía , Neoplasias Torácicas/cirugía , Procedimientos Quirúrgicos Torácicos , Pared Torácica/anomalías , Pared Torácica/cirugía , Titanio , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
Patients with chronic kidney disease (CKD) have signs of genomic instability and, as a consequence, extensive genetic damage, possibly due to accumulation of uraemic toxins, oxidative stress mediators and other endogenous substances with genotoxic properties. We explored factors associated with the presence and background levels of genetic damage in CKD. A cross-sectional study was performed in 91 CKD patients including pre-dialysis (CKD patients; n = 23) and patients undergoing peritoneal dialysis (PD; n = 33) or haemodialysis (HD; n = 35) and with 61 healthy subjects, divided into two subgroups with the older group being in the age range of the patients, serving as controls. Alkaline comet assay and cytokinesis-block micronucleus assay in peripheral blood lymphocytes were used to determine DNA and chromosome damage, respectively, present in CKD. Markers of oxidative stress [malondialdehyde (MDA), advanced glycation end products (AGEs), thiols, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine] and markers of inflammation (C-reactive protein, interleukin-6 and tumour necrosis factor alpha) were also measured. Micronucleus (MN) frequency was significantly higher (P < 0.05) in the CKD group (46±4) when compared with the older control (oC) group (27.7±14). A significant increase in MN frequency (P < 0.05) was also seen in PD patients (41.9±14) versus the oC group. There was no statistically significant difference for the HD group (29.7±15.6; P = NS) versus the oC group. Comet assay data showed a significant increase (P < 0.001) of tail DNA intensity in cells of patients with CKD (15.6±7%) with respect to the total control (TC) group (11±1%). PD patients (14.8±7%) also have a significant increase (P < 0.001) versus the TC group. Again, there was no statistically significant difference for the HD group (12.5±3%) compared with the TC group. Patients with MN values in the upper quartile had increased cholesterol, triglycerides, AGEs and MDA levels and lower albumin levels. Multiple logistic regression analysis showed that male gender, diabetes and treatment modality were independently associated with higher levels of DNA damage. Our results suggest that oxidative stress, diabetes, gender and dialysis modality in CKD patients increased DNA and chromosome damage. To confirm these data, prospective clinical trials need to be performed.
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Inestabilidad Cromosómica , Diálisis Peritoneal/efectos adversos , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/fisiopatología , 8-Hidroxi-2'-Desoxicoguanosina , Adulto , Anciano , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Proteína C-Reactiva/metabolismo , Ensayo Cometa , Estudios Transversales , Daño del ADN , Desoxiguanosina/análogos & derivados , Desoxiguanosina/sangre , Femenino , Productos Finales de Glicación Avanzada/sangre , Humanos , Inflamación , Interleucina-6/sangre , Modelos Logísticos , Linfocitos/patología , Masculino , Malondialdehído/sangre , Pruebas de Micronúcleos , Persona de Mediana Edad , Estrés Oxidativo , Insuficiencia Renal Crónica/genética , Albúmina Sérica/análisis , Triglicéridos/sangre , Factor de Necrosis Tumoral alfa/sangreRESUMEN
Introducción: La infección de origen dentario, constituye un motivo muy frecuente de consulta en nuestra práctica diaria. Ocasionalmente dicha infección puede extenderse a través de los espacios cervicales y llegar al mediastino, condicionando una mediastinitis necrotizante descendente (MND).Objetivo: Analizar las posibles causas odontogénicas desencadenantes, así como establecer los gérmenes implicados, sintomatología, tratamiento y evolución. Caso clínico: Paciente varón de 29 años de edad que acude al servicio de urgencias del hospital General universitario de Alicante presentando una mediastinitis descendente necrotizante derivada de una pericoronaritis aguda a nivel del 48. Conclusiones: Las causas más habituales de la MND de carácter odontogénico, son infecciones a nivel de los molares mandibulares, siendo frecuentes los casos derivados de pericoronaritis agudas de los terceros molares inferiores. Se trata de una infección polimicrobiana mixta, que refleja la naturaleza odontogénica. El tratamiento requerido consiste en medidas generales con drenaje adecuado de las colecciones purulentas (AU)
Introduction: This infection originating from the teeth is a frequent subject of consultation in daily practice. The infection may occasionally spread by way of cervical spaces and reach the mediastinum, giving rise to descending necrotising mediastinitis (DNM).Objective: Analyse the possible odontogenic causes and establish the microorganisms involved, symptoms, treatment and development. Clinical case: Male patient aged 29 attends the emergency department of General university hospital in Alicante suffering from descending necrotising mediastinitis deriving from severe pericononitis of level 48.Conclusions: The most common causes of DNM of an odontogenic nature are infectionsof the mandibular molars, cases deriving from severe pericononitis of the third lower molar being frequent. It is a mixed polymicrobial infection, which is a reflection of its odontogenic nature. The treatment required consists of general measures with adequate drainage of purulent collections (AU)
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Humanos , Masculino , Adulto , Mediastinitis/etiología , Infección Focal Dental/complicaciones , Necrosis/etiología , Enfermedades Dentales/complicacionesRESUMEN
OBJECTIVE: Knowledge on the distribution and determinants of tuberculous pleural effusions (TBPE) is incomplete. We aimed to describe the epidemiological trends and individual characteristics of TBPE in Galicia, Spain, over a 10-year period (2000-2009). DESIGN: A retrospective, observational study based on epidemiological data obtained from the Galician Tuberculosis Register. RESULTS: There were 1835 cases of TBPE (16.3% of the total 11,241 TB cases reported). The number and incidence of TBPE decreased significantly during the study period, from (262 and 9.6/100,000 inhabitants in 2000, to 133 and 4.8 in 2009, respectively; P<.001 for both). The mean annual decrease in TBPE incidence was 6.9%, and 50% overall. TBPE mainly affected males (63.5%), precisely 61.2% young males between 15 and 44 years. Twenty-five percent had lung involvement (chest X-ray), and 41.7% had a positive sputum culture. A significant increase (P<.001) was observed during the study in the percentage of patients who had more TB risk factors. CONCLUSIONS: The incidence of TBPE decreased significantly during the study period, with no changes in epidemiological characteristics, and with trends similar to the total number of TB cases. The introduction of the Galician Prevention and Control Plan (GPCP) for tuberculosis appears to be effective for better control of TB.
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Derrame Pleural/epidemiología , Salud Pública/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Tuberculosis Pleural/epidemiología , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Derrame Pleural/microbiología , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: Presentation of an experience in benchmarking in 13 university Spanish thoracic surgery services. METHODS: The minimum basic data set (MBDS) for hospitalization, corresponding to 2007, including all registered hospital discharges, was used. The performance of the hospitals was compared using an external reference pattern (SN) and internal average (BMG). Cases were chosen in which a major pulmonary resection (lobectomy or pneumonectomy) was done for bronchogenic carcinoma. Performance indicators were the complexity of the casuistry (average weight and relative weight). Performance results indicators included average length of stay (preoperative, postoperative, and global lengths of stay were analyzed separately for lobectomies as well as pneumonectomies), complications, mortality, and urgent readmissions. RESULTS: A total number of 4778 cases were analyzed, with major thoracic surgeries being prominent with 1779 (37.3%). For average weight, there was a dispersion between 2.5 and 5.68, with an average of 3.45 for the BMG and 3.43 for the SN. There were some very significant differences in morbidity, with groups having a gross rate of few complications (2.6%) up to many (16.1%). The mortality rate ranged between 1.6% and 6.6%. There were considerable differences in urgent readmissions, with gross rates between 2.6% and 7.3%, considering as points of reference 5.4% (BMG) and 4.7% (SN). Concerning the results of pulmonary resections for bronchogenic carcinoma, the index of pneumonectomies was between 8% and 29%. The average length of stay for lobectomy was between 6 and 9.5, with an average of 7 in BMG. In the case of pneumonectomies, it was between 6 and 26 days, with an average of 9 for BMG. Average preoperative stay also varied widely, between 0.2 and 2.4, while postoperative stay was between 7.5 and 12.1. The gross global rate of complications ranged from 2.7% to 36.7%, with points of reference of 15.6% (BMG) and 13.8% (SN). The complication rate ranged from 3% to 33%, with an average of 14.5% for lobectomies, with higher variability for pneumonectomies (0-58%). CONCLUSIONS: Benchmarking could be an effective method for improving clinical management. A considerable variability was detected in our study among the participating groups.
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Benchmarking , Procedimientos Quirúrgicos Torácicos/normas , Carcinoma Broncogénico/cirugía , Femenino , Investigación sobre Servicios de Salud/métodos , Mortalidad Hospitalaria , Hospitales Universitarios/normas , Humanos , Tiempo de Internación/estadística & datos numéricos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Neumonectomía/efectos adversos , Neumonectomía/normas , Complicaciones Posoperatorias/epidemiología , Indicadores de Calidad de la Atención de Salud , España/epidemiologíaRESUMEN
PURPOSE: To address whether preoperative chemotherapy plus surgery or surgery plus adjuvant chemotherapy prolongs disease-free survival compared with surgery alone among patients with resectable non-small-cell lung cancer. PATIENTS AND METHODS: In this phase III trial, 624 patients with stage IA (tumor size > 2 cm), IB, II, or T3N1 were randomly assigned to surgery alone (212 patients), three cycles of preoperative paclitaxel-carboplatin followed by surgery (201 patients), or surgery followed by three cycles of adjuvant paclitaxel-carboplatin (211 patients). The primary end point was disease-free survival. RESULTS: In the preoperative arm, 97% of patients started the planned chemotherapy, and radiologic response rate was 53.3%. In the adjuvant arm, 66.2% started the planned chemotherapy. Ninety-four percent of patients underwent surgery; surgical procedures and postoperative mortality were similar across the three arms. Patients in the preoperative arm had a nonsignificant trend toward longer disease-free survival than those assigned to surgery alone (5-year disease-free survival 38.3% v 34.1%; hazard ratio [HR] for progression or death, 0.92; P = .176). Five-year disease-free survival rates were 36.6% in the adjuvant arm versus 34.1% in the surgery arm (HR 0.96; P = .74). CONCLUSION: In early-stage patients, no statistically significant differences in disease-free survival were found with the addition of preoperative or adjuvant chemotherapy to surgery. In this trial, in which the treatment decision was made before surgery, more patients were able to receive preoperative than adjuvant treatment.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anemia/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carboplatino/administración & dosificación , Carboplatino/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Esquema de Medicación , Fatiga/inducido químicamente , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neutropenia/inducido químicamente , Paclitaxel/administración & dosificación , Paclitaxel/efectos adversos , Cuidados Preoperatorios , Resultado del TratamientoRESUMEN
BACKGROUND: Intermediate outcomes are associated with the survival of long-term haemodialysis patients; however, outcome variability across centres may result in heterogeneous quality of care. The study aim was to evaluate a multifaceted quality improvement activity (QIA) targeting several haemodialysis clinical performance measures. METHODS: A total (prevalent and incident) of 313 patients from four dialysis units were included. The QIA was based on a multifaceted strategy involving collection of haemodialysis clinical performance measures every 6-8 months, feedback about results, improvement plans and benchmarking, and it was tested in a 3-year prospective interventional study. Two timepoints of clinical performance measures were considered for evaluating the QIA: baseline (February 2003, pre-QIA) and final (February 2006, post-QIA). RESULTS: Centres showed significant improvement in percentage of patients with haemoglobin <11 g/dl, mean haemoglobin; percentage of patients with Kt/v <1.2, mean Kt/v; percentage of patients with phosphorous >5.5 mg/dl, mean phosphorous; percentage of patients with calcium phosphate product >55, mean calcium phosphate product; and percentage of patients with ferritin <200 ng/ml, mean ferritin. No change was observed in percentage of patients with haemoglobin between 11 and 13 g/dl, erythropoietin consumed; percentage of patients with ferritin <100 ng/ml; percentage of patients with ferritin >800 ng/ml; percentage of patients with albumin <3.5 g/dl, mean albumin; or percentage of native arteriovenous fistula. The percentage of patients with haemoglobin >13 g/dl was increased. CONCLUSIONS: Quality-improvement strategies can help improve haemodialysis performance for anaemia, dialysis dose and bone metabolism. The importance of assessing patients with high haemoglobin level should be stressed.