18 research outputs found
Influence of immigration on tuberculosis transmission patterns in Castellón, Spain (2004–2007)
Objetivo
Describir los patrones de transmisión de la tuberculosis en Castellón en un periodo de importantes cambios demográficos.
MĂ©todos
Estudio prospectivo descriptivo de los pacientes con cultivo positivo en la provincia de Castellón entre 2004 y2007. Se describen los pacientes por año y nacionalidad, y se cotejan con los casos declarados a la Dirección General de Salud Pública (DGSP). Se estudia la población con patrón molecular disponible por RFLP (restriction fragment length polymorphism) y se analizan las variables de los pacientes agrupados (clusters) a partir de los datos de la DGSP y del Programa de Gestión del Laboratorio.
Resultados
SegĂşn la DGSP, la tasa global de tuberculosis por 100.000 habitantes en la provincia de CastellĂłn fue de 15,7 en 2004, 19,9 en 2005, 18,2 en 2006 y 17,5 en 2007. En nuestro laboratorio se identificaron las cepas de 301 pacientes, que suponen el 77% (301/390) de los casos declarados y el 94% (301/321) aquellos con cultivo positivo. El porcentaje de tuberculosis en extranjeros aumentĂł hasta superar el 50% en 2007. Se disponĂa de estudio molecular en el 95% de los casos (286), con un 58% de españoles y un 42% de extranjeros. El porcentaje de agregaciĂłn fue del 40%, con un 30% de clusters mixtos. SegĂşn el estudio convencional de contactos, el 85% de los pacientes en cluster habĂan sido considerados casos aislados.
Conclusiones
El aumento de la tasa de tuberculosis en CastellĂłn se debe, principalmente, al creciente nĂşmero de los casos en extranjeros. Disponer del estudio molecular de todos los pacientes con cultivo positivo nos ha permitido analizar cĂłmo y dĂłnde se transmite la tuberculosis. El 40% de los pacientes se agruparon en clusters, y eran mixtos un tercio de ellos, lo que indica una elevada integraciĂłn de los inmigrantes.Background
This study aimed to identify tuberculosis transmission patterns in CastellĂłn in a period of major demographic changes.
Methods
A prospective study of patients with positive culture in the province of Castellon over a 4-year period (2004–2007) was carried out. Cases were described by year and nationality and were compared with those reported to the Department of Public Health. We studied the population with available molecular patterns, identified through restriction fragment length polymorphism (RFLP) and analyzed the variables from patient clusters, based on data collected in surveys of the Department of Health and the Laboratory Management Program.
Results
According to data from the Department of Public Health, the overall rate of tuberculosis per 100,000 inhabitants in the province of CastellĂłn was 15.7 in 2004, 19.9 in 2005, 18.2 in 2006 and 17.5 in 2007. In our laboratory, strains were identified from 301 patients, representing 77% (301/390) of reported cases and 94% (301/321) of reported cases with a positive culture. The percentage of tuberculosis among foreigners increased with age, exceeding 50% in 2007. Molecular studies were available in 95% of patients (286); 58% were Spanish and 42% were foreigners, of whom 54% were Romanians. The cluster percentage was 40%, with 30% of mixed clusters. According to conventional contact studies, 85% of patients in clusters had been considered isolated cases.
Conclusions
The increased rate of tuberculosis in CastellĂłn was mainly due to the increasing number of cases among foreigners, mostly Romanians. The availability of molecular studies in all patients with a positive culture allowed us to analyze how and where tuberculosis is transmitted in our province. Forty percent of the patients were grouped into clusters; of these, mixed clusters accounted for one third, indicating the high integration of immigrants in our area
New GOLD classification: longitudinal data on group assignment
Rationale: Little is known about the longitudinal changes associated with using the 2013 update of the
multidimensional GOLD strategy for chronic obstructive pulmonary disease (COPD).
Objective: To determine the COPD patient distribution of the new GOLD proposal and evaluate how this
classification changes over one year compared with the previous GOLD staging based on spirometry only.
Methods: We analyzed data from the CHAIN study, a multicenter observational Spanish cohort of COPD patients
who are monitored annually. Categories were defined according to the proposed GOLD: FEV1%, mMRC dyspnea,
COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and exacerbations-hospitalizations. One-year
follow-up information was available for all variables except CCQ data.
Results: At baseline, 828 stable COPD patients were evaluated. On the basis of mMRC dyspnea versus CAT, the
patients were distributed as follows: 38.2% vs. 27.2% in group A, 17.6% vs. 28.3% in group B, 15.8% vs. 12.9% in
group C, and 28.4% vs. 31.6% in group D. Information was available for 526 patients at one year: 64.2% of patients
remained in the same group but groups C and D show different degrees of variability. The annual progression by
group was mainly associated with one-year changes in CAT scores (RR, 1.138; 95%CI: 1.074-1.206) and BODE index
values (RR, 2.012; 95%CI: 1.487-2.722).
Conclusions: In the new GOLD grading classification, the type of tool used to determine the level of symptoms
can substantially alter the group assignment. A change in category after one year was associated with longitudinal
changes in the CAT and BODE index
New GOLD classification: longitudinal data on group assignment
In the new GOLD grading classification, the type of tool used to determine the level of symptoms can substantially alter the group assignment. A change in category after one year was associated with longitudinal changes in the CAT and BODE index
Comentarios al artĂculo “SituaciĂłn actual de las resistencias de Mycobacterium tuberculosis en la poblaciĂłn inmigrante de la Comunidad de Madrid” (Cartas al Director)
Grave afectaciĂłn laringotraqueal secundaria a rinoescleroma por Klebsiella pneumoniae ssp. ozaenae (Cartas al Director)
Comentarios al artĂculo “SituaciĂłn actual de las resistencias de Mycobacterium tuberculosis en la poblaciĂłn inmigrante de la Comunidad de Madrid”
Evolution of resistant Mycobacterium tuberculosis in the province of CastellĂłn (Spain): 1992 throug 1998
Objetivos
Conocer la frecuencia de las resistencias a Mycobacterium tuberculosis y los factores de riesgo asociados a Ă©stas en la provincia de CastellĂłn.
Material y métodos
Se ha realizado un estudio prospectivo de la sensibilidad a los tuberculostáticos, por el mĂ©todo de las proporciones de Canetti, de todas las cepas de M. tuberculosis aisladas en nuestra provincia (532) desde enero de 1992 a diciembre de 1998 (7 años), de las que 461 correspondĂan a casos nuevos.
Resultados
Encontramos una tasa global de resistencias del 4,7% (25/532), de las cuales el 3,9% (18/461) fueron primarias y el 11,1% (7/63) secundarias. Por fármacos, el 3% eran resistentes a isoniacida, el 1,87% a rifampicina, el 1,87% a estreptomicina y el 0,56% a etambutol. La multirresistencia hallada ha sido del 0,2% (1/461) para los casos nuevos y del 1,1% (6/532) para el total.
La presencia de resistencia de M. tuberculosis se asocia al antecedente de tratamiento antituberculoso previo (OR = 3,14; p=0,017), y a la presencia de uno o más factores de riesgo para tuberculosis (OR=3,32; p=0,666).
Conclusiones
La tasa global de resistencias de M. tuberculosis y la multirresistencia son bajas en la provincia de CastellĂłn; sin embargo, se asocian a un aumento de la mortalidad, de manera que el control de algunos de estos factores de riesgo de tuberculosis prevenibles podrĂa, tal vez, disminuir la frecuencia de resistencias.Objectives
To determine the frequency of resistant Mycobacterium tuberculosis and the risk factors associated with resistence in the province of CastellĂłn (Spain).
Material and methods
This prospective study of M. tuberculosis sensitivity applied Canetti's method of proportions to all strains isolated in CastellĂłn (n = 532) from January 1992 through December 1998 (7 years); 461 cases were new.
Results
The overall frequency of resistant strains was 4.7% (25/532), of which 3.9% (18/461) were instances of primary resistance and 11.1% (7/63) were of secondary resistance. Thre percent were resistant to isoniazid, 1.87% to rifampicin, 1.87% to streptomycin and 0.56% to ethambutol. Multiple drug resistance was found in 0.2% (1/461) of the new cases and 1.1% (6/532) overall.
The presence of resistant M. tuberculosis was associated with a history of antituberculous treatment (OR=3.14; p=0.017) and the presence of one or more risk factors for tuberculosis (OR=3.32; p = 0.066).
Conclusions
The overall rates of resistant M. tuberculosis and multiple drug resistance are low in the province of CastellĂłn; however resistance is associated with higher mortality such that controlling some preventable risk factors might reduce the frequency of resistance
El papel del neumĂłlogo en una unidad multidisciplinar de Esclerosis Lateral AmiotrĂłfica. Reto, oportunidad y privilegio
The Role of the Pulmonologist in a Multidisciplinary Amyotrophic Lateral Sclerosis Unit. Challenge, Opportunity, and Privilege
Physical Activity and its Relationship with the State of Health of Stable Copd Patients
IntroducciĂłn
Estudios previos han resaltado que la actividad fĂsica (AF) en la EPOC se asocia a mejor calidad de vida y menor morbimortalidad. Nuestro objetivo ha sido conocer los hábitos de AF en la vida diaria de pacientes EPOC estables fuera de un programa de rehabilitaciĂłn respiratoria.
Material y métodos
Estudio observacional descriptivo transversal multicĂ©ntrico en pacientes EPOC estables controlados ambulatoriamente por neumĂłlogos. Para conocer el Ăndice de AF (IAF) se utilizĂł el Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ), diferenciando segĂşn el gasto energĂ©tico, los siguientes grupos: inactivos (menos de 1.000kcal/semana), moderadamente activos (entre 1.000 y 3.000kcal/semana) y muy activos (más de 3.000kcal/semana). Se analizĂł la relaciĂłn entre el IAF y variables socioeconĂłmicas, de severidad de la enfermedad y de nivel de salud de los pacientes.
Resultados
Se incluyĂł a 132 pacientes (121 varones). Edad media: 66,3 años, FEV1 medio 45%. Un 32,6% de ellos realizaba una AF menor de 1.000kcal/semana, un 38,6% entre 1.000 y 3.000 y el 28,8% más de 3.000. Los pacientes EPOC más inactivos, tenĂan mayor obstrucciĂłn bronquial, una enfermedad más severa, referĂan más disnea y caminaban menos metros en el 6MWT.
Conclusiones
Los pacientes EPOC estables realizan un bajo nivel de AF. Una menor AF se asocia con un peor estado de salud y con una mayor gravedad de la enfermedad.Introduction
Previous studies have shown that physical activity (PA) in COPD is associated with a better quality of life and less morbidity and mortality. Our aim was to study the daily PA in the lives of stable COPD patients, outside the setting of a pulmonary rehabilitation program.
Material and methods
Observational, descriptive and transversal multi-center study in patients with stable COPD controlled in an outpatient clinic by pneumologists. In order to determine the Physical Activity Index (PAI), the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) was used to differentiate the following groups according to the energy expenditure: inactive (less than 1,000 kilocalories per week), moderately active (between 1,000 and 3,000 kilocalories per week) and very active (more than 3,000 kilocalories per week). We analyzed the relationship between PAI and disease severity, health level and socioeconomic variables of the patients.
Results
A total of 132 patients (121 men) were included in the study. Mean age was 66; mean FEV1 was 45%. Regarding PA, 32.6% had energy expenditures of less than 1,000 kilocalories/week, 38.6% between 1,000 and 3,000 and 28.8% more than 3,000. The most inactive COPD patients had more bronchial obstruction, more severe disease, more dyspnea and walked fewer meters in the 6MWT.
Conclusions
Stable COPD patients perform low levels of PA. Lower PA is associated with poorer health and with more severe disease