Estudi sobre la malaltia del pulmó del cuidador d'aus

El pulmó del cuidador d'aus es produeix sobretot en persones aficionades a la colombofilia i afecta entre el 4 i el 8% d'aquestes persones, però també pot afectar al cuidador de qualsevol altra au. La recerca següent és, fins ara, la sèrie que descriu un major nombre de casos d'afectats, amb un total de 86, i aprofundeix en aspectes com la importància de fer un diagnòstic primerenc per a la curació total de la malaltia.El pulmón del cuidador de aves se da sobre todo en personas aficionadas a la colombofilia y afecta a entre el 4 y el 8% de las mismas, pero también puede afectar al cuidador de cualquier otra ave. La siguiente investigación es hasta ahora la serie que describe una mayor número de casos de afectados, con un total de 86, y profundiza en aspectos como la importancia de hacer un diagnóstico temprano para la curación total de la enfermedad.Bird fancier's lung (BFL) affects between 4% and 8% of people who are fond of pigeon, and also people taking care of other types of birds. The current study is an in-depth research into the clinical characteristics of BFL in the largest series examined for this purpose by a single group, 86 cases, taking into account acute, subacute, or chronic clinical presentation. The research studies in depth topics such as the importance of an early diagnosis for the total recovery from the disease

El decolorant i els bronquis del perruquer

L'exposició a les sals de persulfat, molt freqüents en la indústria cosmètica, són una de les causes més freqüents de l'asma ocupacional, especialment dins del gremi de la perruqueria. Aquest estudi analitza l'evolució de 10 pacients en funció del seu grau d'exposició al agent. Els que van evitar el contacte van mostrar una millor hiperresposta bronquial, mentre que els que el van mantenir van mostrar un pitjor pronòstic de l'asma ocupacional.La exposición a las sales de persulfato, muy frecuentes en los productos decolorantes, son una de las causas más frecuentes del asma ocupacional, especialmente en el gremio de la peluquería. Este estudio analiza la evolución de 10 pacientes en función de su grado de exposición al agente. Quienes evitaron el contacto mostraron una mejor hiperrespuesta bronquial, mientras que quienes lo mantuvieron mostraron un peor pronóstico del asma ocupaciona

Angiotensinogen gene G-6A polymorphism influences idiopathic pulmonary fibrosisdisease progression

Angiotensin II is a growth factor that plays a key role in the physiopathology of idiopathic pulmonary fibrosis (IPF). A nucleotide substitution of an adenine instead of a guanine (G-6A) in the proximal promoter region of angiotensinogen (AGT), the precursor of angiotensin II, has been associated with an increased gene transcription rate. In order to investigate whether the G-6A polymorphism of the AGT gene is associated with IPF development, severity and progression, the present study utilised a case–control study design and genotyped G-6A in 219 patients with IPF and 224 control subjects. The distribution of G-6A genotypes and alleles did not significantly differ between cases and controls. The G-6A polymorphism of the AGT gene was not associated with disease severity at diagnosis. The presence of the A allele was strongly associated with increased alveolar arterial oxygen tension difference during follow-up, after controlling for the confounding factors. Higher alveolar arterial oxygen tension changes over time were observed in patients with the AA genotype (0.37¡0.7 mmHg (0.049¡0.093 kPa) per month) compared to GA genotype (0.12¡1 mmHg (0.016¡0.133 kPa) per month) and GG genotype (0.2¡0.6 mmHg (0.027¡0.080 kPa) per month). G-6A polymorphism of the angiotensinogen gene is associated with idiopathic pulmonary fibrosis progression but not with disease predisposition. This polymorphism could have a predictive significance in idiopathic pulmonary fibrosis patients.Supported by grants from FIS-PI; FISPI060064, FIS-IDIBAPS CM05/00118, Sociedad Española de Neumologia y Cirugia Torácica (SEPAR)-Fundación Respira and Faculdade Capivari, Spain.Peer reviewe

Human Mesenchymal Stem Cells Resolve Airway Inflammation, Hyperreactivity, And Histopathology In A Mouse Model Of Occupational Asthma

Occupational asthma (OA) is characterized by allergic airway inflammation and hyperresponsiveness, leading to progressive airway remodeling and a concomitant decline in lung function. The management of OA remains suboptimal in clinical practice. Thus, establishing effective therapies might overcome the natural history of the disease. We evaluated the ability of human adipose-tissue-derived mesenchymal stem cells (hASCs), either unmodified or engineered to secrete the IL-33 decoy receptor sST2, to attenuate the inflammatory and respiratory symptoms in a previously validated mouse model of OA to ammonium persulfate (AP). Twenty-four hours after a dermal AP sensitization and intranasal challenge regimen, the animals received intravenously 1 x 10(6) cells (either hASCs or hASCs overexpressing sST2) or saline and were analyzed at 1, 3, and 6 days after treatment. The infused hASCs induced an anti-inflammatory and restorative program upon reaching the AP-injured, asthmatic lungs, leading to early reduction of neutrophilic inflammation and total IgE production, preserved alveolar architecture with nearly absent lymphoplasmacytic infiltrates, negligible smooth muscle hyperplasia/hypertrophy in the peribronchiolar areas, and baseline airway hyperreactivity (AHR) to methacholine. Local sST2 overexpression barely increased the substantial efficacy displayed by unmodified hASCs. Thus, hASCs may represent a viable multiaction therapeutic capable to adequately respond to the AP-injured lung environment by resolving inflammation, tissue remodeling, and bronchial hyperresponsiveness typical of OA

Platelet Thromboembolism after Lung Transplantation

Lung transplant patients have an increased risk of pulmonary embolism which is often associated with hypercoagulability disorders. We present a case of sudden death resulting from pulmonary intravascular platelet thromboembolism following a single-lung transplant

Clinical and functional characteristics of patients two years after being affected by the soybean asthma epidemic in Barcelona

Background: Patients affected during the asthma outbreaks caused by soybean dust inhalation in Barcelona presented with sudden onset of severe asthma followed by the rapid relief of symptoms after treatment. Two years after the epidemics ended, a case-control study was conducted in which the clinical, functional, and immunological characteristics of these asthma patients (a randomised sample of asthmatic patients admitted as emergency cases on epidemic days, n = 213) were compared with those of a control group (a random sample of asthmatic patients admitted as emergency cases for attacks of asthma on non-epidemic days, n = 170). METHODS--The study included the administration of the ATS-DLD78 standardised respiratory questionnaire, the measurement of atopy, and performance of spirometric tests and a methacholine inhalation test. Results: Patients with epidemic asthma reported fewer symptoms of asthma, had attended emergency departments less frequently during the previous year for acute attacks of asthma, were taking fewer inhaled corticosteroids at the time of the study, and attended medical follow up less frequently than did the patients with non-epidemic asthma. However, the cases and controls showed no differences in ventilatory capacity or reactivity to the methacholine bronchoprovocation test. Conclusions: Two years after the end of the soybean epidemics, people affected by epidemic asthma had a favourable prognosis. This finding contrasts with a higher risk of life threatening asthma and death during the epidemics. This paradox could be the result of a complex interaction between host and conditions of exposure

Persistence of Asthmatic Response after Ammonium Persulfate-Induced Occupational Asthma in Mice

Since persulfate salts are an important cause of occupational asthma (OA), we aimed to study the persistence of respiratory symptoms after a single exposure to ammonium persulfate (AP) in AP-sensitized mice. BALB/c mice received dermal applications of AP or dimethylsulfoxide (DMSO) on days 1 and 8. On day 15, they received a single nasal instillation of AP or saline. Airway hyperresponsiveness (AHR) was assessed using methacholine provocation, while pulmonary inflammation was evaluated in bronchoalveolar lavage (BAL), and total serum immunoglobulin E (IgE), IgG1 and IgG2a were measured in blood at 1, 4, 8, 24 hours and 4, 8, 15 days after the single exposure to the causal agent. Histological studies of lungs were assessed. AP-treated mice showed a sustained increase in AHR, lasting up to 4 days after the challenge. There was a significant increase in the percentage of neutrophils 8 hours after the challenge, which persisted for 24 hours in AP-treated mice. The extent of airway inflammation was also seen in the histological analysis of the lungs from challenged mice. Slight increases in total serum IgE 4 days after the challenge were found, while IgG gradually increased further 4 to 15 days after the AP challenge in AP-sensitized mice. In AP-sensitized mice, an Ig-independent response is induced after AP challenge. AHR appears immediately, but airway neutrophil inflammation appears later. This response decreases in time; at early stages only respiratory and inflammatory responses decrease, but later on immunological response decreases as well

Nuevas perspectivas en trasplante de pulmón

Premi Extraordinari de Doctorat concedit pels programes de doctorat de la UAB per curs acadèmic 2017-2018Dos de las complicaciones que tienen más impacto en la supervivencia tras el trasplante de pulmón (TP) son la disfunción primaria del injerto (DPI) y la infección respiratoria. El presente trabajo de tesis está compuesto por dos investigaciones sobre estas complicaciones. En el primer trabajo se ha estudiado el papel del biomarcador proadrenomedulina en la DPI. El objetivo del trabajo fue investigar la asociación entre sus niveles en plasma (medidos mediante inmunofluorescencia) en los primeros tres días del postoperatorio y la función del injerto [definida mediante el cociente presión arterial de oxígeno/fracción inspiratoria de oxígeno (PaO2/FIO2)], los diferentes grados de DPI y la mortalidad en la unidad de cuidados intensivos (UCI). Para ello, se diseñó un estudio prospectivo que incluyó 100 receptores de TP ingresados en la UCI tras la cirugía. Se confirmó la presencia de asociación entre los valores del biomarcador y el índice PaO2/FIO2 en los primeros tres días. Los niveles de proadrenomedulina medidos a las 24 horas fueron significativamente más elevados en la población de enfermos que a las 72 horas presentaba DPI grado tres, único grado asociado a una mayor mortalidad en la UCI. Los niveles de proadrenomedulina medidos a las 48 y a las 72 horas fueron significativamente más elevados en los pacientes que fallecieron en la UCI. Por último, el área debajo de la curva ROC de la DPI grado tres a las 72 horas para predecir la mortalidad en la UCI fue optimizada añadiendo al modelo la de los niveles de proadrenomedulina medidos a las 72 horas. Tras la investigación se puede concluir que los niveles elevados de proadrenomedulina medidos en el postoperatorio inmediato del TP están significativamente asociados con el grado más grave de DPI y con la mortalidad precoz. Estos hallazgos tienen implicación en el pronóstico de estos pacientes y son relevantes para investigaciones futuras sobre DPI. En el segundo trabajo se ha estudiado la repercusión de la infección respiratoria en el postoperatorio inmediato del TP. El objetivo principal de la investigación fue evaluar el efecto de la neumonía y la traqueobronquitis asociadas a ventilación mecánica (VAP y VAT respectivamente) en el tiempo de estancia en la UCI y en el hospital y con la mortalidad. Como objetivos secundarios, se identificaron los gérmenes causantes de dichas infecciones y los factores de riesgo de aparición de las mismas. Para ello se diseñó un estudio retrospectivo donde se analizaron los datos clínicos de 170 receptores de TP ingresados en la UCI tras la cirugía. Los pacientes que sufrieron infección respiratoria asociada a ventilación mecánica estuvieron más tiempo en UCI y en el hospital. Asimismo, la mortalidad fue más elevada en los pacientes que sufrieron VAP, no así en los pacientes con VAT. Pseudomonas aeruginosa fue el germen que más frecuentemente causó infección asociada a ventilación mecánica. En el caso de la VAP, 8/12 fueron Pseudomonas aeruginosa multirresistente. En el análisis multivariado, se encontró que la paresia gástrica fue un factor de riesgo independiente para el desarrollo de VAP, asociación que se mantuvo al ajustar el análisis por los días de ventilación mecánica. Asimismo, se evidenció que la paresia gástrica y la paresia frénica fueron factores de riesgo para el desarrollo de VAT. Se puede concluir que la prevención de VAP disminuiría la mortalidad precoz en receptores de TP, que el tratamiento empírico de la misma ha de cubrir gérmenes multirresistentes, que la prevención de paresia gástrica disminuiría la incidencia de VAP y que la prevención de paresia frénica disminuiría la incidencia de VAT.Two of the complications that have the greatest impact on survival after lung transplantation (LT) are primary graft dysfunction (PGD) and respiratory infections. This thesis includes two studies on these complications. The first of these studies analyzed the role of the biomarker proadrenomedullin (proADM) in PGD. The objective was to assess the association between proADM plasma levels (measured by immunofluorescence) in the first three days after surgery and graft function [defined by the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio], the different degrees of PGD and mortality in the intensive care unit (ICU). In this prospective study including 100 LT recipients admitted to the ICU after surgery, a significant association was confirmed between the biomarker levels and the PaO2/FIO2 ratio in the first three days. Proadrenomedullin levels measured at 24 hours were significantly higher in the population of patients who presented grade 3 PGD at 72 hours, the only degree associated with increased ICU mortality. Proadrenomedullin levels measured at 48 and 72 hours were significantly higher in patients who died in the ICU. Finally, adding the individual predictive utility for ICU mortality of grade 3 PGD at 72 hours to that of proADM measured at 72 hours improved the model's predictive value. The conclusion was that higher proADM levels measured following LT are associated with the most severe grade of PGD and with early mortality. These findings may have implications for prognosis in LT recipients and may also be relevant to future research works into PGD. The second study assessed the impact of respiratory infections in the immediate postoperative period after LT. The main objective was to evaluate the effect of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) on ICU and hospital length of stay and on early mortality. Secondary objectives were to identify their causative organisms and their potential risk factors. A retrospective study was designed in which the clinical data of 170 consecutive LT recipients admitted to the ICU after surgery were analyzed. Suffering ventilator-associated respiratory infection was associated with more days of mechanical ventilation and with longer ICU and hospital stays. Mortality in the ICU was higher in patients who had VAP, but not in patients with VAT. Pseudomonas aeruginosa was the most frequent germ causing ventilator-associated respiratory infection. In the VAP cases, 8/12 were multidrug resistant. The multivariate analysis showed that gastric paresis was an independent risk factor for the development of VAP, an association that remained significant when adjusting for days of mechanical ventilation. Further, both gastric and phrenic paresis were risk factors for the development of VAT. In conclusion, prevention of VAP following LT may reduce early mortality. The empirical treatment of ventilator-associated respiratory infections should cover multidrug resistant pathogens. Finally, prevention of gastroparesis may reduce the incidence of VAP and prevention of phrenic paresis may reduce the incidence of VAT

Business Case 01: Producción de Bicicletas New Generation City Bikes

2019/202