Análisis de ingresos hospitalarios por asma

El asma bronquial es una enfermedad crónica, con gran repercusión sobre la calidad de vida de los pacientes. Los ingresos hospitalarios por exacerbaciones de esta enfermedad consumen un elevado número de recursos sanitarios. Por lo tanto, conocer las características de los pacientes hospitalizados por esta causa, así como los factores de riesgo asociados a las agudizaciones, puede favorecer el control de la enfermedad, disminuyendo las visitas a urgencias y los ingresos hospitalarios. Objetivos Caracterizar al paciente asmático ingresado en el Servicio de Neumología del Hospital General Universitario Gregorio Marañón desde el 1 de enero de 2016 hasta el 31 de diciembre de 2018 por una agudización de su enfermedad. Describir los patrones de prescripción en vida real en función del diagnóstico del asma, según la guía GINA, y valorar la adecuación del tratamiento de los pacientes a las guías de práctica clínica. Evaluar los resultados de los ingresos hospitalarios por asma teniendo en cuenta la estancia hospitalaria, los reingresos, los factores asociados a los mismos y la mortalidad. Material y métodos Estudio retrospectivo, observacional y longitudinal de los pacientes hospitalizados por exacerbación asmática durante el periodo de estudio. Se recogieron las características clínicas, las pruebas de función pulmonar, el tratamiento de la enfermedad y las comorbilidades. Además, se registraron los reingresos en los seis meses posteriores al alta hospitalaria..

Sonic Hedgehod y comportamiento de precursores neuroepiteliales

En los estadios tempranos del desarrollo embrionario, el cerebro tiene dos componentes fundamentales: fluido cerebroespinal embrionario (E-CSF) y precursores neuroepiteliales. En esta investigación nos centraremos en explicar la influencia de un factor de transcripción, sonic hedgehog (SHH), presente en el E-CSF, sobre el comportamiento de los precursores neuroepiteliares. Empleamos técnicas de Wester-Blot para demostrar la presencia de SHH en el E-CSF y técnicas de cultivo organotípico de neuroepitelio de pollo, combinados con inmunobloque de SHH. La replicación celular lo valoramos por incorporación de BrdU y la neurogénesis por inmunodetección de β-3-Tubulina. Los resultados obtenidos demuestran que SHH, presente en el E-CSF, juega un papel relevante en la expansión de la población de precursores neuroepiteliales del cerebro embrionario y en menor grado en el proceso de neurogénesis, que por otra parte ve alterada su polarización basal fisiológica.OtroGrado en Medicin

All Roads Lead to Rome: Results of Non-Invasive Respiratory Therapies Applied in a Tertiary-Care Hospital Without an Intermediate Care Unit During the COVID-19 Pandemic

Introducción. Las terapias respiratorias no invasivas (TRNI) fueron ampliamente utilizadas en la primera ola de la pandemia de COVID-19, en escenarios distintos según los medios disponibles. El objetivo fue presentar la supervivencia a 90 días y los factores asociados a esta de los pacientes tratados con TRNI en un centro de tercer nivel sin Unidad de Cuidados Respiratorios Intermedios. Como objetivo secundario comparar los resultados obtenidos de las distintas terapias. Métodos. Estudio observacional de pacientes tratados con TRNI fuera de un ambiente de Cuidados Intensivos o Unidad de Cuidados Respiratorios Intermedios, diagnosticados de COVID-19 y con síndrome de distrés respiratorio agudo por criterios radiológicos y de ratio SpO2/FiO2. Se desarrolló un modelo multivariante de regresión logística para determinar las variables independientemente asociadas, y se compararon los resultados de la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea. Resultados. Se trataron 107 pacientes y sobrevivieron 85 (79,4%) a los 90 días. Antes de iniciar la TRNI el ratio medio de SpO2/FiO2 fue de 119,8±59,4. Un mayor score de SOFA se asoció significativamente a la mortalidad (OR 2,09; IC95% 1,34 – 3,27), mientras que la autopronación fue un factor protector (OR 0,23; IC95% 0,06 – 0,91). La terapia de alto flujo con cánula nasal fue utilizada en 63 sujetos (58,9%), y la presión positiva continua en la vía aérea en 41 (38,3%). No se encontraron diferencias entre ellas. Conclusión. Aproximadamente cuatro de cada cinco pacientes tratados con TRNI sobrevivieron a los 90 días, y no se encontraron diferencias significativas entre la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea.S

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Influence of Pneumonia on the Survival of Patients with COPD

Background: Pneumonia is a frequent infection. Chronic obstructive pulmonary disease (COPD) can present with comorbidities, including pneumonia. It is known that COPD worsens the evolution of pneumonia, but few studies describe the impact of pneumonia on COPD evolution. This study analyzes the influence of pneumonia on the survival of COPD patients. Methods: Observational study of a cohort of 273 patients with COPD who attended spirometry in 2011, with a prospective follow-up of six years. Patients were divided into two groups according to their acquisition of pneumonia during follow-up. The difference in survival between the two groups was analyzed. Results: Survival was lower in the group with pneumonia compared with that without pneumonia (p = 0.000), both globally and after stratification by COPD phenotype. Pneumonia (Hazard Ratio -HR- 2.65; 95% Confidence Interval -CI- 1.57&ndash;4.48), advanced age (HR 1.08; 95% CI 1.03&ndash;1.09), and high Charlson index (HR 1.31; 95% CI 1.17&ndash;1.47) were identified as risk factors independently associated with mortality, while a high body mass index (HR 0.92; 95% CI 0.87&ndash;0.96) was identified as a protective factor. Conclusions: Pneumonia is associated with worse prognosis in COPD patients. It is important to take into account this comorbidity for a comprehensive care of these patients

Rituximab for the treatment of acute exacerbation of interstitial lung disease associated with connective tissue disease

Background Acute exacerbation of interstitial lung disease (AE-ILD) is a severe complication with a poor prognosis. No clinical trials have supported the use of rituximab in AE-ILD associated with connective tissue disease.Methods We present a series of four cases in which administration of rituximab was associated with appropriate clinical, radiological and functional progress.Results The four patients were alive 30 days after discharge following their exacerbation.Conclusions Given the speed of action, safety and efficacy profile observed for rituximab, we believe that this agent should be further investigated in clinical trials so that it could be included in the daily clinical management of this severe condition

Natural killer cell hyporesponsiveness and impaired development in a CD247-deficient patient

Depto. de Inmunología, Oftalmología y ORLFac. de MedicinaTRUEMinisterio de Economía y Competitividad (MINECO)Instituto de Salud Carlos III (ISCIII)Comunidad de MadridNational Institutes of Healthpu