Estudio de la influencia del equilibrio coagulación-fibrinolisis endopleural en la pleurodesis con talco

Hemos estudiado el balance coagulacion/fibrinolisis endopleural y otros parametros bioquimicos en 104 pacientes tras toracoscopia. En 81, 77 malignos y 4 benignos recurrentes, se realizo pleurodesis con talco. Los otros 23, 16 benignos y 7 malignos, se incluyeron como control. Se determinaron de forma basal, tras biopsia, a las 3,24 y 48 horas, u en caso de recidiva, los niveles de trombina-antitrombina (tat), dimero-d e inhibidor del activador del plasminogeno (pai-1) y otros parametros (ph, ldh, glucosa, lactico, proteinas y celulas). La pleurodesis fue un exito en el 80x100 de los casos, con un valor predictivo positivo para el fracaso de la pleurodesis de un 67x100 para los casos con ph menor 7.2. La toracoscopia origino por si sola una marcada respuesta de los parametros inflamatorios en la pleura. Los niveles basales de coagulacion y fibrinolisis fueron similares en ambos grupos, con correlacion entre niveles de dimero-d y extension tumoral. Tras toracoscopia se activo la coagulacion y elevaron los niveles de pai en todos los grupos, con una caida significativa de la fibrinolisis (p menor 0,001) a las 24 horas en los pacientes con buen resultado de la pleurodesis e incremento de dicha fibrinolisis en los fracasos. El maximo pico en el indice tat/dimero-d se produce a las 24 horas, por ello en este momento la succion pleural debe ser maxima

Seasonal variability in clinical care of COPD outpatients: results from the Andalusian COPD audit

OBJECTIVES: Clinical practice in chronic obstructive pulmonary disease (COPD) can be influenced by weather variability throughout the year. To explore the hypothesis of seasonal variability in clinical practice, the present study analyzes the results of the 2013-2014 Andalusian COPD audit with regard to changes in clinical practice according to the different seasons. METHODS: The Andalusian COPD audit was a pilot clinical project conducted from October 2013 to September 2014 in outpatient respiratory clinics of hospitals in Andalusia, Spain (8 provinces with more than 8 million inhabitants) with retrospective data gathering. For the present analysis, astronomical seasons in the Northern Hemisphere were used as reference. Bivariate associations between the different COPD guidelines and the clinical practice changes over the seasons were explored by using binomial multivariate logistic regression analysis with age, sex, Charlson comorbidity index, type of hospital, and COPD severity by forced expiratory volume in 1 second as covariates, and were expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS: The Andalusian COPD audit included 621 clinical records from 9 hospitals. After adjusting for covariates, only inhaler device satisfaction evaluation was found to significantly differ according to the seasons with an increase in winter (OR, 3.460; 95% CI, 1.469-8.151), spring (OR, 4.215; 95% CI, 1.814-9.793), and summer (OR, 3.371; 95% CI, 1.391-8.169) compared to that in autumn. The rest of the observed differences were not significant after adjusting for covariates. However, compliance with evaluating inhaler satisfaction was low. CONCLUSION: The various aspects of clinical practice for COPD care were found to be quite homogeneous throughout the year for the variables evaluated. Inhaler satisfaction evaluation, however, presented some significant variation during the year. Inhaler device satisfaction should be evaluated during all clinical visits throughout the year for improved COPD management.This study was funded by an unrestricted grant from Menarini, SpainYe