Felipe Villar Álvarez

ESTUDIO BIBLIOMÉTRICO DE LOS ARTÍCULOS ORIGINALES DE LA REVISTA ESPAÑOLA DE SALUD PÚBLICA (1991-2000). PARTE TERCERA: ANÁLISIS DE LAS REFERENCIAS BIBLIOGRÁFICAS

Fundamentos: El avance del conocimiento se apoya en los resultados de las investigaciones precedentes, lo que en un articulo cientifico se refleja en las referencias bibliograficas. El objetivo de este trabajo es estudiar el consumo de la informacion cientifica en la Revista Espanola de Salud Publica (RESP) a partir de las referencias bibliograficas de los articulos originales publicados durante la decada 1991-2000. Metodos: De las referencias bibliograficas de los 290 originales publicados en el periodo estudiado se extrajo la informacion relativa al ano y a la fuente de publicacion, tipo de documento, idioma y pais de publicacion, se calcularon los indices de obsolescencia, de Price y de aislamiento y el porcentaje de autocita, y se elaboro la distribucion en nucleos de Bradford segun las revistas fuente. Resultados: En el apartado de Bibliografia de los 290 originales se cito un total de 7.465 referencias. La media de referencias por articulo fue de 25,7. El indice de Price de 40,7. Los articulos cientificos presentaron un indice de obsolescencia de 5, y los libros y capitulos de libros de 6. El 50,6% de las citas proceden de trabajos escritos en espanol. El indice de aislamiento de las referencias fue de 48,1. El primer nucleo de Bradford esta formado por 10 revistas, las cuatro primeras de ellas son espanolas. El indice de autocita fue del 3,8%. Conclusiones: El consumo de informacion de los originales publicados en la RESP muestra unos parametros similares al de otras revistas espanolas de ciencias de la salud en esos mismos anos y en aquellos que se diferencia de ellas podria explicarse por la idiosincrasia de la salud publica, que no se circunscribe a los patrones propios de las disciplinas clinicas.

Enfermedad pulmonar obstructiva crónica e insuficiencia cardíaca

Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure. Individuals with COPD have a 4.5-fold greater risk of developing heart failure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heart failure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heart failure, although treatment of COPD undeniably affects the clinical course of patients with heart failure and viceversa.

Recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

Felipe Villar Álvareza,*,1, Ignacio Muguruza Truebab,1, José Belda Sanchisc, Laureano Molins López-Rodód, Pedro Miguel Rodríguez Suáreze, Julio Sánchez de Cos Escuínf, Esther Barreirog, M. Henar Borrego Pintadoh, Carlos Disdier Vicentei, Javier Flandes Aldeyturriagaj, Pablo Gámez Garcíak, Pilar Garrido Lópezl, Pablo León Atancem, José Miguel Izquierdo Elenan, Nuria M. Novoa Valentíno, Juan José Rivas de Andrésp, Íñigo Royo Crespop, Ángel Salvatierra Velázquezq, Luis M. Seijo Maceirasr, Segismundo Solano Reinas, David Aguiar Bujandat, Régulo J. Ávila Martínezk, José Ignacio de Granda Oriveu, Eva de Higes Martínezv, Vicente Díaz-Hellín Gudek, Raúl Embún Florp, Jorge L. Freixinet Gilarte, María Dolores García Jiménezm, Fátima Hermoso Alarzak, Samuel Hernández Sarmientot, Antonio Francisco Honguero Martínezm, Carlos A. Jiménez Ruizw, Iker López Sanzn, Andrea Mariscal de Albak, Primitivo Martínez Vallinap, Patricia Menal Muñozx, Laura Mezquita Pérezl, María Eugenia Olmedo Garcíal, Carlos A. Rombolám, Íñigo San Miguel Arreguiy, María del Valle Somiedo Gutiérrezj, Ana Isabel Triviño Ramírezm, Joan Carles Trujillo Reyesc, Carmen Vallejoz, Paz Vaquero Lozanos, Gonzalo Varela Simóo y Javier J. ZuluetaaaThe Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Chronic Obstructive Pulmonary Disease and Heart Failure

Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure. Individuals with COPD have a 4.5-fold greater risk of developing heart failure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heart failure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heart failure, although treatment of COPD undeniably affects the clinical course of patients with heart failure and viceversa.

Identification of novel pathogenic mechanisms triggered by arginase activation in patients with COPD

Introduction: The advancement in the pathophysiology of COPD regarding inflammation has led to new questions and research lines.Our objectives were to establish new pathogenic mechanisms of COPD in stable and exacerbated phases, through inflammation and immunosuppression, and describe the role of arginase in these phases. Patients and Methods: Prospective and case control study with three groups: healthy subjects (15), COPD in stable phase (18) and COPD in exacerbated phase (14). This last one was reassessed 3 months later in stable phase and were included in the COPD stable group (total number: 32). Biometrical data, respiratory function and blood analytical data were obtained. Arginase activity in serum, total lymphocyte subpopulations count and CD3z expression were measured. Results: There were no differences between control group and stable COPD group regarding arginase activity but CD3z expression was lower in stable COPD group (p 0.081) Regarding control and exacerbated COPD group, arginase activity was higher in exacerbated COPD group (p 0.039). CD3z expression, CD3, CD4 and NK-CD56++ count were lower in the exacerbated COPD group (p Arginase activity was higher in exacerbated COPD group compared to stable COPD group (p 0.110). CD3z expression, CD3, CD4, CD8 and NK-CD56++ count were lower in exacerbated COPD group (p Conclusion: A trend towards higher values of arginase activity and lower CD3z expression was noted in COPD patients in stable and exacerbated phases.

Characterization of readmissions in patients hospitalized with COPD exacerbation

Introduction: Inflammation, eosinophilia or FEV1 could play a role in readmissions after a COPD exacerbation. Our aim was to identify which factors could facilitate readmissions during the first and third month after a hospitalization by COPD exacerbation. Methods: One year observational retrospective study of hospitalized patients with COPD exacerbation. After hospital discharge we measured FEV1, Karnofsky Index, exacerbations (hospitalization or not) in the last year, GOLD and GesEPOC classifications, cardiovascular comorbidity, C reactive protein, peripheral eosinophilia and exacerbation severity scores BAP-65 and DeCOPD. Results: From 181 discharged patients with COPD exacerbation. The values at first month in 65 (36%) readmitted patients were: GOLD D (55%), GesEPOC exacerbator with enphysema (52%), BAP-65 II and moderate DeCOPD. In no readmitted patients were: GOLD D (39%), gesEPOC non-exacerbator (65%), BAP-65 II and moderate DeCOPD (53%). We observed differences (p 0,05). Conclusions: Readmissions at the first and third month were more frequent in GOLD D, exacerbators with emphysema, BAP-65 II and moderate DeCOPD. The number of previous hospitalizations, FEV1 and Karfnosky Index were the most related factors with readmissions.

Home care in patients hospitalized for exacerbation of COPD

INTRODUCTION: With the objective of reducing the rate of readmissions of discharged for COPD exacerbation, our chronic outpatient respiratory care unit (UCCRA) was created. METHODS: Observational study in which we compared data of patient included in UCCRA from January to October 2015 with patients with not home care, and with the patients included in UCCRA in the same period in 2014 with only telephone follow-up. Patients were admitted in UCCRA if they fit our criteria, based on our Readmission Risk Scale (RRS) that incorporates these variables: age, exacerbations (hospitalization or not) in the last year, FEV1, bacterial colonization, chronic bronchitis, Karnofsky index and cardiovascular comorbidity. Patients were included in UCCRA if they had suffered > 2 hospitalizations in the last year or > 7 points in our RRS. RESULTS: We included 399 patients, 234 patients were discharged after an exacerbation of COPD in 2015, with a mean age (MA) of 71.8 years, mean stay (MS) of 7.4 days and 13.3% of readmissions. 108 were included in UCCRA, who had significantly higher MS and previous exacerbations, reduced FEV1 and Karnofsky, and higher percentage of readmissions than not included (22.2 vs 6.3%). Patients with home care in 2015, compared with 2014 with telephone follow-up (165 patients, MA: 72.6, MS: 6.2), had more previous non-hospital exacerbations (p CONCLUSIONS: UCCRA with home care was valid to reduce readmissions in COPD patients, compared with telephone follow-up. Previous hospitalizations was the variable that better predict readmission.

Apuntes sobre recidivas y segundos tumores en el cáncer de pulmón

Between 30% and 70% of lung cancer (LC) patients treated with surgery will experience local or distant relapse within the first 5 years, mostly during the first 2 years; recurrence rates after 5 years are between 5% and 15%. Distant recurrences are still the most frequent, and occur in up to 70% of cases.1 As relapse rates fall with the passing of time, rates of second primary tumors increase. These second primaries occur more often in year 5 post-surgery than in year 2, and the most prevalent are pulmonary strains, with higher relapse rates occurring after small cell carcinomas.2 An analysis of recurrence patterns in LC shows that incidence of relapse appears to peak at 3 time points: 9 months, 2 years and 4 years; while the appearance of second primary lung tumors is more linear.3 Investigators Sánchez de Cos Escuín et al. reported that most relapses occur in the first 3 years, and are relatively common up to the 5-year mark, after which recurrence rates fell greatly. In contrast, the appearance of second primary tumors in the lung or in extrapulmonary sites was more common after 5 years. Moreover, the incidence of second primary tumors was higher than the predicted incidence of cancer in general populations of similar age and sex, primary lung cancers being the most common. With regard to histological type, they also found that second primary lung tumors were more common after small cell disease.4 These findings, though similar to those reported in previous studies, were observed over a longer follow-up period, irrespective of the treatment initially prescribed. The reason for recurrence and second tumors is currently a topic of discussion. One of the causes, perhaps the most important, is persistent smoking. This habit plays a significant role in the etiology and pathogenesis of LC and other cancers that subsequently develop as second primary tumors.2 Moreover, smoking may be associated with poor response to treatment, since worse outcomes have been observed in patients with a history of smoking

Budesónida/formoterol en el tratamiento de la EPOC

Resumen Existen dos grandes ensayos clinicos realizados con la combinacion de budesonida-formoterol en la EPOC estable a largo plazo que han mostrado unos claros datos acerca de la eficacia de esta combinacion sobre la mejoria de la funcion pulmonar, los sintomas, la calidad de vida relacionada con la salud y sobre la reduccion del numero de exacerbaciones. Previamente a estos estudios, ya existia informacion acerca de la eficacia de sus monocomponentes sobre esta misma enfermedad, aunque los principales datos clinicos obtenidos con formoterol y budesonida por separado en el tratamiento de la EPOC provienen del estudio de las respectivas ramas de estos farmacos en los dos grandes ensayos clinicos que se describen en este articulo. Con respecto a la mejoria encontrada en las variables de funcion pulmonar (FEV 1 , FVC y PEF), siempre era mayor con la combinacion de budesonida-formoterol. La puntuacion obtenida en los cuestionarios de calidad de vida tambien fue mas favorable en las ramas de tratamiento combinado ya desde la primera semana de tratamiento y mantenida hasta los 12 meses de seguimiento, asi como en la mejoria de los sintomas y en el uso de medicacion de rescate. La frecuencia de exacerbaciones leves y graves, asi como el uso de corticoides orales, fue menor en el grupo tratado con budesonida-formoterol. De igual modo, el tiempo transcurrido hasta la primera exacerbacion tambien fue mas prolongado en este mismo grupo. En esta revision se ponen de manifiesto los principales hallazgos demostrados acerca de la eficacia de la combinacion de budesonida-formoterol en la EPOC estable.Two large, 12-month clinical trials have been performed with budesonide-formoterol in patients with stable COPD and have shown clear data on the efficacy of this combination in improving pulmonary function, symptoms and health-related quality of life and in reducing the number of exacerbations. Before these trials, information was already available on the efficacy of both monocomponents in this disease, although the main clinical data obtained with formoterol and budesonide separately in the treatment of COPD come from the respective branches of these drugs in the two large clinical trials described in the present article. Improvement in pulmonary function variables [forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF)] was always greater with the combination of budesonide-formoterol. The scores obtained in quality of life questionnaires were also more favorable in the combination treatment branches as early as the first week of treatment and persisted at 12 months of follow-up. Improvement in symptoms and in the use of reliever medication was also greater in the combination branch. The frequency of mild and severe exacerbations, as well as the use of oral corticosteroids, was lower in the budesonide-formoterol branch. The time to first exacerbation was also more prolonged in this group. The present review discusses the main findings on the efficacy of the combination of budesonide-formoterol in stable COPD.Two large, 12-month clinical trials have been performed with budesonide-formoterol in patients with stable COPD and have shown clear data on the efficacy of this combination in improving pulmonary function, symptoms and health-related quality of life and in reducing the number of exacerbations. Before these trials, information was already available on the efficacy of both monocomponents in this disease, although the main clinical data obtained with formoterol and budesonide separately in the treatment of COPD come from the respective branches of these drugs in the two large clinical trials described in the present article. Improvement in pulmonary function variables [forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF)] was always greater with the combination of budesonide-formoterol. The scores obtained in quality of life questionnaires were also more favorable in the combination treatment branches as early as the first week of treatment and persisted at 12 months of follow-up. Improvement in symptoms and in the use of reliever medication was also greater in the combination branch. The frequency of mild and severe exacerbations, as well as the use of oral corticosteroids, was lower in the budesonide-formoterol branch. The time to first exacerbation was also more prolonged in this group. The present review discusses the main findings on the efficacy of the combination of budesonide-formoterol in stable COPD.