Laura Novella

Manejo de la amiloidosis traqueobronquial mediante técnicas broncoscópicas terapéuticas

Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease.

Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?

Severity assessment is made at the time of the initial clinical presentation in patients with community‐acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP.

Comparación de costes y resultados clínicos entre la administración hospitalaria o ambulatoria de omalizumab, en pacientes con asma grave no controlada

OBJECTIVES To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. METHOD We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. RESULTS We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28 ± 6 kg/m(2), 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3 ± 2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<0.001), ACQ (P<0.001), improvement in FEV1% (P<0.001), reduction in total admissions (P<0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P<0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. CONCLUSION The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

Differential Characteristics of Patients With Mild Acute Respiratory Distress Syndrome Due to Community-Acquired Pneumonia Admitted to ICU

Aims: To determine the characteristics of patients with community-acquired pneumonia and mild acute respiratory distress syndrome (CAP-mild ARDS) who require ICU admission. Methods: Analysis of demographic characteristics, comorbidities, etiology and outcomes of patients with CAP-mild ARDS admitted to ICU comparing to those who did not. X2, t student and logistic regression were used to compare both groups. Results: In a series of 1314 CAP patients, 164 (12.5%) showed mild ARDS at admission, of whom 25% (41 cases) were admitted to ICU. ICU patients were younger [57.5 (16) vs. 68.7 (15.4) years, p<0.01], and had a lower duration of symptoms [3.4 (1.9) vs. 6.5 (6) days, p<0.01] than no ICU patients. Pneumonia severity was higher in ICU group (PSI V: 39% vs. 17.1%; p=0.004). Multivariate analysis showed that age <65 years (OR 9.79, 95%CI 3.13-30.68), septic shock (OR 7.76, 95%CI 2.36-25.50), and PSI V (OR 7.28, 95%CI 2.16-24.56) were associated with ICU admission in CAP-mild ARDS patients; they showed a longer length of stay (LOS) [27 (28.6) vs. 10.6 (6) days, p<0.01] and more complications compared to those that were treated in a general ward (100% vs. 4.9%, p<0.01). Mortality was higher in ICU CAP mild-ARDS group but not statistically significant (17.1% vs. 7.3%, p= 0.068). Conclusions: 1-In our series, 25% of patients with CAP-mild ARDS required ICU admission. 2- Age <65 years, the presence of septic shock, and pneumonia severity were factors that determine ICU admission of CAP-mild ARDS patients in our series. 3-Patients with CAP-mild ARDS and ICU admission showed more complications and longer LOS without differences in mortality.