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la COVID-19 supuso una amenaza para la capacidad hospitalaria por el elevado número de ingresos, lo que llevó al desarrollo de diversas estrategias para liberar y crear nuevas camas hospitalarias. Dada la importancia de los corticoides sistémicos en esta enfermedad, se evaluó la eficacia de estos en la reducción de la duración de la estancia hospitalaria (EH) y se comparó el efecto de 3 corticosteroides diferentes sobre este resultado.

Los datos disponibles avalan las diferencias por género en el liderazgo de las investigaciones clínicas (IC). Este estudio analiza en qué medida las mujeres lideran estas investigaciones.

Given poor medication adherence in severe asthma is difficult to evaluate in daily practice, using at least two methods concurrently is recommended. We aimed to determine the prevalence of nonadherence to inhalers using the Test of Adherence to Inhalers questionnaire and the medication possession ratio obtained from the pharmacy refill data in patients with severe asthma treated with anti-interleukin-5 biologics and to evaluate their concordance.

Objective This study examined whether bronchoscopy leads to clinicoradiological improvement in cystic fibrosis (CF) and the predictive factors. The study also investigated whether pulmonary atelectasis is a poor prognostic factor in CF.Methods This multicenter, case–control, observational, retrospective study included two groups of patients with CF: a case group (patients with persistent atelectasis who were followed-up at least for 2 years) and a control group (patients without atelectasis matched 1:1 by sex and age [±3 years]). We recorded demographic data, lung function test results, pulmonary complications, comorbidities, treatments (including bronchoscopies, surgery and transplantation), and deaths.Results Each group included 55 patients (case group: 20 men, mean age 25.4 ± 10.4 years; control group: 20 men, mean age 26.1 ± 11.4 years). Bronchoscopy did not lead to clinicoradiological improvement. Allergic bronchopulmonary aspergillosis (ABPA) was more frequent in the case group. Patients in the case group more frequently used inhaled steroids, their pre-atelectasis lung function was statistically worse, and they had more exacerbations during follow-up.Conclusion Moderate-to-severe pulmonary disease and ABPA can favor atelectasis. Pulmonary atelectasis can be a poor prognostic factor in CF because it increases exacerbations. Despite our results, we recommend enhancing treatment, including bronchoscopy, to prevent persistent atelectasis.

En este documento se refieren las bases legales nacionales y, más en concreto, las autonómicas andaluzas que dan respaldo a la figura del profesor contratado doctor vinculado y a la posibilidad de convocar las plazas correspondientes en las facultades de medicina de las universidades públicas españolas. Se exponen, asimismo, las características asistenciales y académicas que deben darse para llevar a cabo la convocatoria pública de dichas plazas. Se resume, a continuación, cuál es la situación actual existente en relación con dicha figura del profesorado en las facultades de medicina españolas. Se analizan también las ventajas y las posibles limitaciones que actualmente se derivan de contar con profesores contratados doctores vinculados y ello tanto para los médicos especialistas eventualmente interesados en optar a una de estas plazas como para el centro sanitario y la facultad de medicina correspondientes. Finalmente, se reseña la posible utilidad del documento elaborado por la Conferencia Nacional de Decanos de Facultades de Medicina de España (CNDFME) en la Asamblea General que se celebró en la Facultad de Medicina de Oviedo del 17 al 19 de mayo del 2018 y actualizado en marzo de 2020.

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Estamos asistiendo a un progresivo incremento de la supervivencia en la fibrosis quística (FQ). Hasta ahora, la afectación renal era minoritaria, pero con la mejoría de la esperanza de vida, probablemente veremos un aumento de su prevalencia. Nuestro objetivo principal fue evaluar la función renal en FQ y estudiar factores de riesgo asociados a su deterioro.

ABSTRACTTo evaluate the changes in the gut microbiota associated with changes in the biochemical markers of nonalcoholic fatty liver disease (NAFLD) after a lifestyle intervention with the Mediterranean diet. Participants (n = 297) from two centers of PREDIMED-Plus trial (Prevención con Dieta Mediterránea) were divided into three different groups based on the change tertile in the Hepatic Steatosis Index (HSI) or the Fibrosis−4 score (FIB−4) between baseline and one year of intervention. One-year changes in HSI were: tertile 1 (T1) (−24.9 to −7.51), T2 (−7.5 to −1.86), T3 (−1.85 to 13.64). The most significant differences in gut microbiota within the year of intervention were observed in the T1 and T3. According to the FIB−4, participants were categorized in non-suspected fibrosis (NSF) and with indeterminate or suspected fibrosis (SF). NSF participants showed higher abundances of Alcaligenaceae, Bacteroidaceae, Bifidobacteriaceae, Clostridiaceae, Enterobacteriaceae, Peptostreptococcaceae, Verrucomicrobiaceaecompared to those with SF. Then, participants were divided depending on the FIB−4 tertile of change: T1 (−89.60 to −5.57), T2 (−5.56 to 11.4), and T3 (11.41 to 206.24). FIB−4 T1 showed a decrease in Akkermansiaand an increase in Desulfovibrio. T2 had an increase in Victivallaceae, Clostridiaceae, and Desulfovibrio. T3 showed a decrease in Enterobacteriaceae, and an increase in Sutterella, Faecalibacterium, and Blautia. A relation between biochemical index changes of NAFLD/NASH (HSI and FIB−4) and gut microbiota changes were found. These observations highlight the importance of lifestyle intervention in the modulation of gut microbiota and the management of metabolic syndrome and its hepatic manifestations.

La disminución significativa y progresiva en el número de profesores permanentes en las facultades de Medicina (catedrático, profesor titular y profesor contratado doctor) es motivo de preocupación para la Conferencia Nacional de Decanos. Esta disminución se intensificará en la próxima década (2017-2026). Se jubilará el 43% del profesorado permanente: un 55% del profesorado vinculado de áreas clínicas, un 34% del profesorado no vinculado de áreas clínicas y un 32% del profesorado de áreas básicas. Este déficit es importante en el momento actual y en pocos años la situación será insostenible, especialmente en áreas clínicas. Este informe pone de manifiesto la necesidad inaplazable de adoptar medidas urgentes que palíen la situación actual y que prevengan un mal mayor. La formación de los futuros médicos, responsables inmediatos de salud de nuestra sociedad, depende en gran parte de la enseñanza teórica y práctica que se imparte en las facultades de Medicina, con la colaboración esencial de las instituciones sanitarias. Paradójicamente, a la vez que disminuye sustancialmente el número de profesores, aumenta exponencialmente el número de facultades de Medicina y el número de alumnos que se admiten cada año sin justificación académica ni sanitaria.

Los inhibidores de la PCSK9, disponibles desde el año 2015, son capaces de reducir la concentración de colesterol transportado en las lipoproteínas de baja densidad entre un 40-70% y, por consiguiente, disminuir el riesgo cardiovascular. Presentamos un caso en el que un episodio cardiovascular grave apareció al espaciar la administración del tratamiento hipolipidemiante; discutiremos la importancia de mantener una concentración baja de colesterol, para conseguir un mayor beneficio clínico según los últimos estudios publicados.

Las neumoconiosis son un grupo de enfermedades pulmonares intersticiales (EPI) debidas a la inhalación de polvos inorgánicos en concentraciones altas y, en su mayoría, relacionadas con la exposición laboral. Tienen un tiempo de latencia entre la exposición al polvo inorgánico y el inicio de las manifestaciones clínicas o su diagnóstico prolongado. Los síntomas habituales son, al igual que en otras EPID, la disnea y la tos seca. La prueba de imagen inicial recomendada es la radiografía de tórax; sin embargo, la tomografía computadorizada de alta resolución (TCAR) de tórax resulta más sensible y ofrece una mayor definición de las lesiones. Los hallazgos anatomopatológicos varían desde los nódulos silicóticos en la silicosis a la fibrosis intersticial en la asbestosis o el simple depósito de partículas de hierro en la siderosis. En la actualidad, una vez instaurada la enfermedad, no se dispone de tratamiento específico alguno que haya demostrado beneficio, y únicamente pueden instaurarse medidas de prevención a distintos niveles.

El síndrome antisintetasa (ASA) se caracteriza por manifestaciones clínicas como miositis, fiebre, manos de mecánico y enfermedad pulmonar intersticial (EPI) asociadas a la positividad ante anticuerpos antisintetasa. La presencia de EPI será la que, en gran medida, marcará la respuesta al tratamiento y el pronóstico.

Estimar la relación coste-utilidad de seis meses de tratamiento con apixaban (10 mg/12 h, siete primeros días; 5 mg/12 h después) para el primer evento de tromboembolismo venoso (TEV) y prevención de recurrencias frente a dabigatrán (150 mg/12 h) después de cinco días con heparina de bajo peso molecular (HBPM/dabigatrán) y frente a rivaroxaban (15 mg/12 h los 21 primeros días; después 20 mg/día). Se simuló con un modelo de Markov la evolución de la enfermedad en 1.000 pacientes adultos a lo largo de su vida. La eficacia se obtuvo de un metanálisis, calculándose los años de vida ganados (AVG) y años de vida ajustados por calidad (AVAC) obtenidos con las opciones terapéuticas evaluadas. Según la perspectiva del Sistema Nacional de Salud (SNS) se incluyeron los costes sanitarios directos. Los costes unitarios (€ de 2014) fueron obtenidos de la literatura y bases de datos nacionales. Se aplicó una tasa de descuento (3%) a costes y beneficios en salud. Se realizaron análisis de sensibilidad (AS) determinísticos y probabilístico. Al finalizar la simulación apixaban resultó una terapia más efectiva, 7,182 AVG y 5,865 AVAC, que HBPM/dabigatrán (7,162 AVG y 5,846 AVAC) y con menor coste total (13.374,70 € frente a 13.516,50 €). Igualmente frente a rivaroxaban (7,174 AVG y 5,857 AVAC y coste total 13.537,8 €). El AS probabilístico confirmó el dominio de apixaban. Apixaban fue una alternativa dominante frente a HBPM/dabigatrán y frente a rivaroxaban para el SNS en el tratamiento de TEV y prevención de sus recurrencias. Cost-utility analysis of a 6-month treatment of apixaban (10 mg/12 h, first 7 days; 5 mg/12 h, afterwards) for the treatment of the first event of venous thromboembolism (VTE) and prevention of recurrences, versus dabigatran (150 mg/12 h) after 5 days taking low molecular weight heparins (LMWH/dabigatran) and versus rivaroxaban (15 mg/12 h, the first 21 days; 20 mg/day, afterwards). The course of the disease of a 1,000 adult patients was modeled using a life-long Markov model. Efficacy was obtained from a meta-analysis, calculating life years gained (LYG) and quality adjusted life years (QALYs) obtained from the therapeutic options evaluated. Based on a Spanish National Health System (NHS) perspective, only direct medical costs were included. Unit costs (€, 2014) were obtained from literature review and national databases. A 3% discount rate was applied for health outcomes and costs. Several sensibility analyses (SA) were performed. Apixaban resulted the most effective therapy with 7.182 LYG and 5.865 QALYs, versus 7.162 LYG and 5.846 QALYs with LMWH/dabigatran and lower total cost (€13,374.70 vs €13,516.50). LYG and QALYs with rivaroxaban were 7.174 and 5.857 and a total cost of €13,537.80. Probabilistic SA confirmed dominance of apixaban versus LMWH/dabigatran and rivaroxaban. Apixaban versus LMWH/dabigatran and versus rivaroxaban was a dominant treatment for the NHS perspective for VTE treatment and prevention of recurrences.

Objetivo: Reflexionar desde el análisis de los datos del número de histerectomías laparoscópicas que puede realizar cada miembro de un servicio de ginecología de un hospital terciario sobre la conveniencia de limitar este procedimiento a un número limitado de profesionales.

The COVID-19 pandemic has posed a threat to hospital capacity due to the high number of admissions, which has led to the development of various strategies to release and create new hospital beds. Due to the importance of systemic corticosteroids in this disease, we assessed their efficacy in reducing the length of stay (LOS) in hospitals and compared the effect of 3 different corticosteroids on this outcome.

Cost-effectiveness analysis of a 6-month treatment of apixaban (10 mg/12h, first 7 days; 5 mg/12h afterwards) for the treatment of the first event of venous thromboembolism (VTE) and prevention of recurrences, versus low-molecular-weight heparins/vitamin K antagonists treatment (LMWH/VKA).

La protección mediante patentes a los medicamentos es limitada y, al expirar estos títulos de propiedad intelectual, entran en el mercado otros medicamentos copiados que compiten con los innovadores. Inicialmente estos fueron idénticos a los originales, los llamados medicamentos genéricos, pero, en los últimos años, a raíz de la irrupción de las terapias biológicas y la expiración de muchas de sus patentes han aparecido también los medicamentos biosimilares. Aunque no son copias exactas del original, al igual que los medicamentos genéricos, los medicamentos biosimilares tienen que demostrar equivalencia en calidad seguridad y eficacia respecto a los originales.

We assessed the effects of chronic nasal continuous positive airway pressure (CPAP) therapy on lung function in a series of unselected patients with overlap syndrome, and we determined whether there were differences in the response induced by CPAP between hypercapnic (PaCO 2 ≥ 45 mm Hg) and eucapnic patients with overlap syndrome. The study population included 55 unselected patients (48 men, mean age of 58.5 ± 10.5 years) with a concurrent diagnosis of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea-hypopnea syndrome (OSAHS) who had been referred to the Department of Pulmonology of our hospital over 2 consecutive years and in whom work-up studies resulted in the prescription of nasal CPAP therapy. An apnea-hypopnea index (AHI) greater than or equal to 10 in the cardiorespiratory polygraphy was required for the diagnosis of OSAHS. A forced expiratory volume in one second (FEV 1) less than 80% and FEV 1-forced vital capacity (FVC) ratio less than 70% of the reference values were required for the diagnosis of COPD. Control lung function studies and arterial blood gas measurements were performed at 6 and 18 months of CPAP therapy. These patients with overlap syndrome accounted for 28.5% of all patients with OSAHS treated with CPAP during the study period. The mean AHI was 37.3 ± 26.1 and the mean CPAP level 7.3 ± 1.3 cm H 2O. Thirty-three patients were hypercapnic (PaCO 2 ≥ 45 mm Hg) and 22 eucapnic. The hypercapnic group had higher AHI value (44.3 ± 26.9) than the eucapnic group (28.6 ± 21.9) ( P < 0.05). After 6 months of CPAP therapy, there were statistically significant increases in PaO 2, FEV 1, and FVC, accompanied by significant decreases in PaCO 2, serum bicarbonate levels, and alveolar-arterial oxygen difference. Response of overlap syndrome patients to CPAP therapy was superior in the hypercapnic group, particularly in relation to improvement of arterial blood gases. However, statistically significant differences in all parameters for the comparison between 6 and 18 months were not recorded.

Many patients with familial hypercholesterolaemia (FH) or in secondary prevention situations and with statin intolerance do not achieve LDL-C targets, and require treatment with PCSK9 inhibitors (iPCSK9) and ezetimibe. The case is presented on a patient with FH and total intolerance to statins. Treatment with iPCSK9 and ezetimibe failed to achieve her LDL-C target. A compound with red yeast rice derivatives containing 3mg of monacolin K was added, with good therapeutic compliance, and a very good control of LDL-C. The addition of red yeast rice derivatives containing low doses of monacolin K, together with IPCSK9 in patients with total intolerance to statins, may open a new path to obtain LDL-C targets in patients with high/very high cardiovascular risk.

Precisar la prevalencia de enfermos con fibrosis quística (FQ) diagnosticados en edades superiores a los 18 años y analizar sus características clínicas, genéticas y microbiológicas.

La sustitución grasa de las células miocárdicas es un proceso degenerativo que afecta en mayor medida al ventrículo derecho y se encuentra en el 50% de las personas ancianas. El problema se origina cuando esta degeneración se produce en grado masivo, planteando la necesidad de realizar el diagnóstico diferencial con otras enfermedades. Se presenta el caso de un paciente que falleció de forma súbita y en su autopsia se encontró esta dolencia como única explicación del desenlace.

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Abstract: Blast injuries after terrorist attacks are seen with increasing frequency worldwide. Thousands of victims were attended in the hospitals of Madrid, Spain, on March 11, 2004 after the bombing attacks against the commuter trains. Thirty-six patients were attended in our institution. Seventeen of them suffered from severe or life-threatening injuries, and 19 had mild injuries. The most common lesions were thoracic trauma and blast lung injury, acoustic trauma, and orbital and paranasal sinus fractures. Other findings were hepatic and splenic lacerations, and vertebral and limb fractures. Emergency radiology had an important role in the correct management of the victims. Prompt radiological diagnoses of these complex lesions are crucial to efficient treatment. Therefore, radiologists have to become familiar with the injury patterns and specific lesions caused by blast wave.

Introduction Bronchoalveolar lavage (BAL) is a fundamental technique in the diagnosis of different respiratory diseases including lung cancer. Tumor marker values can be determined in the BAL fluid, but controversy still exists about how to express the results.Objective The aim of this study was to determine the best method of expressing tumor markers in BAL, either referring to total proteins or volume of fluid recovered.Patients and Methods A prospective, randomized, non-blind study was carried out. Seventy-six patients (72 men and 4 women) diagnosed with lung cancer and 17 subjects without respiratory disease were included. BAL was performed in all patients and the fluid retrieved was divided into two fractions: a bronchiolar fraction (F0) and an alveolar fraction (F1). Five tumor markers: cytokeratin fragment 19 (CYFRA 21–1), squamous cell carcinoma antigen (SCC), tissue polypeptide antigen (TPA), tissue polypeptide-specific antigen (TPS) and neuron-specific enolase (NSE) as well as total protein were measured in both fractions. The concentrations were expressed in relation to the volume of BAL fluid recovered (ng or mU/mL) and in milligrams of total protein of lavage fluid (ng or mU/mg TP). The SPSS 11.01 software was used for statistical analysis. Mann-Whitney U test and ROC curves were developed when significant differences were found.Results We found significant differences in the CYFRA 21-1 values in the two BAL fractions and in both ways of expressing its concentration; in SCC in F1 expressed in ng/mg TP; in TPA in F0 expressed in mU/mg TP; in TPS in both fractions expressed in mU/mg TP, and in NSE in both fractions in ng/mg TP. The markers that best differentiated tumors from controls (ROC curves) were CYFRA 21-1 in F0 and NSE in both fractions in ng/mg TP.Conclusions Our study demonstrates that the concentrations of tumor markers in BAL expressed in relation to total protein were more effective than if expressed in mL of BAL fluid collected.

Patients with end-stage renal disease treated by hemodialysis with bioincompatible membranes are exposed during the dialysis period to acute effects on lung microcirculation, which may result in pulmonary fibrosis and diffusion defects in long-standing dialysis. To investigate the occurrence of these possible chronic pulmonary alterations, we determined lung function in patients with chronic renal failure not undergoing hemodialysis and in patients who had been receiving regular hemodialysis both for short and long periods of time. Forty-three patients divided into three groups were studied: 17 patients before dialysis with a mean (SD) creatinine clearance of 14.1 (6.8) ml/minl 1.73 m2, 10 patients receiving regular hemodialysis for a period of less than 12 months (mean 6.4 ± 3.5 months), and 16 patients receiving regular hemodialysis for more than 5 years (mean 8.3 ± 3.6 years). First-use bioincompatible cellulosic dialysis membranes were used in all the cases. The following parameters were recorded: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), total lung capacity (TLC), residual volume (RV), carbon monoxide transfer factor (TLCO), accesible lung volume (VA), carbon monoxide transfer factor/accesible lung volume (KCO—that is, TLCO/VA), and arterial blood gases. Patients receiving regular hemodialysis for more than 5 years showed significantly lower values of TLCOand KCOthan patients before dialysis and patients receiving regular hemodialysis for less than 12 months. Seventy-five percent of patients on long-term hemodialysis had markedly reduced TLCOor KCOvalues (below 80% of the reference value) as compared with 17% of patients before dialysis and 10% of patients dialyzed for less than 12 months (P<0.001). Differences among groups for the remaining parameters were not observed. In conclusion, patients undergoing long-term regular hemodialysis with a bioincompatible membrane showed a selective reduction in pulmonary diffusing capacity possibly due to chronic pulmonary fibrosis.

Background and study objective: The importance of tobacco smoking in the origin of sleep ventilatory abnormalities is disputed. The purpose of our study was to evaluate the influence of cigarette smoking behavior on the sleep respiratory alterations in a healthy population. Design and methods: We studied 38 healthy volunteers (21 M, 17 F; age 42 ± 12 years; BMI 23.7 ± 3.6 kg/m who were divided into two matched groups: current tobacco smokers (n = 18; over 10 pack-years) and nonsmokers (n = 20). All individuals underwent a single nocturnal domiciliary polygraphic study (Polygraphics CNS, Minneapolis, Minnesota). Apnea (AI), apnea-hypopnea (AHI), and desaturation (DI) indexes were defined according to conventional criteria. A nocturnal hypoxia index (NHI) was calculated as an index of the magnitude and duration of oxyhemoglobin desaturation during sleep. The mean transcutaneous oxygen saturation (SpO 2) of the first 60 seconds of oxymetric registration (subject supine and awake) was considered basal SpO 2. Venous carboxyhemoglobin (COHb) levels were measured (CO-Oximeter AVL-912, Basel, Switzerland) in all individuals before (22:00 h) and after (10:00 h) sleep. A correction factor of 0.9 x COHb was applied to the basal SpO 2 values to calculate the corrected basal SpO 2 (SpO 2 corr). Results: AI, AHI, and DI were not significantly different between smokers and nonsmokers. The smokers have significantly higher NHI than nonsmokers [median (25th percentile–75th percentile): 5.3 (0–39.7) vs. 0.5 (0–1.7); p = 0.017]. There were significant correlations (P < 0.05) in smokers between NHI and pack-years index, between NHI and COHb levels, and between current smoking intensity and COHb levels. As expected, smokers had higher COHb levels at 10:00 as well as at 22:00 hours. The Sp0 2 corr was significantly lower (p < 0.001) among smokers than nonsmokers (88.9 ± 3.3% vs. 94.7 ± 1.3%). In multiple regression analyses, AHI and DI showed a significant correlation (p = 0.02 and p = 0.05, respectively) with habitual snoring, and NHI with pack-years and BMI (p = 0.02 and p = 0.04, respectively). Conclusions: Cigarette smoking does not seem to be associated with increased apneic activity during sleep. However, it is associated with a decrease in nocturnal oxygen saturation.

Objective We aimed to assess the relationship between major air pollutants and the natural history and mortality of idiopathic pulmonary fibrosis (IPF).Methods We conducted a retrospective cohort study from 2013 to 2019 among 52 patients with IPF from the pneumology department of a tertiary hospital. According to their geocoded residential address, each patient was assigned a mean concentration of carbon monoxide (CO), nitrogen dioxide, particulate matter 2.5 and 10, ozone, and sulfur dioxide, as measured at a single surveillance station in central Madrid, Spain. We analyzed forced vital capacity (FVC), CO diffusing capacity, 6-minute walking test, degree of dyspnea, radiologic pattern, and signs of pulmonary hypertension in all patients.Results Patients’ mean age was 66 ± 10 years, and 79% were men. The mean predicted FVC was 78.9 ± 0.5%. Forty-two patients met the criteria for severe disease, and 18 patients died. Mortality was significantly associated with increased CO exposure (for each 0.1 mg/m2increase: odds ratio 2.45, 95% confidence interval 1.39–4.56). We observed no association between any of the other investigated contaminants and IPF mortality or severity.Conclusions Air pollution, specifically that caused by carbon monoxide, can increase mortality in patients with IPF.