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Sánchez-García S, Soto-Retes L, Chiner E, Cisneros C. [Remote visits for severe asthma patients after the COVID-19 pandemic: How to address the challenge?]. Rev Clin Esp 2023; 223:S0014-2565(23)00031-0. [PMID: 36777238 PMCID: PMC9894769 DOI: 10.1016/j.rce.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 02/05/2023]
Affiliation(s)
- S. Sánchez-García
- Servicio de Alergología, Hospital Infantil Universitario Niño Jesús, Madrid, España,Autor para correspondencia
| | - L. Soto-Retes
- Servicio de Alergología y Neumología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - E. Chiner
- Servicio de Neumología, Hospital Universitari San Juan d’Alacant, Alicante, Valencia, España
| | - C. Cisneros
- Servicio de Neumología, Hospital Universitario de la Princesa. Instituto de Investigación Biomédica La Princesa (IP), Madrid, España
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Cisneros-Serrano C, Rial MJ, Gómez-Bastero-Fernández A, Igea JM, Martínez-Meca A, Fernández-Lisón LC, López-Carrasco V, Villamañán-Bueno E, Plá-Martí MJ, Chiner E. Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration. Rev Clin Esp 2023; 223:154-164. [PMID: 36549642 DOI: 10.1016/j.rceng.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. MATERIALS AND METHODS This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. RESULTS One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. CONCLUSION Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.
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Affiliation(s)
- C Cisneros-Serrano
- Pulmonology Department, Hospital Universitario La Princesa, Madrid, Spain.
| | - M J Rial
- Allergy Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - J M Igea
- Clínica Alergoasma, Salamanca, Spain
| | - A Martínez-Meca
- Pulmonology Department Nurse, Hospital Universitario de La Princesa, Madrid, Spain
| | - L C Fernández-Lisón
- Hospital Pharmacy Department, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
| | - V López-Carrasco
- Allergy Department Nurse, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | | | - M J Plá-Martí
- Allergy Department Nurse, Hospital Universitario La Fe, Valencia, Spain
| | - E Chiner
- Pulmonology Department, Hospital Universitario San Juan d'Alacant, Alicante, Spain
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Sánchez-García S, Soto-Retes L, Chiner E, Cisneros C. Remote visits for severe asthma patients after the COVID-19 pandemic: how to address the challenge? Rev Clin Esp 2023; 223:188-191. [PMID: 36736728 PMCID: PMC9930084 DOI: 10.1016/j.rceng.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S Sánchez-García
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - L Soto-Retes
- Allergy and Pneumology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Autonomous University of Barcelona (UAB), Barcelona, Spain.
| | - E Chiner
- Pneumology Section, Hospital Universitari San Juan d'Alacant, Alicante, Valencia, Spain
| | - C Cisneros
- Pulmonology Department, Hospital Universitario de la Princesa, Instituto de Investigación Biomédica La Princesa (IP), Madrid, Spain
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Cisneros-Serrano C, Rial M, Gómez-Bastero-Fernández A, Igea J, Martínez-Meca A, Fernández-Lisón L, López-Carrasco V, Villamañán-Bueno E, Plá-Martí M, Chiner E. Consenso multidisciplinar español sobre las características de los pacientes con asma grave en tratamiento con biológicos susceptibles de pasar a tratamiento domiciliario. Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Martinez-Garcia MA, Oscullo G, Ponce S, Pastor E, Orosa B, Catalán P, Martinez A, Hernandez L, Muriel A, Chiner E, Vigil L, Carmona C, Mayos M, Garcia-Ortega A, Gomez-Olivas JD, Beauperthuy T, Bekki A, Gozal D. Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials. Sleep Med 2021; 89:71-77. [PMID: 34915264 DOI: 10.1016/j.sleep.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/31/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old. METHODS Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. RESULTS From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. CONCLUSIONS The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.
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Affiliation(s)
- M A Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - G Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Ponce
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - E Pastor
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - B Orosa
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - P Catalán
- Internal Medicine Department, Hospital General de Requena, Valencia, Spain
| | - A Martinez
- Pneumology Department, Hospital General Universitario de Castellón, Spain
| | - L Hernandez
- Pneumology Department, Hospital General Universitario de Alicante, Valencia, Spain
| | - A Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Nursing Department, Alcala University, Madrid, Spain
| | - E Chiner
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - L Vigil
- Pneumology Department, Hospital de Sabadell, Corporació Sanitaria Parc Tauli, Barcelona, Spain
| | - C Carmona
- Pneumology Department, Hospital Universitario Virgen Del Rocio, Sevilla, Spain
| | - M Mayos
- Pneumology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - A Garcia-Ortega
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Beauperthuy
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Bekki
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D Gozal
- University of Missouri School of Medicine, Department of Child Health, Columbia, MO, USA
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Nagore E, Martinez-Garcia MA, Gomez-Olivas JD, Manrique-Silva E, Martorell A, Bañuls J, Carrera C, Ortiz P, Gardeazabal J, Boada A, de Eusebio E, Chiner E, Gonzalez C, Pérez-Gil A, Cullen D, Formigón M, de Unamuno B, Navarro-Soriano C, Muriel A, Gozal D. Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: an observational multicentric study in 443 patients with melanoma. Br J Dermatol 2021; 185:756-763. [PMID: 33453061 DOI: 10.1111/bjd.19813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/01/2020] [Accepted: 01/11/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis. OBJECTIVES To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma. METHODS We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded. RESULTS The mean (SD) age of the patients was 55·98 (15·3) years and 50·6% were male. The median Breslow thickness was 0·85 mm. In total, 48 (10·8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2·6, 95% confidence interval (CI) 1·4-4·9; P = 0·004)] and > 4 mm (OR 3·6, 95% CI 1·7-7·9; P = 0·001), TMR > 5 per mm2 (OR 4·5, 95% CI 1·4-13·7; P = 0·009), SLN involvement (OR 2·3, 95% CI 1-5·7; P = 0·038) and tumour stages III-IV (vs. I-II) (OR 3·4, 95% CI 1·6-7·4; P = 0·002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness. CONCLUSIONS T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.
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Affiliation(s)
- E Nagore
- Dermatology Department, Instituto Valenciano de Oncologia, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - M A Martinez-Garcia
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain.,CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - E Manrique-Silva
- Dermatology Department, Instituto Valenciano de Oncologia, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - A Martorell
- Dermatology Department, Hospital de Manises, Valencia, Spain
| | - J Bañuls
- Dermatology Department, Hospital General de Alicante, Alicante, Spain
| | - C Carrera
- Dermatology Department, Hospital Clinic, Barcelona, Spain
| | - P Ortiz
- Dermatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - J Gardeazabal
- Dermatology Department, Hospital de Cruces, Bilbao, Spain
| | - A Boada
- Dermatology Department, Hospital Germans Trials i Pujol, Barcelona, Spain
| | - E de Eusebio
- Dermatology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - E Chiner
- Pneumology Department, Hospital San Juan de Alicante, Spain
| | - C Gonzalez
- Dermatology Department, Hospital d Getafe, Madrid, Spain
| | - A Pérez-Gil
- Dermatology Department, Hospital de Valme, Seville, Spain
| | - D Cullen
- Dermatology Department, Fundación Jiménez Diaz, Madrid, Spain
| | - M Formigón
- Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - B de Unamuno
- Dermatology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - C Navarro-Soriano
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - A Muriel
- Biostatistic Unit, Hospital Ramón y Cajal. IRYCIS, CIBERESP, Nursery Department and Physiotherapy, Alcalá University, Madrid, Spain
| | - D Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA
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Andreu AL, Chiner E, Sancho-Chust JN, Pastor E, Llombart M, Gomez-Merino E, Senent C, Barbé F. Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea. Eur Respir J 2011; 39:305-12. [PMID: 21719490 DOI: 10.1183/09031936.00013311] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS). Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital follow-up; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C). 66 patients were included (22 per branch), 83% were males, aged mean±sd 52±10 yrs, body mass index 34±7kg·m(-2), apnoea/hypopnoea index 43±20 h(-1), CPAP pressure 8±2 cmH(2)O, with no between-group differences. Clinical response showed an ESS of mean±sd 15±3 to 6±4, a FOSQ of 16±3 to 18±2, symptoms of 43±7 to 25±7, and activity of 37±11 to 25±8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A €590±43, group B €894±11 and group C €644±93 (p<0.001). In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.
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Affiliation(s)
- A L Andreu
- Secció de Pneumologia, Hospital Universitari Sant Joan d'Alacant, Ctra. Alacant-València s/n. CP 03550, Sant Joan d'Alacant, Spain
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Chiner E, Sancho-Chust J, Llombart M, Senent C, Camarasa A, Signes-Costa J. Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure. Respiration 2010; 80:321-6. [DOI: 10.1159/000314074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/02/2010] [Indexed: 11/19/2022] Open
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Sancho JN, Chiner E, Camarasa A. [Recurrent lithoptysis in a patient with bronchiectasis]. Arch Bronconeumol 2009; 45:157-8. [PMID: 19286118 DOI: 10.1016/j.arbres.2008.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 04/16/2008] [Accepted: 04/26/2008] [Indexed: 10/21/2022]
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Sancho-Chust JN, Chiner E, Camarasa A, Llombart M. Recent-onset bronchial asthma as a manifestation of systemic mastocytosis. J Investig Allergol Clin Immunol 2009; 19:513-515. [PMID: 20128434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- J N Sancho-Chust
- Pulmonology Section, Hospital Universitari Sant Joan d'Alacant, Alacant, Spain
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Senent C, Betlloch I, Chiner E, Llombart M, Moragón M. Tuberculous empyema necessitatis. A rare cause of cutaneous abscess in the XXI century. Dermatol Online J 2008; 14:11. [PMID: 18627713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
A 24-year-old Moroccan man was admitted to the hospital because of a tumor of the abdominal wall, fever, and purulent sputum. Imaging tests showed the presence of a pleural effusion and tumor in the right abdominal wall. The organized collection of liquid in the mass was contiguous with the thoracic collection and that of the subphrenic space. Thoracocentesis removed purulent material suggestive of empyema. Cultures and polymerase chain reaction (PCR) tests confirmed the diagnosis of tuberculous empyema. Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Various infectious etiologies may be responsible. Tuberculous empyema necessitatis is a rare complication of tuberculosis (TB); our case is even more unusual because this condition presented as an abdominal wall abcess and the patient was immunocompetent. His only predisposing factors were his country of origin, where there is a high prevalence of TB and the delay in diagnosis due to a lack of access to health care.
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Affiliation(s)
- C Senent
- Servicio de Neumología. Hospital San Juan de Alicante
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Senent C, Betlloch I, Chiner E, Llombart M, Moragón M. Tuberculous empyema necessitatis. A rare cause of cutaneous abscess in the XXI century. Dermatol Online J 2008. [DOI: 10.5070/d34q535204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Chiner E, Llombart M, Signes-Costa J, Andreu AL, Gómez-Merino E, Pastor E, Arriero JM. [Description of a new procedure for fiberoptic bronchoscopy during noninvasive ventilation through a nasal mask in patients with acute respiratory failure]. Arch Bronconeumol 2006; 41:698-701. [PMID: 16373046 DOI: 10.1016/s1579-2129(06)60337-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A new method is described for performing oral fiberoptic bronchoscopy during noninvasive ventilation through the nose. The technique was successfully applied in 2 patients suffering from acute respiratory failure. The bronchoscope was inserted through a glove finger fitted into a mouth guard. The system works as a valve and does not affect performance of the bronchoscopy procedure or the pressures administered during noninvasive ventilation. We conclude that the procedure has potential advantages over bronchoscopy through the nose and face masks or helmets, particularly for the management of secretions or in special clinical circumstances (hemoptysis or presence of foreign bodies). This method can be used to substitute for or complement other bronchoscopy techniques performed with other interfaces.
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Affiliation(s)
- E Chiner
- Sección de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
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Pastor E, Andreu AL, Chiner E. [Acute pneumonitis and adult respiratory distress syndrome after subcutaneous injection of liquid silicone]. Arch Bronconeumol 2006; 41:702-3. [PMID: 16373047 DOI: 10.1016/s1579-2129(06)60338-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Díez-García MJ, Andreu AL, Chiner E. Bronchopneumonia Due to Nocardia asteroides in a Man With Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2005; 41:642-3. [PMID: 16324608 DOI: 10.1016/s1579-2129(06)60303-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Llombart M, Chiner E, Signes-Costa J, Arriero JM, Gómez-Merino E, Andreu A, Pastor E, Ortiz de la Tabla V. [Thoracic actinomycosis: an old disorder with new clinical manifestations]. An Med Interna 2005; 22:124-9. [PMID: 15839821 DOI: 10.4321/s0212-71992005000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three cases of thoracic actinomycosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empyema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are thoroughly analyzed.
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Affiliation(s)
- M Llombart
- Servicios de Neumología, Hospital Universitari Sant Joan d'Alacant, Alicante.
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Calpe J, Chiner E, Marín J, Armero V, Calpe A. [Tuberculosis epidemiology in area 15 of the Spanish autonomous community of Valencia: evolution from 1987 through 2001]. Arch Bronconeumol 2005; 41:118-24. [PMID: 15766463 DOI: 10.1016/s1579-2129(06)60411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe the evolution of tuberculosis epidemiology in Area 15 of the Autonomous Community of Valencia. MATERIAL AND METHODS Cases of tuberculosis were identified by active case finding in Area 15 from January 1987 through December 2001. Clinical and epidemiological data were extracted from case records and a patient interview. RESULTS Four hundred seventy-six diagnosed cases of mycobacterial infection were identified (459 tuberculosis, 16 atypical, and 1 mixed); 423 tuberculosis patients were residents of Area 15. The mean annual incidence rate was 24.6/100 000 population, representing a rate decrease of 41.5% from 1990. The most frequent risk factors were smoking (38%), alcoholism (20%), human immunodeficiency virus (HIV) infection (18%), and contact with a tuberculosis patient (14%). The site of tuberculosis involvement was the lung in 61% (49% bacillus positive, with a nonsignificant trend to decrease over time), nonpulmonary in 26%, and mixed in 13%. The radiographic pattern observed most often was pulmonary infiltrates (67%), and lower lobe involvement tended to increase over time. Diagnosis was by acid-fact bacillus stain for 77%, clinical picture for 16%, and histological for 7%. Isoniazid resistance was detected in 1.5% and rifampicin resistance in 0.3%. Patients were hospitalized during diagnosis in 79% of cases; the mean stay was 18 days. CONCLUSIONS The incidence of tuberculosis has decreased in spite of the HIV pandemic. Risk factors have not changed, bacteriological diagnosis has improved, and the location of pulmonary infiltrates has changed. No influence of immigration on the incidence rate of tuberculosis has been detected to date.
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Affiliation(s)
- Jl Calpe
- Servicio de Neumología, Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
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Calpe J, Chiner E, Marín J, Armero V, Calpe A. Evolución de las características epidemiológicas de la tuberculosis en el Área 15 de la Comunidad Valenciana en el período 1987-2001. Arch Bronconeumol 2005. [DOI: 10.1157/13071581] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pastor E, Andreu A, Llombart M, Chiner E. [Pneumonia as a presentation of an endobronchial chondroma]. An Med Interna 2004; 21:565-6. [PMID: 15538910 DOI: 10.4321/s0212-71992004001100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Calpe JL, Chiner E, Marín-Pardo J, Pardo JM, Calpe A, Armero V. Impact of the human immunodeficiency virus on the epidemiology of tuberculosis in area 15 of the Valencian community in Spain. Int J Tuberc Lung Dis 2004; 8:1204-12. [PMID: 15527152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
SETTING Area 15 in Valencia. OBJECTIVES To describe the epidemiology (1987-2001) of tuberculosis (TB) in human immunodeficiency virus (HIV) patients. METHODS Study of annual incidence, age distribution, excess cases attributed to HIV, etiological risk fraction (ERF), population attributable fraction (PAF) and f factor. RESULTS Of 476 cases diagnosed, 459 were TB, 16 environmental and one mixed; 76% of environmental cases were HIV-positive (P < 0.001). There was a mean annual TB incidence of 24.6/100000, with an annual reduction of 4%. Seventy-three patients were HIV coinfected (16%) (mean incidence 3834/100 000 seropositives). The principal risk factor was drug use (59%) for HIV+ and contact with TB for HIV-. We found no difference in pulmonary or extra-pulmonary location between groups, contrary to mixed cases (P < 0.001). In HIV+ there was a lower frequency of infiltrates (P < 0.001) and cavitation (P < 0.01), and a higher frequency of adenitis (P < 0.001), miliary or nodular pattern and normal X-ray (P < 0.001). Seropositives had a 174 times higher probability of developing TB. The mean ERF attributed to HIV was 99%, the PAF was 16% and the f factor was 1.19. Highly active antiretroviral therapy (HAART) reduced the risk of TB in HIV+ by 80%. CONCLUSIONS TB has continued its decline, although HIV generated an excess of cases in the 1990s. HAART has reduced the TB risk in HIV+ and possibly the overall rate of TB.
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Affiliation(s)
- J L Calpe
- Pneumology Service, Hospital Marina Baixa, Alicante 03570, Spain.
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Andreu AL, Chiner E, Gómez Merino E, Signes-Costa J. [Pleural effusion as a manifestation of ovarian hyperstimulation syndrome, after treatment with triptoreline for uterus myomata]. An Med Interna 2004; 21:308-9. [PMID: 15283650 DOI: 10.4321/s0212-71992004000600014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Chiner E, Signes-Costa J, Andreu AL, Andreu L. [Mycoplasma pneumoniae pneumonia: and uncommon cause of adult respiratory distress syndrome]. An Med Interna 2003; 20:597-8. [PMID: 14624660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Jover F, Chiner E, Arriero JM, Signes-Costa J, Marco J, Izura V. [Acute respiratory insufficiency as onset form of Lambert-Eaton's syndrome associated with pulmonary small cell carcinoma]. An Med Interna 2002; 19:243-5. [PMID: 12108000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The Lambert-Eaton myasthenic syndrome is a rare disorder of neuromuscular transmission, usually presenting as a paraneoplastic process associated with a small cell lung cancer. Recently, respiratory muscular impairment has been described in these patients. Acute respiratory failure as a presenting symptom has been reported in few cases. We present a case of acute ventilatory failure as the first manifestation of Lambert-Eaton myasthenic syndrome associated with small cell lung cancer and discuss the main features of this disease, including its treatment. The Lambert-Eaton myasthenic syndrome should be considered in cases of unexplained acute respiratory failure and clinical evidence of neoplasic disease. We thought that electromyographic studies could reveal the real involvement of respiratory muscles, including diaphragm, in this condition.
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Affiliation(s)
- F Jover
- Servicio de Medicina Interna, Neumología, Hospital Clínico Universitario de San Juan, Alicante
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Gómez-Merino E, Chiner E, Signes-Costa J, Arriero JM, Zaragozí MV, Onrubia JA, Mayol MJ. Pulmonary dirofilariasis mimicking lung cancer. Monaldi Arch Chest Dis 2002; 57:33-4. [PMID: 12174700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
We describe the case of a 30-year-old asymptomatic farmer who underwent a pulmonary segmentectomy due to the casual finding of a pulmonary nodule in preoperative chest radiography. As bronchoscopic samples rule out mycobacterium infection and malignancy, surgery could have been avoided with the use of serological tests and radiographic follow-up based on epidemiology of dirofilariasis in our country.
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Affiliation(s)
- E Gómez-Merino
- Respiratory and Pathology Departments, Sección de Neumología, Hospital Universitari Sant Joan d'Alacant, Carretera Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain.
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Calpe JL, Chiner E, Marín J, Martínez C, López MM, Sánchez E. [Tuberculosis notification from 1987 to 1999 for the public health area of the community of Valencia (Spain)]. Arch Bronconeumol 2001; 37:417-23. [PMID: 11734122 DOI: 10.1016/s0300-2896(01)75111-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Under notification of tuberculosis (TB) is common worldwide but has hardly been studied in Spain. The objective of this study was to determine how many cases of TB are reported in our health care area. MATERIAL AND METHOD Between 1987 and 1999 we carried out a direct study of the incidence and reporting of TB cases in our area (106,632 inhabitants on the census). Cases were taken from mandatory notification, pathology and bacteriology files and were then reviewed. RESULTS Of the 410 TB cases diagnosed, 378 were residents of the area (annual incidence: 27/100,000 inhabitants), 223 of whom were reported (54%). Forty-eight patients were under 15 years of age. Sixty-seven percent of the pediatric cases and 53% of the adult cases were reported (n.s.). Of the 78 cases with HIV co-infection, only 32% were reported, in contrast with 60% of HIV-negative cases (p < 0.001). Of the 300 cases with pulmonary involvement, 56% were reported, versus 50% of those with exclusively extrapulmonary involvement (n.s.). For the 149 with positive Ziehl-Neelsen stain, 61% were reported, in contrast with 51% of those who were smear negative (n.s.). Diagnosis was based on clinical signs in 65 cases (16%), 51% of which were reported, versus 55% of those in which diagnosis was based on bacteriology or histology consistent with TB (n.s.). Overall under notification tended to decrease during the study period (r = 0.73, p < 0.005). Under notification also tended to decrease for patients with pulmonary involvement (r = 0.83, p < 0.0001) and for those with positive Ziehl-Neelsen staining of sputum (r = 0.79, p< 0.001). Likewise, under notification also decreased for HIV negative patients (r = 0.74, p < 0.02) but not significantly so for HIV positive patients r = 0.44, n.s.). CONCLUSIONS Direct quantification of cases revealed a significant degree of under notification that is tending to decrease. Under notification is greatest for HIV-positive patients and is not changing. No differences were seen for smear positive and smear negative patients, by pulmonary or extra-pulmonary involvement, for clinical versus laboratory diagnosis, or for patients who were younger or older than 15 years of age. Reporting should be improved so that measures to decrease the incidence of TB can be taken.
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Affiliation(s)
- J L Calpe
- Sección de Neumología, Hospital Marina Baixa, Alicante.
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Arriero JM, Chiner E, Signes-Costa J, Marco J, Cañizares R, Mayol MJ, Onrubia JA. Chronic alveolar consolidation and watery sputum in an elderly woman. Respiration 2001; 67:693-5. [PMID: 11124656 DOI: 10.1159/000056303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- J M Arriero
- Respiratory, University Hospital of San Juan de Alicante, Spain.
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Abstract
A 52-yr-old man with a residual phase of schizophrenia developed sleep apnoea-hypopnoea syndrome (SAHS). After five days of continuous positive airway pressure (CPAP) treatment, the patient developed an aggressive mood with incoherence, prominent hallucinations and agitation, and attempted to hit his relatives. He was finally admitted to the hospital with an acute psychotic episode. Withdrawal of CPAP, and neuroleptic treatment controlled the episode, and clinical symptoms of SAHS reappeared 10 days later. Schizophrenia associated to sleep apnoea-hypopnoea syndrome has rarely been reported, but, to the authors' knowledge, the induction of a psychotic episode by continuous positive airway pressure treatment in a patient with sleep apnoea-hypopnoea syndrome and coexisting schizophrenia has never been previously reported.
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Affiliation(s)
- E Chiner
- Pneumology Section, Hospital Universitari Sant Joan d'Alacant, Spain
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Arriero J, Signes-Costa J, Chiner E, Marco J. Spontaneous remission of pulmonary and splenic lesions in sarcoidosis. Radiography (Lond) 2000. [DOI: 10.1053/radi.2000.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arriero JM, Chiner E, Signes-Costa J. [Treatment of tracheal stenosis with a new self-expanding metal prosthesis with "shape memory"]. Arch Bronconeumol 2000; 36:290. [PMID: 10916669 DOI: 10.1016/s0300-2896(15)30170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chiner E, Signes-Costa J, Arriero JM, Marco J, Fuentes I, Sergado A. Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies? Thorax 1999; 54:968-71. [PMID: 10525553 PMCID: PMC1745404 DOI: 10.1136/thx.54.11.968] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Polysomnography (PSG) is currently the "gold standard" for the diagnosis of the sleep apnoea hypopnoea syndrome (SAHS). Nocturnal oximetry (NO) has been used with contradictory results. A prospective study was performed to determine the accuracy of NO as a diagnostic tool and to evaluate the reduction in the number of PSGs if the diagnosis of SAHS had been established by this method. METHODS Two hundred and seventy five patients with a clinical suspicion of SAHS were admitted to undergo, in the same night, full PSG and NO. Desaturation was defined as a fall in the haemoglobin saturation level (SaO(2)) to lower than 4% from the baseline level and an oxygen desaturation index per hour (ODI) was obtained in each patient with three cut off points: >/= 5 (ODI-5), >/= 10 (ODI-10), and >/= 15 (ODI-15). RESULTS SAHS was diagnosed in 216 patients (194 men). After withdrawing patients with abnormal lung function (forced expiratory volume in one second (FEV(1)) lower than 80% predicted), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV) of NO were: ODI-5 (80%, 89%, 97%, 48%); ODI-10 (71%, 93%, 97%, 42%); ODI-15 (63%, 96%, 99%, 38%). The accuracy for each ODI was 0.81, 0.75, and 0.70, respectively. If NO had been considered as a diagnostic tool and PSG had been performed only in patients with a negative NO (false negative and true negative) and those with a positive NO and abnormal pulmonary function tests, 135/275 (ODI-5), 156/275 (ODI-10), and 170/275 (ODI-15) PSGs would have been performed, a reduction of 140, 119, and 105, respectively. CONCLUSION Nocturnal oximetry in patients with suspected SAHS and normal spirometric values permits the institution of therapeutic measures in most patients.
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Affiliation(s)
- E Chiner
- Sección de Neumología, Hospital Universitario San Juan de Alicante, Carretera Alicante-Valencia s/n, 03550 San Juan de Alicante, Spain
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Chiner E, Arriero JM, Signes-Costa J, Marco J, Fuentes I. [Validation of the Spanish version of the Epworth Sleepiness Scale in patients with a sleep apnea syndrome]. Arch Bronconeumol 1999; 35:422-7. [PMID: 10596338 DOI: 10.1016/s0300-2896(15)30037-5] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A Spanish version of the Epworth Sleepiness Scale (ESS-Sp) was developed by translation, back-translation, formal discussion, and a meeting of researchers with a group of patients with sleep apnea syndrome (SAS). The translated questionnaire was then tested in 345 patients, 275 with SAS at various levels of severity and 70 without SAS. Significant differences existed between the two groups as to age (53 +/- 11 years versus 47 +/- 13, p < 0.001) and BMI (32 +/- 5 versus 29.5 +/- 5, p < 0.001). Patients with SAS had significantly higher scores (14 +/- 5) than did those without SAS (10 +/- 5) (p < 0.001). Reproducibility was tested in 146 patients (113 SAS and 33 non-SAS), with no significant differences found among patients with SAS (14.9 +/- 5 versus 14.2 +/- 5, p = n.s.); significant differences in BMI were found, however, among the 33 non-SAS patients (12 +/- 5 versus 10 +/- 5, p < 0.01). Total scores and individual item scores were related in both groups. Likewise, each item was related to total score in patients with SAS. Sensitivity to post-treatment changes was assessed in 77 SAS patients, with initial scores of 16 +/- 4 seen to decrease to 4 +/- 3 after continuous positive airway pressure. ESS-Sp scores over 10 were recorded for 85% of patients with SAS: 78% of those with mild SAS, 85% of those with moderate disease and 92% of those whose SAS was severe. Significant inter-group differences were found upon applying a test of variance (p < 0.001). Differences continued to be detected when multiple correlations were looked for, with differences increasing with severity. SAS patients with ESS-Sp level one scores (< 10) had lower apnea-hypopnea indices (AHI) (35 +/- 18 versus 42 +/- 20, p < 0.05), lower desaturation levels (21 +/- 21 versus 34 +/- 28, p < 0.01) and higher minimum saturation (80 +/- 10 versus 75 +/- 12, p < 0.05), with no differences in age or BMI. A significant correlation was found between ESS-Sp score and respiratory variables recorded during polysomnography: AHI, r = 0.23 (p < 0.001); percent time in apnea-hypopnea, r = 0.18 (p < 0.01); desaturation index, r = 0.27 (p < 0.01) and minimum saturation (r = -0.14, p < 0.05). We conclude that the Spanish version of the ESS is equivalent to the original, is reproducible in patients with SAS, sensitive to post-treatment changes and seems to discriminate level of severity, showing correlation with polysomnograph variables.
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Affiliation(s)
- E Chiner
- Sección de Neumología, Hospital Universitari Sant Joan d'Alacant
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Chiner E, Arriero JM, Signes-Costa J, Marco J, Corral J, Gomez-Esparrago A, Ortiz de la Tabla V, Martin C. Corynebacterium pseudodiphtheriticum pneumonia in an immunocompetent patient. Monaldi Arch Chest Dis 1999; 54:325-7. [PMID: 10546474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Corynebacterium pseudodiphtheriticum is a coryneform and diphtheromorphic bacteria rarely found as a cause of pneumonia in immunocompetent hosts. A case of an immunocompetent patient with C. pseudodiphtheriticum pneumonia is presented. This infection responded well to initial empirical treatment with cefotaxime. Very few cases of pneumonia associated with C. pseudodiphtheriticum have been described in the medical literature, this organism mainly being found in immunocompromised hosts. We report a case of pneumonia in an immunocompetent patient in which C. pseudodiphtheriticum was the only micro-organism isolated.
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Affiliation(s)
- E Chiner
- Dept of Pulmonary Diseases, University Hospital of San Juan de Alicante, Spain
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Arriero JM, Chiner E, Marco J, Mayol MJ, Serna M. Simultaneous obstructing and pseudomembranous necrotizing tracheobronchitis due to Aspergillus flavus. Clin Infect Dis 1998; 26:1464-5. [PMID: 9636883 DOI: 10.1086/517666] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- J M Arriero
- Pneumology Section, Hospital Universitario San Juan, Alicante, Spain
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Arriero JM, Pujalte E, Chiner E. [Malignant pheochromocytoma: one of the causes of lung metastasis with prolonged survival]. Arch Bronconeumol 1998; 34:272-3. [PMID: 9656071 DOI: 10.1016/s0300-2896(15)30441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chiner E, Blanquer J, Arriero JM, Marco J. [Obstructive sleep apnea syndrome in the Community of Valencia: current situation, study of needs and future prospects]. Arch Bronconeumol 1998; 34:177-83. [PMID: 9611651 DOI: 10.1016/s0300-2896(15)30449-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To analyze the infrastructure needs for diagnosing sleep apnea syndrome (SAS) in the Community of Valencia, we studied available resources and the diagnostic approaches to SAS in departments of pneumology and neurophysiology in 23 of the 25 public hospitals by means of a telephone interview. Only 52% of pneumology departments and 56% of neurophysiology departments studied SAS at any level. Level I study (conventional polysomnography) was performed by 42% of the pneumology departments and 100% of the neurophysiology departments. The remaining pneumology units used nighttime oximetry (a level IV technique). A special unit and trained personnel were available at 40% of hospitals. Home studies were performed by only 17%. Although 2,000 studies are performed annually, only 1,100 are level I and large interdepartmental differences were detected. The average waiting period was 16 months. Relations between pneumology and neurophysiology units were few and only one hospital took an interdisciplinary approach. The ratio of polysomnographs to inhabitants was 0.52/250,000 and the prevalence of nasal continuous positive airway pressure treatment was 36/100,000, lower than in other communities. We conclude that Valencia is understaffed and under-equipped, and that in some cases resources are under-used. Interdisciplinary approaches are scarcely used by the various specialists involved and the waiting lists for diagnostic tests required for prescribing empirical treatment are long. To attend the approximately 100,000 SAS patients estimated to reside in Valencia, it would be necessary to have 14 polysomnograph devices rather than the 8 available now, as well as to increase staff to meet demand and shorten waiting lists.
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Affiliation(s)
- E Chiner
- Sección de Neumología, Hospital Universitari Sant Joan d'Alacant, Alicante-Valencia
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Calpe JL, Chiner E, Sánchez E, Armero V, Puigcerver MT, Carbonell C, Vilar A. [Microepidemics of tuberculosis; apropos of 2 school outbreaks in the area 15 of the Valencia community]. Arch Bronconeumol 1997; 33:566-71. [PMID: 9508472 DOI: 10.1016/s0300-2896(15)30514-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Schools are settings with high concentrations of young people with little exposure to Mycobacterium tuberculosis and greater risk of developing disease when infection occurs as the result of sporadic localized outbreaks. We studied two outbreaks in two elementary schools (A and B) after two cases of bacilliferous pulmonary tuberculosis were detected in teachers in 1990 and 1994. Contacts were trace din school A by the primary care physician and in school B by the pneumologist and public health authorities. Contacts were classified as belonging to the risk group (RG) or the low risk group (LRG). The RG was composed of 187 contacts in school A and 59 in school B. Individuals in the LRG numbered 429 and 116 respectively. Mantoux positives numbered 108 in the RG and 45 in the LRG in school A (p < 0.001). In school B 50 RG individuals and 29 LRG individuals were positive (p < 0.001). The proportion of Mantoux positives was greater in the RG of school B than in the RG of school A (p < 0.01), probably owing to longer time of evolution of disease and possible laryngeal involvement in the index case. Likewise, tuberculin positives were fewer in the LRG of school A than in the LRG of school B (p < 0.001), owing to the small size of the LRG in school A. Thirteen cases of tuberculosis were seen in school A, six of which called for drug prophylaxis after contacts were traced. The nature of the index case and the conditions of exposure are both important in such outbreaks, demonstrating the need to act appropriately to trace contacts, preferably under the supervision of a pneumologists.
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Affiliation(s)
- J L Calpe
- Seccione de Neumología, Hospital de la Marina Baixa, Alicante
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Larramendi CH, Chiner E, Calpe JL, Puigcerver MT. Comparative study of inhaled amiloride and inhaled furosemide in exercise-induced asthma. Allergol Immunopathol (Madr) 1997; 25:85-90. [PMID: 9150838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Certain diuretics such as furosemide, when inhaled, have been found to be useful in preventing Exercise-Induced Asthma (EIA). STUDY OBJECTIVE To assess the possible preventive effect of inhaled amiloride in EIA. DESIGN A double blind, randomized, cross-over study comparing the effect of inhaled amiloride, inhaled furosemide and placebo in EIA. PATIENTS Sixteen asthmatic patients (8 males and 8 females) with an average age of 21 years (range 9-31) who presented a FEV1 decrease of over 15% in a previous free-running exercise test. INTERVENTIONS Solutions were inhaled with a Hudson nebulizer connected to an oxygen source in different days before exercise testing. A Vitalograph Compact (Ohmeda, England) spirometer was used and FEV1 was obtained at baseline, three minutes after solution inhalation, immediately after exercise and then every 5 min. until 20 minutes post-exercise. The changes in FEV1 percentages (FEV1%) and the mean FEV1 decreases expressed as percentages for each solution were compared. RESULTS Inhaled furosemide diminished the fall in the FEV1 at every time after exercise. The maximum decrease in mean FEV1 was at 5 minutes post-exercise and was 11 +/- 7% with furosemide, 24 +/- 14% (p < 0.01) with amiloride and 19 +/- 12% (p < 0.05) with placebo. Amiloride administration resulted in a slight but significative increase in the FEV1 fall (p < 0.01 when compared with placebo). CONCLUSIONS Amiloride is not useful to protect EIA whereas Furosemide does it. These differences results may be related to the differents mechanisms of action of the two diuretics.
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Affiliation(s)
- C H Larramendi
- Seccions d'allèrgia i pneumologia, Hospital de la Marina Baixa, La Vila Joiosa (Alacant), Spain
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Abstract
OBJECTIVE To evaluate the presence of endobronchial tuberculosis in HIV-infected patients. METHODS Review of the clinical records of HIV-infected patients in whom diagnostic bronchoscopy was performed because of pulmonary signs or symptoms during a 3-year period. RESULTS Seventy bronchoscopies were performed in 59 HIV-infected patients. tuberculosis was diagnosed in 25 patients, of whom six showed endobronchial tuberculosis. The most noteworthy radiological finding was mediastinal and/or hilar lymphadenopathy in five patients, occasionally associated with chest miliary infiltrates (in one), or a small pleural effusion (in two). Chest radiograph was normal in one case. The endoscopic findings were hyperaemia in five, caseating bronchial masses in four, or protrusion of extratracheal lymph nodes (broad, thickened carina and patchy bronchial lesions) in three out of the six patients. Mycobacterium tuberculosis infection was confirmed by smear and culture from bronchial aspirate, bronchoalveolar lavage or bronchial biopsies. In three cases the diagnosis was confirmed by transcarinal needle mediastinal puncture aspiration. Tuberculosis was the first opportunistic pulmonary infection in every case. The clinical course with standard treatment was satisfactory in all cases with no bronchial sequelae. CONCLUSION Endobronchial tuberculosis may be more frequent than suspected in HIV-infected patients. Routine fibrobronchoscopy in HIV-positive patients with tuberculosis could show the true frequency of endobronchial tuberculosis.
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Affiliation(s)
- J L Calpe
- Department of Respiratory Medicine, Villajoyosa Hospital, Alicante, Spain
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Gutiérrez Rodero F, Ortiz de la Tabla V, Martínez C, Masiá MM, Chiner E, Calpe JL. Legionnaires' disease in patients infected with human immunodeficiency virus. Clin Infect Dis 1995; 21:712-3. [PMID: 8527592 DOI: 10.1093/clinids/21.3.712] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Chiner E, Larramendi C, Calpe J. Rinitis y asma bronquial inducida por guantes de látex. Arch Bronconeumol 1992. [DOI: 10.1016/s0300-2896(15)31352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Blanquer J, Chiner E. Enfermedades pulmonares no infecciosas en el SIDA. Arch Bronconeumol 1992. [DOI: 10.1016/s0300-2896(15)31388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Chiner E, Custardoy J, Pérez M, Marín J. Repercusión funcional de la pleurodesis con tetraciclinas en el neumotórax espontáneo. Archivos de Bronconeumología 1991. [DOI: 10.1016/s0300-2896(15)31478-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Affiliation(s)
- I Betlloch
- Servei de Medicina Interna, Hospital de La Vila Joiosa, Benidorm, Spain
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49
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Amador C, Chiner E, Calpe JL, Ortiz de la Table V, Martinez C, Pasquau F. Pneumonia due to Bordetella bronchiseptica in a patient with AIDS. Rev Infect Dis 1991; 13:771-2. [PMID: 1925302 DOI: 10.1093/clinids/13.4.771] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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50
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Chiner E, Larramendi C, Carbonell C, Calpe JL, Rosado L, Vilar A. [Respiratory distress and multiple organ failure after intravesical instillation of BCG]. An Med Interna 1991; 8:349-51. [PMID: 1932496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of probable hypersensitivity reaction with multi-organic failure, following bladder installation of BCG, in a male with a diagnosis of bladder carcinoma is presented. The patient developed respiratory, renal and liver failure as well as leukocytosis, thrombopenia and an increase in muscular enzymes. It was resolved with hemodynamic support. The rare complication, occasionally described in medical literature and its probable pathogenic mechanisms are discussed.
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Affiliation(s)
- E Chiner
- Sección de Neumolgía, Hospital de la Vila Joiosa-Benidorm, Alicante
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