Cross-cultural adaptation to Spanish of the Perceived Sensivity to Medicines scale

BACKGROUND AND OBJECTIVE

Patients' views regarding the actions and side effects of medicines can be measured with the Perceived Sensitivity to Medicines (PSM) scale. The aim of this study was to translate and adapt the PSM scale for use in the Spanish population.

MATERIALS AND METHODS

The translation and cultural adaptation of the PSM scale and a pretest of the Spanish version were carried out with 50 patients receiving outpatient care in various specialties.

RESULTS

There were no difficulties in the stages of the translation and adaptation process. In the cognitive interview, participants found the five items easy to understand (mean score of 3.86±0.24 out of 4).

CONCLUSION

Given its brevity, the Spanish version of the PSM scale represents an easily applicable tool for both research and clinical purposes.

First evidence of microplastics isolated in European citizens' lower airway

Microplastics (MPs) have been detected in all environmental locations, including the atmosphere. However, few studies have investigated the presence of airborne MPs in the human respiratory system. Our research purpose was to investigate these pollutants in the lower human airways of 44 adult European citizens, using bronchoalveolar lavage fluid (BALF) collection as a minimally invasive method, that enables the detection of these pollutants in living patients. We studied the relationship between the patients' life habits and physiological parameters, based on background information and medical and occupational history, and the concentration of MPs isolated from their respiratory systems. Our results indicate that most MPs were in the form of microfibers (MFs) (97.06%), with an average concentration of 9.18 ± 2.45 items/100 mL BALF, and only 5.88% (0.57 ± 0.27 items/100 mL BALF) were particulate MPs, without a significant relationship with environmental, physiological, or clinical factors. The average size was 1.73 ± 0.15 mm, with the longest dimension (9.96 mm) corresponding to a polyacrylic fiber. Taken together, the results demonstrated the occurrence of MPs in the lower human airway, although more studies are necessary to elucidate the negative effects these pollutants could induce in the human respiratory system and its associated diseases.

[Sarcopenia index in hospitalized patients with chronic obstructive pulmonary disease exacerbation]

Sarcopenia (loss of muscle mass and function) implies a worse prognosis. However, its diagnosis is complex and is not made in routine clinical care. A biomarker has been proposed as a surrogate estimator of skeletal muscle mass, the so-called sarcopenia index ([serum creatinine/cystatine C] x100) which is associated with prognostic features in various diseases including patients with stable chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate the potential clinical and prognostic information of this biomarker in COPD exacerbation. This is a one-year prospective study of consecutive patients admitted for COPD exacerbation. A total of 89 patients, 70 men (79%) and 19 women (21%) were included. Those with lower values of the sarcopenia index had a higher level of dyspnoea and a longer hospitalization. In the correlation analysis, the index had statistically significant values with FEV1 (r = 0.23), PaCO2 (r = -0.30), bicarbonate (r = -0.31), dyspnoea (r = -0.25) and length of admission (r = -0.30). In patients admitted for COPD exacerbation, the sarcopenia index was related to prognostic characteristics, so that lower values were associated with longer duration of hospital admission, more dyspnoea and greater functional impairment. As this is an index associated with muscle mass, its determination may identify patients who could be the subject of a differentiated therapeutic plan.

Predictive factors for cardiac conduction abnormalities with hydroxychloroquine-containing combinations for COVID-19

This longitudinal, prospective cohort study aimed to assess risk of QTc interval prolongation and its predicting factors in subjects treated with combinations containing hydroxychloroquine (HCQ) for COVID-19. Moderate-to-severe QTc prolongation during therapy was defined as a QTc interval >470 ms in men or >480 ms in women. Patients were treated under strict cardiac supervision. A total of 105 adults were included [56% male; median (IQR) age 69 (57-79) years]. All patients received therapy with HCQ in combination with azithromycin (AZM), and 95 (90%) also with lopinavir/ritonavir (LPV/r). Concomitant medications classified as having risk of developing torsades de pointes (TdP) were simultaneously used in 81 patients (77%). Moderate-to-severe QTc prolongation was observed in 14 patients (13%), mostly at Days 3-5 from baseline, with 6 (6%) developing severe prolongation (>500 ms). There was no evidence of TdP arrhythmia or TdP-associated death. Adding LPV/r to HCQ+AZM did not significantly prolong the QTc interval. Multivariable Cox regression revealed that comedications with known risk of TdP (HR = 11.28, 95% CI 1.08-117.41), higher neutrophil-to-lymphocyte (NLR) ratio (HR = 1.10, 95% CI 1.03-1.18 per unit increase) and higher serum hs-cardiac troponin I (HR = 4.09, 95% CI 1.36-12.2 per unit increase) were major contributors to moderate-to-severe QTc prolongation. In this closely screened and monitored cohort, no complications derived from QTc prolongation were observed during pharmacological therapy containing HCQ for COVID-19. Evidence of myocardial injury with elevated troponin and strong inflammatory response, specifically higher NLR, are conditions requiring careful QTc interval monitoring.

[Hyperlactatemia in hospitalized patients with asthma. Frequency and clinical implications]

Increased levels of lactic acid have been described in patients treated for asthma exacerbation. However, the frequency and clinical significance of hyperlactatemia in real-world practice is unknown. The objective of the study was to evaluate the characteristics associated with hyperlactatemia in blood gas analysis of patients with asthma exacerbation hospitalized in a pulmonary department. This is a retrospective 3-year study (2015 to 2017) of patients discharged from the pulmonary department. The level of lactic acid in the blood gas test and the possible relationship with clinical, laboratory, therapy, spirometric values, hospitalization length and use of critical care resources were analyzed. A total of 112 patients with 182 admissions were included in the study. Thirty-two (29%) patients had hyperlactatemia in at least one blood gas analysis. Elevated lactic acid was observed in 42 of 182 admissions (23%), which had larger length hospital stay (median, 6 vs. 5 days, p = 0.013). Hyperlactatemia was present in 8 of 10 admissions in the critical care units, mainly after receiving bronchodilator therapy. There was a significant correlation between lactate level and bicarbonate level (r = -0.417, p = 0.003) and between lactate level and base excess (r = -0.484, p < 0.001) in cases with hiperlactatemia. Hyperlactatemia is a relatively frequent finding in blood gas analysis of patients hospitalized because of asthma (23% of admissions). These admissions with hiperlactatemia are associated with larger hospital length of stay.

Comparison of the bactericidal activity of various fluoroquinolones against Mycobacterium tuberculosis in an in vitro experimental model

OBJECTIVES

To compare the bactericidal activity of various fluoroquinolones against Mycobacterium tuberculosis in the latent and exponential growth phases.

METHODS

Ciprofloxacin, levofloxacin and moxifloxacin were tested against 16 M. tuberculosis clinical isolates (4 resistant and 12 susceptible to fluoroquinolones) from Elche, Spain, isolated between 1992 and 2009. To study bactericidal activity, an inoculum of approximately 10(5) cfu of each isolate was cultured in Middlebrook 7H9 broth. The broth was previously acidified to pH 4.6 to obtain the microorganism in the stationary phase. Cultures with different concentrations (0.1 to 50 mg/L) of antibiotic and antibiotic-free controls were incubated for 48 h then plated onto Middlebrook 7H11 to detect bacterial killing. In all stages of the process the M. tuberculosis strain ATCC 41323 was included as a quality control to ensure reproducible results.

RESULTS

Moxifloxacin and levofloxacin were found to exhibit bactericidal activity at lower concentrations and against more strains in both the latent and the exponential growth phases compared with ciprofloxacin. The bactericidal activity of moxifloxacin was greater than that of levofloxacin against microorganisms in the exponential growth phase, but the opposite was true in the latent phase.

CONCLUSIONS

Our data confirm the usefulness of moxifloxacin in the treatment of tuberculosis and suggest that levofloxacin may be used as an alternative drug in the treatment of latent tuberculosis when it is not possible to use isoniazid. Based on the results presented, ciprofloxacin appears to be a poor choice.

Clinical significance of upper airway dysfunction in motor neurone disease

BACKGROUND

To assess the occurrence, functional characteristics and prognostic value of upper airway dysfunction in motor neurone disease, 27 patients unselected for respiratory symptoms were studied.

METHODS

Upper airway function was evaluated by analysis of the maximal flow-volume loop. Neurological diagnosis was established from the clinical history and physical examination. The degree of impairment was quantified by the Appel score.

RESULTS

Twelve patients (group A) showed abnormalities of the maximal flow-volume loop consistent with flow limitation (seven patients) or instability of upper airway function (gross oscillations of airflow, five patients). The remaining 15 patients (group B) exhibited a normal or generally reduced maximal flow-volume loop, suggestive of muscle weakness. No differences were observed between groups in general physical condition, rate of disease progression, or duration of disease.

CONCLUSIONS

Upper airway dysfunction in patients with motor neurone disease was a frequent finding. It was present more often, but not exclusively, in patients with bulbar features and was unrelated to prognosis.

[A survey of the basic knowledge of chronic respiratory patients]

Sixty patients diagnosed as having chronic respiratory diseases were surveyed in order to establish how many knew the name of their disease, the medications they were taking, the name of the medical specialty dedicated to treating their condition and the nature of spirometry. Only 23 patients (38%) knew the name of their disease; among them were all those suffering asthma or silicosis, but only 24% of those with other diseases. Thirty-three (55%) were unable to name their medications. Only 22% knew what a pneumologist does or could define spirometry, although at least 45% of these patients had undergone the procedure. The majority, on the other hand, knew what a cardiologist (70%) does and what an electrocardiogram (80%) is. A large number of patients with chronic respiratory diseases know very little about basic aspects of their conditions. Use of correct terminology appears to be necessary if patient knowledge is to increase.

Indices of upper airway obstruction in patients with simultaneous chronic airflow limitation

In patients with chronic airflow limitation (CAL), the detection of upper airway obstruction (UAO) by analysis of forced flows can be difficult due to the masking of conventional UAO indices. We analyzed five indices: maximum inspiratory flow at 50% of forced vital capacity (FIF50), the ratio of maximum expiratory to inspiratory flow at 50% of forced vital capacity (FEF50/FIF50), the ratio FEV1/PEFR, the ratio FEV1 to forced expiratory volume in 0.5 s (FEV1/FEV0.5), and the ratio maximum voluntary ventilation (MVV)/FEV1, to determine their usefulness in evaluating patients with simultaneous UAO and CAL. One hundred and thirty-seven patients participated: 54 had UAO alone, 23 presented simultaneous UAO and CAL and 60 suffered from CAL with no evidence of UAO. The patients with UAO and CAL on the average presented fewer abnormal indices and these were less severely altered. Twenty-seven of the 60 with CAL alone presented at least one abnormal index, but in no case were more than two present. FEF50/FIF50 and FEV1/PEFR were significantly less sensitive in patients with both UAO and CAL than in those with UAO alone (35 vs. 85% and 52 vs. 72%, respectively). In all patients the most specific indices (100%) were FEF50/FIF50 and MVV/FEV1. The index MVV/FEV1 was the most accurate in patients with UAO and CAL. We conclude that when patients with CAL present 3 or more abnormal UAO indices, or have FEF50/FIF50 > or = 1 or MVV/FEV1 < or = 25, the possibility of simultaneous UAO must be strongly considered.

[Tracheobronchial involvement in non-Hodgkin's lymphoma]

Tracheobronchial involvement in non-Hodgkin's lymphoma (NHL) has been little described. We present two patients with NHL and endobronchial involvement of different characteristics. In the first case diffuse involvement of the bronchial mucosa was observed in the context of a systemic NHL of 10 years' duration. In the second patient, endobronchial involvement consisted of a mass obstructing the trachea and the right main bronchus which was the first manifestation of lymphoma.

[Primary microcytic carcinoma of the trachea]

Primary microcytic tumors of the trachea are very rare. Among them, primary microcytic carcinoma of the trachea has been described very few times. We present the case of a 44-year-old man with hemoptysis and asthenia, in which the thoracic radiography was normal. However, the bronchofibroscopy detected a microcytic carcinoma localized at the distal third of the trachea with adenopathies and hepatic metastasis. Complete remission was achieved with chemotherapy, remaining the patient free from the disease 10 months after the diagnosis.

[Protected bronchoalveolar lavage: a new endoscopic method in the diagnosis of bacterial pneumonia]

BACKGROUND

The identification of causative microoganisms in severe pneumonias is a usually difficult problem. Protected brushing (PB) has a good specificity but a limited sensitivity. Conventional bronchoalveolar lavage (BAL-C) has an excellent sensitivity but a doubtful specificity. The investigation of a new technique such as the protected bronchoalveolar lavage (BAL-P) appears as logical, as it should combine the advantages of PB and BAL-C without their drawbacks.

METHODS

In 15 patients without bacterial or fungal infections and in 23 with bacterial or fungal pneumonia, quantitative cultures were carried out in the samples obtained with PB, BAL-P and BAL-C. PB and BAL-C were performed with the usual technique. BAL-P was performed through the internal catheter of a telescoped double catheter with reabsorbable distal cap within the fibroscope channel. 40 ml of saline were instillated for the lavage.

RESULTS

With BAL-P sensitivity was 95% and specificity 89%. These were, respectively, 55% and 94% with PB, and 95% and 42% with BAL-C. The technique of BAL-P was more complex an longer than that of PB.

CONCLUSIONS

If these results are confirmed in further studies, BAL-P might become a method of choice for the bacterial pneumonias where now PB is indicated. However, in patients with hypersecretion or when bronchoscopy should be rapidly carried out, PB is technically more feasible.