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Biomedical subjects

V Sobradillo

Publications and source records attributed to V Sobradillo.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Asthma emergencies: can we lower the rate of readmission after discharge?].

INTRODUCTION: The rate of readmission among asthmatic emergency patients varies. In 1991 we observed a 9% rate of readmission following emergency room release. Studies of the number of readmissions or request for medical care are used as the basis for recommendations for releasing patients from hospital emergency care. No studies have assessed disease stability following release or factors related to stability. OBJECTIVES: To assess the course of disease and clinical stability of patients in the period immediately following release from emergency room care. To determine factors that might predict such stability. to determine the rate of readmission in the month following release after applying a treatment protocol and release criteria, with follow-up examination 72 h later. MATERIAL AND METHODS: Prospective, descriptive study with follow-up 72 h and one month after release. SETTING: Emergency and pneumology departments of a general hospital. PERIOD: six months. PATIENTS: 82 asthmatic patients released from the emergency room. RESULTS: Two patients (2.43% were readmitted. At the first follow-up visit (72 h) 81 patients (98.78%) were seen. At the second visit, 66 patients (80.5%) were examined. We observed stability in 70.3% of patients at 72 h and in 86.4% after on month. Stability was statistically related to whether peak expiratory flow greater or less than 70% (76.92% stable versus 46.66% unstable) (p < 0.05). No other clinical, epidemiological or treatment variables recorded upon release were found to influence stability. CONCLUSIONS: 1) A large proportion of patients are in stable condition 72 h after release. 2) When peak expiratory flow upon release is > 70%, stability is significantly increased 72 h later. 3) Our 2.43% rate of readmission one month after release is very low. 4) No differences in stability were seen to be related to oral corticoid prescription upon release.

Acute Disease↗
PubMed1999

[Information seeking and decision making in asthmatic patients].

Patient cooperation in controlling asthma is a key element for achieving the most efficient therapy possible according to current guidelines. Cooperation requires that the patient be adequately informed about his disease and able to make certain decisions. The aim of this study was to analyze whether patients really desire information about asthma and to what point they are disposed to cooperate actively in managing their disease. Ninety-five adult asthmatics with different levels of severity of disease were studied in stable condition. All responded to the Spanish version of the questionnaire on autonomy in asthma, an instrument with a scoring range of 0 to 100 and 26 items grouped in two subscales: preferences in the search for information (PSI) and preferences in decision making (PDM). The second subscale was based on three scenarios describing stable asthma, slight exacerbation and severe exacerbation. The results obtained indicate that although patients are greatly interested in receiving information (PSI scores of 86.4 +/- 8.7) they express substantially less desire to make decisions (PDM 45 +/- 10.2) (p < 0.01). Attitudes did not change in relation to education, number of exacerbations during the last year, duration of disease or severity as assessed by the patient. Only patient age (with older patients scoring higher on PSI) and presence of severe asthma (according to consensus guidelines) increased the desire for information (but not the preference for decision making). These data indicate the need to implement educational programs about asthma, components of which promote effective desire for self-management.

Adult↗
PubMed1999

[Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): recruitment and field work].

Chronic obstructive pulmonary disease (COPD) is a large-scale social and health problem. Because prevalence studies have been performed only in certain areas of Spain, the Spanish Society of Pneumology and Chest Surgery initiated the IBERPOC study with the aim of determining the prevalence of COPD in several parts of the country. IBERPOC is a multicenter, population-based epidemiological study in which subjects have been selected randomly. Seven full-time pneumologists work full-time in seven different areas of Spain. A study of this nature involves a series of difficulties that should be taken into account at the time of planning studies of a similar nature. After 5,827 attempts to reach subjects, a total of 4,967 useful contacts were made, to provide 97.3% of the 5,104 contacts expected. Of those 4,967 useful contacts, 4,035 subjects completed interviews. Among the 932 refusals, 882 (94.6%) agreed to answer a short telephone questionnaire. The field work took 13 months to complete, 30% more time than had been anticipated. The rates at which subjects could not be traced differed from one zone to another, ranging between 5% and 30%; higher rates were attributable to the absence of telephone data in the corresponding census report. In one zone, the dispersion of the census population over a very large area supposed greater difficulty and delay in carrying out the study. In conclusion, the rate of participation and the time required for recruitment can be considered satisfactory. The performance of field work by trained, full-time pneumologists has been essential to the development and quality of the study. Similar epidemiological studies should consider problems derived from the lack of adequate census data, as well as to avoid defining areas of extreme population dispersion in order to facilitate field work.

Epidemiologic Methods↗
PubMed1999

[Epidemiological study of chronic obstructive pulmonary disease in Spain (IBERPOC): prevalence of chronic respiratory symptoms and airflow limitation].

The prevalence of chronic respiratory symptoms and chronic airflow limitation (CAFL) was determined in a multicentric epidemiological study carried out in seven different areas of Spain. Based on a target population of 236,412 persons, a random census sample of 4,035 individuals between 40 and 69 years of age was chosen. Subjects answered several questionnaires and performed spirometric tests followed by a bronchodilation test if bronchial obstruction was detected. Respiratory symptoms were reported by 48% of the population (95% CI: 46.4-49.5%) with greater frequency of symptoms among men than women (55.2% versus 41%, p < 0.001). The following levels of prevalence of chronic symptoms were found: cough, 13.5% (95% CI: 12.5-14.6%); expectoration, 10.7% (95% CI: 9.7-11.6%); dyspnea after one flight of stairs, 10.4% (95% CI: 9.5-11.4%); and wheezing, 40.2% (95% CI: 38.7-41.7%). The prevalence of chronic bronchitis (CB) was 4.8% (95% CI: 4.1-5.4%) and was more frequent among men than among women (8.3% and 1.4%, respectively; p < 0.001). Asthma had been diagnosed previously in 4.9% (95% CI: 4.2-5.5%), more often in women than in men (5.8% and 3.8%, respectively; p < 0.003). CAFL was found in 10.6% (95% CI: 9.6-11.5%), 15.8% in men and 5.5% in women (p < 0.001). All respiratory symptoms except asthma were more frequent among smokers than among ex-smokers, and in turn were more common among ex-smokers than non-smokers. The frequency of symptoms increased in accordance with accumulated smoking. The prevalence of CB and CAFL was vastly different from one region to another. Multivariate analysis showed that factors associated independently with the appearance of CB were smoking, age over 60 years, male sex and having worked in industry. In conclusion, respiratory symptoms, including CB and CAFL, are common in the Spanish population. Smoking and amount of smoking are directly related to the frequency of such symptoms. Substantial differences were found in the prevalence of CB and CAFL among the regions where the study was performed.

Adult↗
PubMed1999

Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease.

The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD). Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off > or = 10(3) colony-forming units (CFU x mL(-1)). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis. Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45-17.9) and current smoking (OR 3.17, 95% CI 2.5-8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19-39.3) being the only variable independently associated with positive bacterial cultures. Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking.

Aged↗
PubMed1998

Low-dose formoterol Turbuhaler (Oxis) b.i.d., a 3-month placebo-controlled comparison with terbutaline (q.i.d.).

This study compared the efficacy of a low dose of formoterol Turbuhaler 6 micrograms b.i.d. (F) with that of terbutaline 0.5 mg q.i.d. (T), and placebo (P) from Turbuhaler. After a 2-week run-in, 397 adults with mild to moderate asthma were randomly allocated to one of the treatments for 12 weeks. During run-in, the mean morning peak expiratory flow (PEF) was 360 (F), 368 (T) and 367 1 min-1 (P). F was better than T (P = 0.014) and P (P = 0.0001) in improving morning PEF [mean changes from run-in: 20 (F), 9 (T), and 21 min-1 (P)]. F was statistically significantly more effective than either T or P in reducing asthma symptoms. F gave also statistically significantly higher evening PEF and less use of rescue medication than P. Bronchodilator response to study drugs and additional 1.25 mg terbutaline was similar before and after the 12-week treatment period. There were no adverse effects of clinical relevance. In conclusion, formoterol Turbuhaler, 6 micrograms b.i.d. was more effective in improving PEF and offered better asthma control than either terbutaline Turbuhaler, 0.5 mg q.i.d. or placebo. Regular use of formoterol did not reduce the bronchodilator response to additional terbutaline. There were no clinically relevant adverse effects.

Adolescent↗
PubMed1997

[Usefulness of computerized tomography in the study of pleural effusion with no presumed diagnosis].

To establish the diagnostic yield of computerized tomography (CT) in pleural effusions with no presumed diagnosis arising from standard clinical examination. A prospective protocol study enrolling all cases of effusion admitted to our hospital between January 1994 through July 1995 without a presumed diagnosis after initial testing that included thoracocentesis. Twenty-two patients were enrolled. All were given a CT scan as well as other complementary examinations considered appropriate and were referred to our outpatient clinic for follow-up. The CT images were read by an expert radiologist and their contribution was classified as "diagnostic", "suggestive" or "nil". A definitive etiologic diagnosis was achieved in 14 cases (8 neoplasms, 4 benign due to asbestos, 1 tuberculosis and 1 pulmonary embolism). The CT contribution was nil in 13 cases (59%), "diagnostic" in 6 (2 mesotheliomas, 1 hypernephroma, 1 lymphoma, 1 adenocarcinoma of the colon and another of the ovary) and "suggestive" in 3 (2 benign due to asbestos and 1 lymphoma). Positive information was obtained in 9 cases (41%). CT gives good yield in the investigation of pleural effusions with no presumed diagnosis and should be made available to this group of patients before other more invasive procedures are resorted to. It is especially useful for detecting neoplastic disease of the upper abdomen, mesothelioma and sings of unsuspected exposure to asbestos.

Aged↗
PubMed1997

[Community acquired pneumonia. Reliability of the criteria for deciding ambulatory treatment].

To determine whether criteria for not admitting community-acquired pneumonia (CAP) patients diagnosed in the emergency room are appropriate, and to characterize the symptoms, etiology and course of CAP. This one-year prospective, protocol study of immunocompetent CAP patients diagnosed in the emergency room of our hospital enrolled patients not considered to require hospital admission according to the recommendations of the Spanish Society of Respiratory Disease (SEPAR). Medical histories, chest X-rays and blood analysis were obtained for all patients. Blood cultures were analyzed for antibodies against Legionella pneumophila, Mycoplasma pneumoniae, Coxiella burnetii, Chlamydia pneumoniae, Chlamydia psittaci and influenza virus types A and B. The patients received erythromycin for 14 days and were regularly checked by the pulmonologist in the outpatient clinic until signs and symptoms had disappeared. One hundred six patients were enrolled. Mean age was 36 +/- 13 years. Only 3 patients had to be admitted to hospital, after which outcome was good. The main symptoms were fever (106, 100%) and cough (83, 78%). In 46 (43.4%) chest sounds were normal. Microbiologic diagnoses were achieved for 28 (26.4%) and Coxiella burnetii was the agent most often found (19, 17.9%). Outcome was good in all cases, with faster disappearance of symptoms than of radiological signs. The SEPAR criteria for admitting patients with CAP are appropriate. The clinical symptoms of such patients are non specific, a noteworthy finding being that many patients had normal chest sounds. Coxiella burnetii was the most common causative agent. Both clinical and radiological outcomes were excellent.

Adolescent↗
PubMed1997

[Protected bacteriologic brushing in patients with severe copd].

To determine the presence of germs and their concentration in a group of patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50%), some of whom were in stable condition and others of whom were in acute phase. Twenty-six patients with severe COPD (14 stable and 12 acute phase) were enrolled. None had received prior antibiotic or corticoid treatment. The stable patients had no signs or symptoms of exacerbation, whereas the acute-phase patients had increased dyspnea, sputum volume and purulence. The patients received aerosol rather than liquid anesthesia when PSB sampling was performed. A PSB finding was considered positive at a level > or = 10(3) CFU/ml. There were no significant differences between the groups with respect to age, sex, proportion of smokers and ex-smokers or packs per year. The only spirometric measure that was significantly different was (FEV1/FVC, which was lower in the acute-phase group (p < 0.05). Positive PSB findings were recorded for 57.1% of the stable patients and for 66.7% of the acute-phase patients (p = NS). H. influenzae was the microorganism found most often in both groups. The mean CFU/ml level was 8,625 in stable patients and 17,375 in acute-phase patients (p = NS). A large proportion of stable patients (57.1%) with severe COPD harbor significant concentrations of germs as revealed by PSB sampling. Germ concentrations were found in a non significantly greater number of acute-phase patients, confirming the lack of congruence between clinical status and bacteriological condition.

Aged↗
PubMed1995

[Current use, methodology and evaluation of nonspecific bronchial provocation tests in our country].

With the aim of determining the current use of non-specific bronchial inhalation challenge (BIC) testing in Spain, 147 questionnaires were sent to hospitals with pneumology departments or units. The questionnaire covered general, technical and methodological aspects of this diagnostic procedure, as well as its assessment and interpretation. Of the 42 informants who returned questionnaires, mainly from large urban hospitals, 34 reported using BIC. The most widespread criterion applied in deciding to use BIC was the presence of atypical asthma symptoms (33/34). The stimulus most often used was methacholine inhalation (33/34). We found that technical preparation of the drug was highly standardized, but that administration and follow-up protocols differed greatly. There was also great variety in the PC20/PD20 value assigned to indicate bronchial hyperresponsiveness. This study contributes to our better understanding of the current use of BIC in Spain and highlights the need to work toward greater standardization for this diagnostic procedure, to enable us to assess and interpret the results more consistently.

Asthma↗
PubMed1995

Influence of three factors on the diagnostic effectiveness of transthoracic needle aspiration in pneumonia.

Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been included in the study. The technique was carried out with an ultrathin needle gauge 25 and without fluoroscopic control. A univariate (UA) and a multivariate statistical analysis were made. The sensitivity of TNA was 34.1%. Fifty-seven of 91 (62.6%) had received antibiotic therapy prior to TNA; sensitivity was higher in nontreated patients than in treated patients (p = 0.0033; UA). There were 34 patients with an infiltrate that was smaller than a lobe (MINLOB); 39 cases affected a complete lobe (LOB) and 18 more than one lobe (MAJLOB). The TNA sensitivity was higher in LOB cases than in MINLOB cases (p = 0.0004; UA) while when comparing LOB cases and MAJLOB cases, sensitivity was higher in the former (p = NS; UA). In 28 of 91 cases (30.8%), the TNA was performed by A (a trained physician who regularly carries out the technique) and in 63 of 91 cases (69.2%) by B (other physicians, 10 in our study, who sporadically perform the technique). The TNA sensitivity was higher when the technique was performed by A, although this difference was not significant; if we add negative TNA with leukocytes present in Gram stains (which would indicate that aspiration was done in the correct area) to positive TNA, the difference between A and B was higher (p = 0.0248). The multivariate statistical analysis confirmed that there are two variables that are independently connected to a positive TNA (prior antibiotic therapy and size of the infiltrate). As regards the variable "person who carries out the technique," a significant association with a positive TNA was not established, although the estimations we obtained show a possible clinical relevance.

Adult↗
PubMed1994

[Pneumonia in alcoholic patients: the clinical and etiological characteristics].

Twenty-four alcoholic patients with community-acquired pneumonia were studied for 2 years in order to define clinical signs and etiology. Blood cultures and serological profiles were done for all patients in addition to standard blood analyses. All had an invasive procedure -transthoracic puncture with an ultrafine 25G needle (20 patients) or telescopic catheter with bacteriologic brush (4 patients). When we were unable to obtain a good sputum sample (5 patients), a culture was grown. The patients' mean age was 48 and 83% had an acute clinical profile (< or = 7 days with symptoms) with "typical" signs. The X-rays showed an alveolar pattern in all patients, with cavitation in 29%. Etiological diagnosis was reached in 17 (71%) cases, with St. Pneumoniae (25%), anaerobic microorganisms (20%) and C. burnetii (12.5%) being the germs found most frequently. The invasive techniques were more useful (54%) than the blood cultures (17%) or sputum cultures (4%), and they were well tolerated and uncomplicated. Empirical antibiotic treatment was modified for 12 patients (50%). Seventeen percent required intensive care treatment and mortality was 12.5%.

Adult↗
PubMed1994

[Clinical and etiological features of community-acquired pneumonia in the elderly].

BACKGROUND: The aim of the present study was to know the clinical and etiologic features of community-acquired pneumonia (CAP) in elderly patients requiring hospital admission. METHODS: A prospective study of 36 consecutive patients aged over 70 years, admitted to a general hospital was performed. Standard analytical determinations, blood cultures, and serologic studies were performed in all patients using invasive techniques: aspirative transthoracic puncture (ATP) with ultrafine needle in 35 (97%) cases, and telescopic catheter (TC) in 1 case. RESULTS: The mean age was 79 years (range: 71-90). Twenty-two patients had received antibiotic treatment prior to admission (61%) and 17 (47%) presented chronic debilitating diseases. The clinical characteristics of CAP were "typical" with acute presentation in most. Fifteen cases (42%) were etiologically diagnosed and the most frequently isolated agents were Streptococcus pneumoniae (22%) and Haemophilus influenzae (8%). Empiric treatment was changed on the basis of isolations in 7 cases (19%). Eight patients died (22%). CONCLUSIONS: According to our results community-acquired pneumonia in the population studied: 1) generally showed an acute presentation with "typical" characteristics, carrying a high mortality rate (22%), 2) is of bacterial etiology, with S. pneumoniae and H. influenzae being the most frequently isolated microorganisms, 3) the use of ATP in community-acquired pneumonia offers a high diagnostic effectiveness, good tolerance and low risk of complications.

Aged↗
PubMed1993

[Transthoracic aspiration punction with ultrafine needle in high risk community acquired pneumonia].

BACKGROUND: The identification of etiologic agents of pneumonias acquired in the community (PAC) with risk factors is difficult. The classical diagnostic methods are not profitable and thus invasive techniques are used. In this study the diagnostic use of an invasive technique such as aspirative transthoracic puncture (ATP) was evaluated in this type of pneumonias. METHODS: In 94 patients of high risk suspect of PAC the ATP was carried out. This was performed with an ultrafine needle (25G) without radioscopic control. In all cases blood cultures, serology (Legionella, Mycoplasma pneumoniae, Coxiella burnetti, Chlamydia psittaci) were performed when atypical clinical manifestations were presented and sputum examination (Gram, Ziehl, culture) was undertaken when possible. RESULTS: The sensitivity of ATP was 36% and increased to 54.6% in cases previously untreated with antibiotics. Specificity was 96.4%. The sensitivity of blood culture was 8% and sputum 13.6%. ATP was well tolerated in 97.9% with complication in only 4 (4.3%). The results of ATP led to changes in treatment in 23.1% of the cases with definitive diagnosis of pneumonia. CONCLUSIONS: Aspirative transthoracic puncture with ultrafine needle without fluoroscopic control was a very well tolerated technique with a minimum number of complications, easy to perform at the patients bedside and was used to modify treatment in 23.1% of the cases.

Adult↗
PubMed1992

Antibiotic treatment in pneumonia due to Q fever.

BACKGROUND: Whether Q fever responds better to doxycycline or erythromycin is unknown. METHODS: The efficacy of doxycycline and erythromycin in the treatment of pneumonia due to Q fever was assessed in a prospective, randomised, double blind study of 82 patients with a diagnosis of pneumonia and features suggestive of Q fever infection; 48 proved to have Q fever. Of the 48, 23 received doxycycline 100 mg twice a day and 25 patients received erythromycin 500 mg six hourly, both for 10 days. RESULTS: Both treatment groups had similar demographic characteristics. Fever showed a more rapid reduction in the doxycycline group (3(1.6) days versus 4.3(2) days). Side effects were observed in two patients receiving doxycycline compared with 11 patients receiving erythromycin (p less than 0.01). No differences were observed in other clinical or radiological measures. By day 40 the chest radiograph was normal in 47 of 48 patients. CONCLUSION: The results demonstrate the self limiting and benign nature of most cases of pneumonia due to Q fever. Doxycycline was more effective than erythromycin.

Adult↗
PubMed1991

[A multicenter study of the breaking of the smoking habit with nicotine chewing gum in health personnel].

BACKGROUND: The health professionals have a leading role in the reduction of the smoking prevalence. Spain has one of the big rate of "per capita" tobacco consumption in the world, and the Spanish doctors have the biggest prevalence of smokers among their colleagues from the EEC countries. METHODS: The effectiveness of a stop smoking programme in health care professionals was evaluated. This programme combined group therapy, nicotine chewing gum and behavioural assistance through the evaluation of CO contained in expired breath; and it is being applied with good results between the smokers of general population in Spain. A total of 211 voluntary smokers working in Spanish six general hospitals were treated, from those 149 (71%) were physicians and nurses (PS) and 62 (29%) others professionals without sanitary responsibilities (PNA). RESULTS: At one year follow-up, 64 (30%) were not smoking, and the P.S. had a higher rate of give up than the PNA (p less than 0.05). Specifically the women of P.S. obtained a greater issue than the women of PNA (p less than 0.05). Both, nicotine chewing gum and behavioural assistance were as effective as usual in smoking cessation programme like this, in our country. CONCLUSIONS: Although the outcome is lower than the obtained with the same approaches in smokers from general population, the better results of the PS than the PNA imply a good change of attitude of them. Specially the women PS obtained a big success, and this is outstanding in this group with a great prevalence of smokers, increasing in the recent years. The subjects who give up smoking increased their corporal weight less than the observed in smokers of the general population, who also give up with this treatment.

Adult↗
PubMed1990

[Pleural effusion associated with primary lymphedema: a rare combination. Apropos of a case].

A case of exclusive association of pleural effusions and primary lymphedema, without ungual dystrophy is described. This isolated combination is an uncommon clinical condition with only 11 cases reported in the literature. The pathogenesis is characterized by aplasia-hypoplasia of the lymphatic vessels with consequent defective lymphatic drainage. We present a pleural effusion associated with a left lower extremity cellulitis, we argue about the differential diagnosis and treat the patient with thoracocentesis and aspiration with a favourable evolution without recidive.

Adolescent↗