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Chronic Obstructive Pulmonary Disease (COPD) is a pathological entity characterized by a series of persistent physical manifestations such as cough, fatigue, dyspnea and sputum production; symptoms that generate discomfort in the patient from the moment of diagnosis and that, being an irreversible disease due to the tissue damage it causes, progressively has a negative impact on quality of life. On the other hand, the presence of psychological symptoms such as depression, insecurity, anxiety and emotional disturbances has been reported in patients diagnosed with COPD. Likewise, patients with this diagnosis tend to develop behaviors that alter their family and work social relationships, as they tend to isolate themselves due to the symptoms, especially physical. This situation generates the need to develop a research work with the objective of recognizing the cluster of physical, psychological and social symptoms of patients diagnosed with COPD, and to identify if a palliative care approach is proposed. The study was developed through a systematic literature review in which 1,776 articles were identified, of which 41 were evaluated for the identification of the symptom cluster. The binomial dyspnea and cough, fatigue and expectoration were identified as the physical symptom cluster; depression and anxiety constitute the psychological symptom cluster, and the impact on quality of life and the perception of isolation or social exclusion. [ABSTRACT FROM AUTHOR]

Introduction: pneumonia, named by Sir William Osler "the captain of the hosts of men's death", represents one of the main health problems in the world. Both the incidence and the mortality rate increase with age because in the geriatric patient there are diseases that increase the risk of pneumonia. In addition, due to their own health conditions and immune senescence, the probability of dying from this cause is very high. Objective: to study the main characteristics of pneumonia in the elderly and mainly the increased risk factors for developing it. Methods: a prospective quantitative-qualitative research was carried out in 950 patients aged 60 years or older with a diagnosis of community-acquired pneumonia admitted to the "Arnaldo Milián Castro" Hospital, in Villa Clara Province, from January 2016 to December 2018 with the aim of determining the risk factors of community-acquired pneumonia in the elderly. Results: the most frequent clinical manifestations were: fever, cough, decay, tachypnea and tachycardia, in various combinations. Smoking, chronic obstructive pulmonary disease, bronchial asthma, heart failure, diabetes mellitus and alcoholism were risk factors. Age was an independent prognostic factor associated with higher mortality, longer hospital stay and longer recovery time. Conclusions: the most frequently found risk factors were smoking, alcoholism, chronic obstructive pulmonary disease, cancer, diabetes mellitus and heart failure. [ABSTRACT FROM AUTHOR]

We present the case of a comorbid patient with Chronic Obstructive Pulmonary disease who developed a pulmonary herniation secondary to a coughing episode. He complained of severe and invalidating somatic pain in the herniation area, pain score was 4 out of 10 in the Verbal Numeric Scale (VNS) at rest, that worsened with cough to 9 out of 10. Buprenorphine and acetaminophen were initiated with only slight improvement in pain. Surgical reparation was discarded. An erector spinae plane nerve block (ESP block) was performed with improvement in the VNS to 0 out of 10 at rest and 6 out of 10 with cough. After the procedure, the patient only needed acetaminophen as analgesic for pain relief, and the improvement was maintained in time. The ESP block was described in 2016, and since then there has been growing evidence of its safety and efficacy in post-operative analgesia for breast, thoracic and abdominal surgery. The main ESP block benefits compared to similar blocks are the relative less incidence of pneumothorax, less systemic absorption of local anaesthetics and the simplicity of its performance. Although there is less evidence in chronic pain, it has been described in the treatment of post thoracotomy chronic pain with good results. This case is described because of the great clinical improvement in an uncommon and very symptomatic disease. [ABSTRACT FROM AUTHOR]

Chronic cough is defined as persistent cough for more than eight weeks without a defined diagnosis. Irwin and other authors have identified sinusitis, asthma and gastroesophageal reflux as the most common causes of chronic cough. Objectives: To know the clinical spectrum and the most common causes of chronic cough, as well as lo perform a comparative analysis with the literature. Material and methods: A retrospective and transversal study was performed analyzing the clinical records of patients attending consultation because of chronic cough at Dr. Jose E. Gonzalez University Hospital at the Autonomous University of Nuevo Leon, and the Clínica Cuauhtemoc y Famosa, in Monterrey, Nuevo Leon, Mexico, from January, 1998, to December, 2000. The main symptoms and signs of each patient were analyzed, as well as the final diagnosis of the cough's cause and the response to treatment. In addition, a comparative analysis of the data found. In this population and those reported by Irwin et al on the main cause of this symptom. For the statistical analysis, multivarianza analysis, x2 test and Mantel Haenszel with 2x2 table were used considering a p < 0 05 as significant. Results: One hundred eight records were reviewed, but only 91 were included. The most common final diagnoses were gastroesophageal reflux in 75 patients (82%), followed by sinusitis in 34 cases (37%) and mixed causes (more than two) in 25 subjects (27%) (p = 0 016). All patients responded properly to specific treatment directed to the identified base-disease, with which symptoms were solved. Conclusions: In our population, unlike described by Irwin, the most frequent cause of chronic cough is gastroesophageal reflux, followed by sinusitis and mixed causes. [ABSTRACT FROM AUTHOR]

Cough is the common symptom of patients who seek medical attention; chronic cough being defined as persistent cough longer than three weeks without a definite diagnosis. Cough is a vagal phenomenon which can be initiated in structures with afferences of the vagus or its branches; besides, cough receptors have been described in different parts of the body, mainly tracheobronchial and digestive tract structures, which send afferents to the central nervous system to form the cough reflex. Main causes of chronic cough are retronasal discharge syndrome, gastroesophagic reflux and asthma. The diagnosis of chronic cough requires a careful history and physical examination and paraclinic tests focused on the most frequent causes. Treatment is oriented to identify and correct the disease; anticough medication should be used carefully since cough is a defense mechanism and an alarm sign. [ABSTRACT FROM AUTHOR]