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[Background] Asthma exacerbations are important events that affect disease control, but predictive factors for severe or moderate exacerbations are not known. The objective was to study the predictive factors for moderate (ME) and severe (SE) exacerbations in asthma patients receiving outpatient care., [Methods] Patients aged > 12 years with asthma were included in the study and followed-up at 4-monthly intervals over a 12-month period. Clinical (severity, level of control, asthma control test [ACT]), atopic, functional, inflammatory, SE and ME parameters were recorded. Univariate analysis was used to compare data from patients presenting at least 1 SE or ME during the follow-up period vs no exacerbations. Statistically significant (p <0.1) factors were then subjected to multiple analysis by binary logistic regression., [Results] A total of 330 patients completed the study, most of whom were atopic (76%), women (nearly 70%), with moderate and mild persistent asthma (>80%). Twenty-seven patients (8%) had a SE and 183 had a ME (58.5%) during follow-up. In the case of SEs, the only predictive factor identified in the multiple analysis was previous SE (baseline visit OR 4.218 95% CI 1.53-11.58, 4-month follow-up OR 6.88 95% CI 2.018-23.51) and inhalation technique (OR 3.572 95% CI 1.324-9.638). In the case of MEs, the only predictive factor found in the multiple analysis were previous ME (baseline visit OR 2.90 95% CI 1.54-5.48, 4-month follow- up OR 1.702 95% CI 1.146-2.529)., [Conclusions] The primary predictive factor for SE or ME is prior SE or ME, respectively. SEs seem to constitute a specific patient "phenotype", in which the sole predictive factor is prior SEs.

Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) commonly coexist in smokers, and the presence of COPD increases the risk of developing LC. Cigarette smoke causes oxidative stress and an inflammatory response in lung cells, which in turn may be involved in COPD and lung cancer development. The aim of this study was to identify differential proteomic profiles related to oxidative stress response that were potentially involved in these two pathological entities. Protein content was assessed in the bronchoalveolar lavage (BAL) of 60 patients classified in four groups: COPD, COPD and LC, LC, and control (neither COPD nor LC). Proteins were separated into spots by two dimensional polyacrylamide gel electrophoresis (2D-PAGE) and examined by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/TOF). A total of 16 oxidative stress regulatory proteins were differentially expressed in BAL samples from LC and/or COPD patients as compared with the control group. A distinct proteomic reactive oxygen species (ROS) protein signature emerged that characterized lung cancer and COPD. In conclusion, our findings highlight the role of the oxidative stress response proteins in the pathogenic pathways of both diseases, and provide new candidate biomarkers and predictive tools for LC and COPD diagnosis.

Lung cancer (LC) and chronic obstructive pulmonary disease (COPD) commonly coexist in smokers, and the presence of COPD increases the risk of developing LC. Cigarette smoke causes oxidative stress and an inflammatory response in lung cells, which in turn may be involved in COPD and lung cancer development. The aim of this study was to identify differential proteomic profiles related to oxidative stress response that were potentially involved in these two pathological entities. Protein content was assessed in the bronchoalveolar lavage (BAL) of 60 patients classified in four groups: COPD, COPD and LC, LC, and control (neither COPD nor LC). Proteins were separated into spots by two dimensional polyacrylamide gel electrophoresis (2D-PAGE) and examined by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/TOF). A total of 16 oxidative stress regulatory proteins were differentially expressed in BAL samples from LC and/or COPD patients as compared with the control group. A distinct proteomic reactive oxygen species (ROS) protein signature emerged that characterized lung cancer and COPD. In conclusion, our findings highlight the role of the oxidative stress response proteins in the pathogenic pathways of both diseases, and provide new candidate biomarkers and predictive tools for LC and COPD diagnosis. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

PURPOSE OF REVIEW: Malignant pleural effusions (MPEs) are one of the most common problems faced by clinicians and, since there is no optimum treatment available, they deserve efforts aimed to improve their management. RECENT FINDINGS: We have reviewed the most recent articles regarding treatment of MPE, with special emphasis on pleurodesis and indwelling pleural catheter placement. Although iodopovidone, silver nitrate and doxycycline are useful, talc continues to be the most effective agent available for pleurodesis. Use of calibrated talc with large particle size is now firmly established, in order to prevent complications. Indwelling pleural catheters are gaining general acceptance, and they are currently a valid option for patients with lung entrapment or those who have a previous failed pleurodesis. Advances in translational medicine related to this topic are also described. SUMMARY: The above results may contribute to improve significantly management of patients with malignant pleural effusions, especially those with advanced disease who are not suitable for pleurodesis procedures. © 2011 Lippincott Williams & Wilkins, Inc.

Fundamento: La tuberculosis en España y Andalucía presenta tasas de incidencia por encima de las de países de nuestro entorno. Muchos autores señalan la necesidad de mejorar la información epidemiológica, la organización de los servicios sanitarios y el apoyo social a los pacientes. El objetivo de este trabajo es evaluar los resultados de una estrategia que contemplaba los tres elementos reseñados en un Distrito de Atención Primaria de Andalucía. Métodos: Se realizó el seguimiento a 234 enfermos de tuberculosis residentes en el Distrito y notificados al Sistema de Vigilancia Epidemiológica de Andalucía durante el período 2004-2008. Se consideraron como indicadores de evaluación el porcentaje que finalizó el tratamiento, el porcentaje de pacientes bacilíferos con estudio de contactos, los nuevos casos detectados en los mismos y la incidencia en menores de 15 años. Resultados:.De los 234 pacientes incluidos se realizó un seguimiento efectivo en el 95%, de ellos finalizaron el tratamiento 182 (78%), fallecieron 18, se trasladaron de domicilio 10 y continuaban aún en tratamiento12. De los 130 casos que presentaron baciloscopia positiva se estudiaron a los contactos de 112 (el 86%). Se detectaron 27 nuevos casos entre los contactos estudiados y la incidencia anual en menores de 15 años fue del 6.65 por 100.000. Las perdidas del seguimiento se redujeron un 30% y las finalizaciones del tratamiento y los estudios de contactos mejoraron un 25% y 30% respectivamente, respecto a los datos del conjunto de Andalucía. Conclusiones: La estrategia seguida ha permitido mejorar los indicadores de evaluación propuestos. El % de casos nuevos detectados en los estudios de contactos y la incidencia anual en menores de 15 años ha sido similar en este estudio que en Andalucía.

La evolución de los derrames pleurales malignos no sigue un comportamiento uniforme en todos los casos. Ante este hecho nos planteamos la cuestión de si existe algún factor cuyo estudio en el líquido pleural que nos queda señalar a priori el comportamiento posterior del derrame, y por tanto la actitud a tomar ante el mismo (pleurodesis como aproximación inicial o no). Durante el período de siete años (año 1993 - 2000), hemos realizado un estudio prospectivo longitudinal, en el que han sido incluidos 100 pacientes con diagnóstico confirmado de derrame pleural neoplásico y con volumen de derrame inferior a 2/3 de un hemitórax. En todos los pacientes se realizaron toracocentesis evacuadores (en función de la clínica del paciente) con determinaciones de rutina en las muestras de líquido pleural extraídas: pH, glucosa, LDH, recuento celular total, proteínas totales, Dímero D y citología. La pleurodesis se indicó en los pacientes con significativa recurrencia del derrame. La pleurodesis fue realizada con talco (10 cc, aproximadamente 6 g de talco seco) mediante toracoscopia con anestesia local y analgesia parenteral. De los 100 pacientes incluidos en el estudio, 60 requirieron pleurodesis con talco en su evolución para controlar el derrame, los 40 pacientes restantes no fueron sometidos a esta técnica (26 de ellos por control del derrame de forma conservadora y los restantes 12 por su situación clínica terminal). Los pacientes que requirieron pleurodesis presentaron una disminución de las cifras de pH en las sucesivas toracocentesis realizadas (cáida de 0,002/día) y un aumento en las cifras de Dímero D también en las toracocentesis realizadas (0,09/día). En los pacientes en los que no se requirió pleurodesis para el control del derame, sucedió lo contrario (aumento de 0,003/día en las cifras de pH y caída de /día en las cifras de Dímero D). En el resto de parámetros estudiados no encontramos diferencias s