Inmaculada Alfageme | Universidad de Sevilla (original) (raw)
Papers by Inmaculada Alfageme
Archivos De Bronconeumologia, Mar 1, 2014
Archivos De Bronconeumologia, Nov 1, 2005
La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente, con un gran impacto en l... more La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente, con un gran impacto en los sistemas de salud debido al importante consumo de re-cursos sanitarios que supone 1,2. Según la guía británica 3 , basada en estudios prospectivos de población de Reino Unido, Finlandia y Norteamérica, la incidencia anual de NAC se sitúa entre 5 y 11 casos por 1.000 personas en población adulta. Esta incidencia varía con la edad, de modo que es de 20 por 1.000 y año en los mayores de 60 años y de 34 por 1.000 en los mayores de 75 años 3. Fine et al 4 elaboraron en 1997 un sistema de estratificación de la gravedad de los pacientes con NAC según el riesgo de muerte. Este sistema reúne una serie de ítems entre los que se incluyen factores demográficos, Financiado por SEPAR y Servicio Andaluz de Salud (53/99).
Archivos De Bronconeumologia, Oct 1, 2017
Objective: To describe the evidence-and experience-based expert consensus on the use of single-ag... more Objective: To describe the evidence-and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Methods: Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among 16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Center for Evidence-based Medicine levels. Results: A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. Conclusions: These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD.
Objective: to assess the role of comorbidities with all cause mortality in patients with stable C... more Objective: to assess the role of comorbidities with all cause mortality in patients with stable COPD Material and Methods: prospective, multicenter, longitudinal study of patients with stable COPD. We recorded demographic characteristics, respiratory functional tests, medication received, comorbidities, Charlson comorbidity index and hospital anxiety and depression scale. Patients were followed up for 3 years. In case of death it was investigated to determine the real cause of death Results: 138 patients were studied with a mean age of 66.3±10.3 years and mean FEV1 of 51.3±16.9%. The mean Charlson index was 4.66 ± 1.57. 17.2% had depression and 12.7% anxiety. Thirteen (9.5%) patients died, 5 of lung cancer, 5 COPD exacerbation, 1 colon cancer, another for acute myocardial infarction (AMI) and another one for congestive heart failure (CHF). The bivariate analysis showed statistical differences in Charlson index, number of comorbidities, hypertension, AMI, CHF, treatment with noninvasive mechanical ventilation, antidepressants and anxiolytics. In the multivariate analysis the number of comorbidities (HR 1.926; 95%IC: 1.384-2.680) and anxiolytic treatment (HR 4.072; IC95%: 1.106-14.987) showed relationship with mortality. Kaplan-Meier survival plots showed that patients with 2 o more comorbilities, in addition to COPD, have higher mortality than patients with 1 or no comorbidity (35.52±0.2 vs 33±1.3 months, p=0,039). Conclusions: The prevalence of comorbidities in patients with stable COPD was high. Mortality in these patients is related to the number of comorbidities and anxiolytic treatment. Mortality was higher in patients with 2 o more comorbidities. Funded by NEUMOSUR.
Archivos De Bronconeumologia, 2008
Chest, Mar 1, 1998
Objectives: To evaluate etiology, bacteriology, stage of disease, treatment, and outcome of HIV-i... more Objectives: To evaluate etiology, bacteriology, stage of disease, treatment, and outcome of HIV-infected patients with thoracic empyema (TE) over a 9-year period at a hospital teaching center. Design: We have retrospectively reviewed the charts of all HIV-infected patients with a hospital discharge diagnosis of empyema between January 1985 and November 1993. Patients: Twenty-three patients were identified (22 male and 1 female). The average patient age was 28.7±5.3 years. All the patients were injection-drug users, and 10 (43%) fulfilled criteria for an AIDS diagnosis. In 15 cases (65%), the empyema was the first cause of medical consultation, which then led to an HIV infection diagnosis in 11 of them (48%). Measurements: In each case, symptoms, chest studies, culture results, procedure timing, length of hospitalization, and outcome were reviewed. Results: Twenty-one patients (91%) had developed an empyema secondary to communityacquired pneumonia. The cultures of pleural fluid were positive in 19 cases (83%). Anaerobes were isolated from 6 patients and aerobes from 13. A single bacteria was isolated from 10 (52%), and multiple organisms (average 2.66 per case) grew in the remaining 9 positive cultures. The most common organism culture growths were Staphylococcus aureus (23%) and Gram-negative bacilli (36%). Length of hospitalization averaged 25.6 days (±15). Intercostal tube drainage was necessary in 18 patients and none required surgery. Patients with AIDS diagnosis needed a longer period of hospitalization, and the presence of bacteremia and bronchopleural fistula was more frequent. However, this did not influence a patient's final outcome. A follow-up was available in 18 cases, with 4 deaths recorded (average survival, 35 months; range, 4 to 84 months). Conclusions: In our series, TE associated with HIV infection was often the primary cause leading to hospital admission and later HIV diagnosis. IV drug abuse was the predominant factor for HIV infection and was also related to clinical presentation and microbiological findings. The best approach to treatment is.as with other patient groups.a prompt drainage and appropriate antibiotic treatment, since a favorable outcome is expected.
Archivos De Bronconeumologia, May 1, 2019
Archivos De Bronconeumologia, Nov 1, 2017
Archivos De Bronconeumologia, 2007
Archivos De Bronconeumologia, Oct 1, 2017
Archivos De Bronconeumologia, 2017
Journal of bronchology & interventional pulmonology, Jul 1, 2009
Pulmonary mucormycosis is a rare fungal infection that appears in patients with hematologic disea... more Pulmonary mucormycosis is a rare fungal infection that appears in patients with hematologic diseases who are immunosuppressed by chemotherapy. We report a case of pulmonary mucormycosis in a 21-year-old man with acute lymphoblastic leukaemia. During the period of pancytopenia he developed invasive mucormycosis. His initial symptoms were pleuritic chest pain with fever and unresponsiveness to broad-spectrum antibiotics. The outcome was favorable after long-term systemic and aerosolized amphotericin B, endobronchial instillations of amphotericin B, posaconazole, and surgery.
Archivos De Bronconeumologia, 2004
Archivos De Bronconeumologia, 2007
El control colinérgico de la vía aérea en pacientes con enfermedad pulmonar obstructiva crónica (... more El control colinérgico de la vía aérea en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) hace que los fármacos anticolinérgicos sean el tratamiento de elección de la obstrucción crónica del flujo aéreo en estos pacientes. El tiotropio, un anticolinérgico ...
Archivos De Bronconeumologia, 2008
CARTAS AL DIRECTOR Neumonía de lenta resolución en un varón fumador de 70 años
Archivos De Bronconeumologia, Nov 1, 2017
Archivos De Bronconeumologia, Oct 1, 2017
Archivos De Bronconeumologia, Mar 1, 2016
Chest, Aug 1, 1994
The aim of this prospective study was to determine the rate of recurrence for spontaneous pneumot... more The aim of this prospective study was to determine the rate of recurrence for spontaneous pneumothorax (SP) after tetracycline pleurodesis (TCP), using that of observation, tube thoracostomy alone, and thoracotomy as references. From 1985 to the end of 1991, 78 patients were treated with tetracycline pleurodesis and 135 patients served as control subjects. Pleurodesis was induced by instillation of tetracycline and ascorbic acid through the pleural drain. The indication was any SP treated with tube thoracostomy, without active pulmonary infection. Follow-up period was from 13 to 95 months (mean, 45 months); follow-up rate was 94 percent. Post-therapy surgery was necessary for eight patients in whom pleurodesis failed due to presence of a persistent air leak. The ipsilateral recurrence rate of patients treated with TCP was 9 percent (6/66) and recurrence time ranged from 2 days to 9 months. The recurrence rate for patients treated with observation was 36 percent, 35 percent for those having chest tube alone,
Archivos De Bronconeumologia, Mar 1, 2014
Archivos De Bronconeumologia, Nov 1, 2005
La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente, con un gran impacto en l... more La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente, con un gran impacto en los sistemas de salud debido al importante consumo de re-cursos sanitarios que supone 1,2. Según la guía británica 3 , basada en estudios prospectivos de población de Reino Unido, Finlandia y Norteamérica, la incidencia anual de NAC se sitúa entre 5 y 11 casos por 1.000 personas en población adulta. Esta incidencia varía con la edad, de modo que es de 20 por 1.000 y año en los mayores de 60 años y de 34 por 1.000 en los mayores de 75 años 3. Fine et al 4 elaboraron en 1997 un sistema de estratificación de la gravedad de los pacientes con NAC según el riesgo de muerte. Este sistema reúne una serie de ítems entre los que se incluyen factores demográficos, Financiado por SEPAR y Servicio Andaluz de Salud (53/99).
Archivos De Bronconeumologia, Oct 1, 2017
Objective: To describe the evidence-and experience-based expert consensus on the use of single-ag... more Objective: To describe the evidence-and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Methods: Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among 16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Center for Evidence-based Medicine levels. Results: A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. Conclusions: These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD.
Objective: to assess the role of comorbidities with all cause mortality in patients with stable C... more Objective: to assess the role of comorbidities with all cause mortality in patients with stable COPD Material and Methods: prospective, multicenter, longitudinal study of patients with stable COPD. We recorded demographic characteristics, respiratory functional tests, medication received, comorbidities, Charlson comorbidity index and hospital anxiety and depression scale. Patients were followed up for 3 years. In case of death it was investigated to determine the real cause of death Results: 138 patients were studied with a mean age of 66.3±10.3 years and mean FEV1 of 51.3±16.9%. The mean Charlson index was 4.66 ± 1.57. 17.2% had depression and 12.7% anxiety. Thirteen (9.5%) patients died, 5 of lung cancer, 5 COPD exacerbation, 1 colon cancer, another for acute myocardial infarction (AMI) and another one for congestive heart failure (CHF). The bivariate analysis showed statistical differences in Charlson index, number of comorbidities, hypertension, AMI, CHF, treatment with noninvasive mechanical ventilation, antidepressants and anxiolytics. In the multivariate analysis the number of comorbidities (HR 1.926; 95%IC: 1.384-2.680) and anxiolytic treatment (HR 4.072; IC95%: 1.106-14.987) showed relationship with mortality. Kaplan-Meier survival plots showed that patients with 2 o more comorbilities, in addition to COPD, have higher mortality than patients with 1 or no comorbidity (35.52±0.2 vs 33±1.3 months, p=0,039). Conclusions: The prevalence of comorbidities in patients with stable COPD was high. Mortality in these patients is related to the number of comorbidities and anxiolytic treatment. Mortality was higher in patients with 2 o more comorbidities. Funded by NEUMOSUR.
Archivos De Bronconeumologia, 2008
Chest, Mar 1, 1998
Objectives: To evaluate etiology, bacteriology, stage of disease, treatment, and outcome of HIV-i... more Objectives: To evaluate etiology, bacteriology, stage of disease, treatment, and outcome of HIV-infected patients with thoracic empyema (TE) over a 9-year period at a hospital teaching center. Design: We have retrospectively reviewed the charts of all HIV-infected patients with a hospital discharge diagnosis of empyema between January 1985 and November 1993. Patients: Twenty-three patients were identified (22 male and 1 female). The average patient age was 28.7±5.3 years. All the patients were injection-drug users, and 10 (43%) fulfilled criteria for an AIDS diagnosis. In 15 cases (65%), the empyema was the first cause of medical consultation, which then led to an HIV infection diagnosis in 11 of them (48%). Measurements: In each case, symptoms, chest studies, culture results, procedure timing, length of hospitalization, and outcome were reviewed. Results: Twenty-one patients (91%) had developed an empyema secondary to communityacquired pneumonia. The cultures of pleural fluid were positive in 19 cases (83%). Anaerobes were isolated from 6 patients and aerobes from 13. A single bacteria was isolated from 10 (52%), and multiple organisms (average 2.66 per case) grew in the remaining 9 positive cultures. The most common organism culture growths were Staphylococcus aureus (23%) and Gram-negative bacilli (36%). Length of hospitalization averaged 25.6 days (±15). Intercostal tube drainage was necessary in 18 patients and none required surgery. Patients with AIDS diagnosis needed a longer period of hospitalization, and the presence of bacteremia and bronchopleural fistula was more frequent. However, this did not influence a patient's final outcome. A follow-up was available in 18 cases, with 4 deaths recorded (average survival, 35 months; range, 4 to 84 months). Conclusions: In our series, TE associated with HIV infection was often the primary cause leading to hospital admission and later HIV diagnosis. IV drug abuse was the predominant factor for HIV infection and was also related to clinical presentation and microbiological findings. The best approach to treatment is.as with other patient groups.a prompt drainage and appropriate antibiotic treatment, since a favorable outcome is expected.
Archivos De Bronconeumologia, May 1, 2019
Archivos De Bronconeumologia, Nov 1, 2017
Archivos De Bronconeumologia, 2007
Archivos De Bronconeumologia, Oct 1, 2017
Archivos De Bronconeumologia, 2017
Journal of bronchology & interventional pulmonology, Jul 1, 2009
Pulmonary mucormycosis is a rare fungal infection that appears in patients with hematologic disea... more Pulmonary mucormycosis is a rare fungal infection that appears in patients with hematologic diseases who are immunosuppressed by chemotherapy. We report a case of pulmonary mucormycosis in a 21-year-old man with acute lymphoblastic leukaemia. During the period of pancytopenia he developed invasive mucormycosis. His initial symptoms were pleuritic chest pain with fever and unresponsiveness to broad-spectrum antibiotics. The outcome was favorable after long-term systemic and aerosolized amphotericin B, endobronchial instillations of amphotericin B, posaconazole, and surgery.
Archivos De Bronconeumologia, 2004
Archivos De Bronconeumologia, 2007
El control colinérgico de la vía aérea en pacientes con enfermedad pulmonar obstructiva crónica (... more El control colinérgico de la vía aérea en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) hace que los fármacos anticolinérgicos sean el tratamiento de elección de la obstrucción crónica del flujo aéreo en estos pacientes. El tiotropio, un anticolinérgico ...
Archivos De Bronconeumologia, 2008
CARTAS AL DIRECTOR Neumonía de lenta resolución en un varón fumador de 70 años
Archivos De Bronconeumologia, Nov 1, 2017
Archivos De Bronconeumologia, Oct 1, 2017
Archivos De Bronconeumologia, Mar 1, 2016
Chest, Aug 1, 1994
The aim of this prospective study was to determine the rate of recurrence for spontaneous pneumot... more The aim of this prospective study was to determine the rate of recurrence for spontaneous pneumothorax (SP) after tetracycline pleurodesis (TCP), using that of observation, tube thoracostomy alone, and thoracotomy as references. From 1985 to the end of 1991, 78 patients were treated with tetracycline pleurodesis and 135 patients served as control subjects. Pleurodesis was induced by instillation of tetracycline and ascorbic acid through the pleural drain. The indication was any SP treated with tube thoracostomy, without active pulmonary infection. Follow-up period was from 13 to 95 months (mean, 45 months); follow-up rate was 94 percent. Post-therapy surgery was necessary for eight patients in whom pleurodesis failed due to presence of a persistent air leak. The ipsilateral recurrence rate of patients treated with TCP was 9 percent (6/66) and recurrence time ranged from 2 days to 9 months. The recurrence rate for patients treated with observation was 36 percent, 35 percent for those having chest tube alone,