Adult smokers, those with comorbidities, and the
elderly, are at greater risk of contracting infe... more Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory infections due to viruses, pneumococcus and other bacteria, affect both healthy and sick adults. There are vaccines that the pulmonologist must know and prescribe. The target strains of the influenza vaccine are defined by the WHO for the Southern hemisphere considering MEDICINA (Buenos Aires) 2024; 84: 108-124 109 Actualización en vacunación en adultos con enfermedades respiratorias crónicas Artículo especial - Revisión those involved in the previous influenza season in the Northern hemisphere. Its effectiveness depends on virulence, concordance between circulating and vaccine strains, and population coverage. The anti-pneumococcal polysaccharide vaccine available since 1983 is being replaced by more effective conjugate vaccines to prevent infections related to serotypes present in them. Immunization against SARS-CoV-2 reduced the contagion, severity, and lethality of COVID-19. The acellular vaccine against Bordetella pertussis for adults is present for specific situations in the adult calendar; vaccinating them strengthens the control of childhood contagion. The double (diphtheria + tetanus), and triple (double + pertussis) bacterial vaccines, and the vaccines against measles, chickenpox, rubella, human papillomavirus, Haemophilus influenzae, meningococcus, herpes zoster, Argentine hemorrhagic fever and yellow fever, are of a more limited use. Soon we will have new vaccines such as the one recently approved by the FDA against respiratory syncytial virus. Through a consensus of experts in respiratory infections, we review the new evidence regarding the immunization of adults who consult a pulmonologist, and thus update the recommendations on vaccination made eight years ago.
DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2022
Who quit smoking and who wants to quit?: Secondary analysis from Global Adult Tobacco Survey in A... more Who quit smoking and who wants to quit?: Secondary analysis from Global Adult Tobacco Survey in Argentina. La reducción del daño a la salud causado por el tabaco depende de la cesación. Se han descripto características sociodemográficas y personales relacionadas con el cese, pero no se cuenta con análisis en esta población. El objetivo fue evaluar los predictores de ser ex fumador o estar en una etapa favorable para dejar de fumar en la población urbana de Argentina.
Las líneas telefónicas de ayuda al fumador son un medio eficaz para promover la cesación. La inco... more Las líneas telefónicas de ayuda al fumador son un medio eficaz para promover la cesación. La incorporación de imágenes y frases como advertencias sanitarias junto al número de la línea en el paquete de cigarrillos se asoció a un incremento sustancial de llamadas, comparable al logrado por fuertes campañas en medios masivos.
Background Lung cancer (LC) screening improves LC survival; the best screening method in terms of... more Background Lung cancer (LC) screening improves LC survival; the best screening method in terms of improving survival is low-dose CT (LDCT), outpacing chest X-ray and sputum cytology. Methods A consensus of experts in Argentina was carried out to review the literature and generate recommendations for LC screening programmes. A mixed-method study was used with three phases: (1) review of the literature; (2) modified Delphi consensus panel; and (3) development of the recommendations. The Evidence to Decision (EtD) framework was used to generate 13 evaluation criteria. Nineteen experts participated in four voting rounds. Consensus among participants was defined using the RAND/UCLA method. Results A total of 16 recommendations scored ≥7 points with no disagreement on any criteria. Screening for LC should be performed with LDCT annually in the population at high-risk, aged between 55 and 74 years, regardless of sex, without comorbidities with a risk of death higher than the risk of death from LC, smoking ≥30 pack-years or former smokers who quit smoking within 15 years. Screening will be considered positive when finding a solid nodule ≥6 mm in diameter (or ≥113 mm 3) on baseline LDCT and 4 mm in diameter if a new nodule is identified on annual screening. A smoking cessation programme should be offered, and cardiovascular risk assessment should be performed. Institutions should have a multidisciplinary committee, have protocols for the management of symptomatic patients not included in the programme and distribute educational material. Conclusion The recommendations provide a basis for minimum requirements from which local institutions can develop their own protocols adapted to their needs and resources.
INTRODUCCIÓN: Los cigarrillos electrónicos (CE) aparecieron en 2004 y actualmente se consumen en ... more INTRODUCCIÓN: Los cigarrillos electrónicos (CE) aparecieron en 2004 y actualmente se consumen en la mayoría de los países. En Argentina, la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) prohibió su venta en 2011. El objetivo principal de este reporte fue informar las prevalencias de consumo actual de cigarrillos tradicionales y de CE en adultos y adolescentes de Argentina. MÉTODOS: Los datos sobre adultos se obtuvieron de la Encuesta Nacional de Factores de Riesgo de 2018 con representatividad nacional. Los datos de jóvenes provinieron de la Encuesta Mundial de Tabaco en Jóvenes de 2018, que incluyó a 1845 alumnos de escuelas públicas y privadas a nivel nacional. RESULTADOS: En adultos, la prevalencia de consumo actual de cigarrillos tradicionales fue del 22,2% y la de CE fue del 1,1%. Entre los jóvenes de 13 a 15 años, el 18,0% refirió haber consumido cigarrillos tradicionales y el 7,1%, CE en los 30 días previos a la encuesta. El 14,4% había consum...
The pulmonologist uses to prescribe vaccines to adult patients. Experts of the Argentina Associat... more The pulmonologist uses to prescribe vaccines to adult patients. Experts of the Argentina Association of Respiratory Medicine who are specialists in areas inv...
Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung ca... more Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung cancer (NSCLC). Patients with poor performance status (PS) are underrepresented in clinical trials. We evaluate the efficacy and safety of ICIs in a real-world setting. We conducted a multi-institutional retrospective study to assess clinical outcomes of NSCLC treated with ICIs. We categorized pts within two groups (PS 0–1 vs 2) and assessed clinical outcomes and safety. Two hundred and sixty nine patients were included, 44 patients (16.4%) had baseline PS 2 and 223 patients (82.9%) PS 0–1. The overall response rate (ORR) was 30.4%, median PFS was 7.26 months (95% CI 5.1–9.4), and median OS was 15.18 months (95% CI 9.5–20.9). Patients with a PS 2 were most likely to received ICIs in the second or later line (84.1% vs 64.6%; p = 0.01), had baseline steroids (21.4% vs 8.2%; p 0.010), lower response rate (16.7% vs 34.5%; p 0.02) and clinical benefit (35.7% vs 71%; p 0.000) compared to PS 0–1 pts. Moreover, PS ≥ 2 patients had shorter PFS, median 2.2 months (95% CI 1.3–3.1) compared to 9.9 months (95% CI 6.7–13.1] and shorter OS, 3.3 months (95% CI 2.6–4.2) versus 24.1 months (95% CI 16.1–32.1), respectively. PS was significantly associated with PFS and OS in multivariate analysis. As it was expected, immunotherapy was well tolerated with a safety profile comparable to the previous published data. Based on these retrospective results, patients with poor baseline performance status seem to have poor clinical outcomes with ICIs in the real-world setting.
Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of t... more Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the ...
To investigate the burden of asthma in a young adult population in urban areas of Argentina. A na... more To investigate the burden of asthma in a young adult population in urban areas of Argentina. A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications. In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with ...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 27, 2016
Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective w... more Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective was to assess the strength of this association in the world population, updating a previous work. Systematic review and meta-analysis of observational studies. Subgroup analyses included continents, WHO regions, country mortality levels, gender, age, risk of bias and study publication date. Independent reviewers selected studies, assessed potential bias and extracted data. We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, AFRICAN INDEX MEDICUS, and LILACS, and other sources from 1989 to 2013 reporting direct measurements of income and current cigarette smoking. We retrieved 13,583 articles and included 93 for meta-analysis. Median smoking prevalence was 17.8% (range 3-70%). Lower income was consistently associated with higher smoking prevalence (OR 1.45 95%CI 1.35-1.56). This association was statistically significant in the subgroup analysis by WHO regions for the Americas (OR 1.54 95%CI 1....
Adult smokers, those with comorbidities, and the
elderly, are at greater risk of contracting infe... more Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory infections due to viruses, pneumococcus and other bacteria, affect both healthy and sick adults. There are vaccines that the pulmonologist must know and prescribe. The target strains of the influenza vaccine are defined by the WHO for the Southern hemisphere considering MEDICINA (Buenos Aires) 2024; 84: 108-124 109 Actualización en vacunación en adultos con enfermedades respiratorias crónicas Artículo especial - Revisión those involved in the previous influenza season in the Northern hemisphere. Its effectiveness depends on virulence, concordance between circulating and vaccine strains, and population coverage. The anti-pneumococcal polysaccharide vaccine available since 1983 is being replaced by more effective conjugate vaccines to prevent infections related to serotypes present in them. Immunization against SARS-CoV-2 reduced the contagion, severity, and lethality of COVID-19. The acellular vaccine against Bordetella pertussis for adults is present for specific situations in the adult calendar; vaccinating them strengthens the control of childhood contagion. The double (diphtheria + tetanus), and triple (double + pertussis) bacterial vaccines, and the vaccines against measles, chickenpox, rubella, human papillomavirus, Haemophilus influenzae, meningococcus, herpes zoster, Argentine hemorrhagic fever and yellow fever, are of a more limited use. Soon we will have new vaccines such as the one recently approved by the FDA against respiratory syncytial virus. Through a consensus of experts in respiratory infections, we review the new evidence regarding the immunization of adults who consult a pulmonologist, and thus update the recommendations on vaccination made eight years ago.
DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2022
Who quit smoking and who wants to quit?: Secondary analysis from Global Adult Tobacco Survey in A... more Who quit smoking and who wants to quit?: Secondary analysis from Global Adult Tobacco Survey in Argentina. La reducción del daño a la salud causado por el tabaco depende de la cesación. Se han descripto características sociodemográficas y personales relacionadas con el cese, pero no se cuenta con análisis en esta población. El objetivo fue evaluar los predictores de ser ex fumador o estar en una etapa favorable para dejar de fumar en la población urbana de Argentina.
Las líneas telefónicas de ayuda al fumador son un medio eficaz para promover la cesación. La inco... more Las líneas telefónicas de ayuda al fumador son un medio eficaz para promover la cesación. La incorporación de imágenes y frases como advertencias sanitarias junto al número de la línea en el paquete de cigarrillos se asoció a un incremento sustancial de llamadas, comparable al logrado por fuertes campañas en medios masivos.
Background Lung cancer (LC) screening improves LC survival; the best screening method in terms of... more Background Lung cancer (LC) screening improves LC survival; the best screening method in terms of improving survival is low-dose CT (LDCT), outpacing chest X-ray and sputum cytology. Methods A consensus of experts in Argentina was carried out to review the literature and generate recommendations for LC screening programmes. A mixed-method study was used with three phases: (1) review of the literature; (2) modified Delphi consensus panel; and (3) development of the recommendations. The Evidence to Decision (EtD) framework was used to generate 13 evaluation criteria. Nineteen experts participated in four voting rounds. Consensus among participants was defined using the RAND/UCLA method. Results A total of 16 recommendations scored ≥7 points with no disagreement on any criteria. Screening for LC should be performed with LDCT annually in the population at high-risk, aged between 55 and 74 years, regardless of sex, without comorbidities with a risk of death higher than the risk of death from LC, smoking ≥30 pack-years or former smokers who quit smoking within 15 years. Screening will be considered positive when finding a solid nodule ≥6 mm in diameter (or ≥113 mm 3) on baseline LDCT and 4 mm in diameter if a new nodule is identified on annual screening. A smoking cessation programme should be offered, and cardiovascular risk assessment should be performed. Institutions should have a multidisciplinary committee, have protocols for the management of symptomatic patients not included in the programme and distribute educational material. Conclusion The recommendations provide a basis for minimum requirements from which local institutions can develop their own protocols adapted to their needs and resources.
INTRODUCCIÓN: Los cigarrillos electrónicos (CE) aparecieron en 2004 y actualmente se consumen en ... more INTRODUCCIÓN: Los cigarrillos electrónicos (CE) aparecieron en 2004 y actualmente se consumen en la mayoría de los países. En Argentina, la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) prohibió su venta en 2011. El objetivo principal de este reporte fue informar las prevalencias de consumo actual de cigarrillos tradicionales y de CE en adultos y adolescentes de Argentina. MÉTODOS: Los datos sobre adultos se obtuvieron de la Encuesta Nacional de Factores de Riesgo de 2018 con representatividad nacional. Los datos de jóvenes provinieron de la Encuesta Mundial de Tabaco en Jóvenes de 2018, que incluyó a 1845 alumnos de escuelas públicas y privadas a nivel nacional. RESULTADOS: En adultos, la prevalencia de consumo actual de cigarrillos tradicionales fue del 22,2% y la de CE fue del 1,1%. Entre los jóvenes de 13 a 15 años, el 18,0% refirió haber consumido cigarrillos tradicionales y el 7,1%, CE en los 30 días previos a la encuesta. El 14,4% había consum...
The pulmonologist uses to prescribe vaccines to adult patients. Experts of the Argentina Associat... more The pulmonologist uses to prescribe vaccines to adult patients. Experts of the Argentina Association of Respiratory Medicine who are specialists in areas inv...
Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung ca... more Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung cancer (NSCLC). Patients with poor performance status (PS) are underrepresented in clinical trials. We evaluate the efficacy and safety of ICIs in a real-world setting. We conducted a multi-institutional retrospective study to assess clinical outcomes of NSCLC treated with ICIs. We categorized pts within two groups (PS 0–1 vs 2) and assessed clinical outcomes and safety. Two hundred and sixty nine patients were included, 44 patients (16.4%) had baseline PS 2 and 223 patients (82.9%) PS 0–1. The overall response rate (ORR) was 30.4%, median PFS was 7.26 months (95% CI 5.1–9.4), and median OS was 15.18 months (95% CI 9.5–20.9). Patients with a PS 2 were most likely to received ICIs in the second or later line (84.1% vs 64.6%; p = 0.01), had baseline steroids (21.4% vs 8.2%; p 0.010), lower response rate (16.7% vs 34.5%; p 0.02) and clinical benefit (35.7% vs 71%; p 0.000) compared to PS 0–1 pts. Moreover, PS ≥ 2 patients had shorter PFS, median 2.2 months (95% CI 1.3–3.1) compared to 9.9 months (95% CI 6.7–13.1] and shorter OS, 3.3 months (95% CI 2.6–4.2) versus 24.1 months (95% CI 16.1–32.1), respectively. PS was significantly associated with PFS and OS in multivariate analysis. As it was expected, immunotherapy was well tolerated with a safety profile comparable to the previous published data. Based on these retrospective results, patients with poor baseline performance status seem to have poor clinical outcomes with ICIs in the real-world setting.
Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of t... more Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the ...
To investigate the burden of asthma in a young adult population in urban areas of Argentina. A na... more To investigate the burden of asthma in a young adult population in urban areas of Argentina. A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications. In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with ...
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 27, 2016
Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective w... more Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective was to assess the strength of this association in the world population, updating a previous work. Systematic review and meta-analysis of observational studies. Subgroup analyses included continents, WHO regions, country mortality levels, gender, age, risk of bias and study publication date. Independent reviewers selected studies, assessed potential bias and extracted data. We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, AFRICAN INDEX MEDICUS, and LILACS, and other sources from 1989 to 2013 reporting direct measurements of income and current cigarette smoking. We retrieved 13,583 articles and included 93 for meta-analysis. Median smoking prevalence was 17.8% (range 3-70%). Lower income was consistently associated with higher smoking prevalence (OR 1.45 95%CI 1.35-1.56). This association was statistically significant in the subgroup analysis by WHO regions for the Americas (OR 1.54 95%CI 1....
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elderly, are at greater risk of contracting infections and
their complications. Community acquired respiratory
infections due to viruses, pneumococcus and other bacteria,
affect both healthy and sick adults. There are vaccines
that the pulmonologist must know and prescribe.
The target strains of the influenza vaccine are defined
by the WHO for the Southern hemisphere considering
MEDICINA (Buenos Aires) 2024; 84: 108-124 109
Actualización en vacunación en adultos con enfermedades respiratorias crónicas Artículo especial - Revisión
those involved in the previous influenza season in the
Northern hemisphere. Its effectiveness depends on
virulence, concordance between circulating and vaccine
strains, and population coverage. The anti-pneumococcal
polysaccharide vaccine available since 1983 is being
replaced by more effective conjugate vaccines to prevent
infections related to serotypes present in them.
Immunization against SARS-CoV-2 reduced the contagion,
severity, and lethality of COVID-19. The acellular
vaccine against Bordetella pertussis for adults is present
for specific situations in the adult calendar; vaccinating
them strengthens the control of childhood contagion.
The double (diphtheria + tetanus), and triple (double +
pertussis) bacterial vaccines, and the vaccines against
measles, chickenpox, rubella, human papillomavirus,
Haemophilus influenzae, meningococcus, herpes zoster,
Argentine hemorrhagic fever and yellow fever, are of a
more limited use. Soon we will have new vaccines such
as the one recently approved by the FDA against respiratory
syncytial virus. Through a consensus of experts
in respiratory infections, we review the new evidence
regarding the immunization of adults who consult a
pulmonologist, and thus update the recommendations
on vaccination made eight years ago.
elderly, are at greater risk of contracting infections and
their complications. Community acquired respiratory
infections due to viruses, pneumococcus and other bacteria,
affect both healthy and sick adults. There are vaccines
that the pulmonologist must know and prescribe.
The target strains of the influenza vaccine are defined
by the WHO for the Southern hemisphere considering
MEDICINA (Buenos Aires) 2024; 84: 108-124 109
Actualización en vacunación en adultos con enfermedades respiratorias crónicas Artículo especial - Revisión
those involved in the previous influenza season in the
Northern hemisphere. Its effectiveness depends on
virulence, concordance between circulating and vaccine
strains, and population coverage. The anti-pneumococcal
polysaccharide vaccine available since 1983 is being
replaced by more effective conjugate vaccines to prevent
infections related to serotypes present in them.
Immunization against SARS-CoV-2 reduced the contagion,
severity, and lethality of COVID-19. The acellular
vaccine against Bordetella pertussis for adults is present
for specific situations in the adult calendar; vaccinating
them strengthens the control of childhood contagion.
The double (diphtheria + tetanus), and triple (double +
pertussis) bacterial vaccines, and the vaccines against
measles, chickenpox, rubella, human papillomavirus,
Haemophilus influenzae, meningococcus, herpes zoster,
Argentine hemorrhagic fever and yellow fever, are of a
more limited use. Soon we will have new vaccines such
as the one recently approved by the FDA against respiratory
syncytial virus. Through a consensus of experts
in respiratory infections, we review the new evidence
regarding the immunization of adults who consult a
pulmonologist, and thus update the recommendations
on vaccination made eight years ago.