We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain ... more We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe communityacquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.
Relationship between Body Mass Index, Sex, Age and Respiratory Abnormalities during Sleep Introdu... more Relationship between Body Mass Index, Sex, Age and Respiratory Abnormalities during Sleep Introduction: Obesity, sex and age are factors that predispose to obstructive sleep apnea (OSA). In order to understand its impact on the indicators of respiratory polygraphy (RP), this study evaluated the relationship of the apnea/hypopnea index (AHI), the desaturation index (ODI) and time of less than 90% saturation (T < 90%) in patients classified by body mass index (BMI), sex and age. Methods: Retrospective study of 635 patients with OSA. The values of IAH, ODI and T <90% and their relationships in obese and non-obese patients were analysed using Kruskal-Wallis and Dunn's multiple comparisons tests. Results: We found an increase in the AHI, which was related to age in women and related to BMI in men. The T < 90% was associated with obesity in both, females and males. The agreement between IAH and IDO was higher in patients with BMI < 30 and it was decreasing proportionally w...
Home mechanical ventilation represents a standard of care in the insufficiency of the ventilatory... more Home mechanical ventilation represents a standard of care in the insufficiency of the ventilatory pump. The follow-up model could change the hospitalization rate. In order to study hospitalizations in patients with home mechanical ventilation, a descriptive study was designed on a systematic collection database. Participants were patients with non-invasive ventilation or invasive mechanical ventilation consecutively included in a day hospital program between July 2014 and December 2016. Hospitalizations and their modality one year before and after the program were analyzed. Ninety four patients participated; 52 men (55%), age 64.4 ± 15.9 years; mean body mass index; 28.60 ± 8.46 kg/m2; 50% had obesity. Eighty patients (85%) received home mechanical ventilation; non-invasive in 77 cases and invasive in three (4%). Thirty two patients were re-admitted to the hospital in one year of follow-up. There were significant differences between the global admission rate before and after the pro...
The six-minute walk-test (6mWT) is potentially useful to define prognosis in patients with idiopa... more The six-minute walk-test (6mWT) is potentially useful to define prognosis in patients with idiopathic pulmonary fibrosis (IPF). The objective of this study w...
Monitoring of chronic home ventilation. Experience based on a day hospital model Introduction: Ho... more Monitoring of chronic home ventilation. Experience based on a day hospital model Introduction: Home mechanical ventilation (HMV) represents a standard of care for chronic ventilatory pump failure. The care model could be determinant in deficiencies in the control of quality of HMV. Material and methods: In order to monitoring compliance during home mechanical ventilation and optimize its effectiveness, we proposed a program through a day hospital conducted by pulmonology doctors and respiratory physiotherapist. A descriptive study was designed on a systematic collection database. Participants were consecutive patients with NIV or mechanical invasive ventilation (MIV) assisted in the Pulmonology Service between July 2014 and December 2016. Results: During 30 months we included 94 patients; 52 men (55%), age 64.4 ± 15.9 years and BMI of 28.6 ± 8.46 kg / m2. Fifty percent were obese or overweight. 80 were found with HMV (84%) noninvasive (NIV) in 77 cases and invasive in three (4%). 15...
Introduction: The diagnosis of Sleep Apnea Hypopnea Obstructive Syndrome (SAHOS) requires confirm... more Introduction: The diagnosis of Sleep Apnea Hypopnea Obstructive Syndrome (SAHOS) requires confirmation by polysomnography (PSG) or respiratory polygraphy (R...
SummaryBackgroundIota-Carrageenan (I-C) is a sulfate polysaccharide synthesized by red algae, wit... more SummaryBackgroundIota-Carrageenan (I-C) is a sulfate polysaccharide synthesized by red algae, with demonstrated antiviral activity and clinical efficacy as nasal spray in the treatment of common cold. In vitro, I-C inhibits SARS-CoV-2 infection in cell culture.MethodsThis is a pragmatic multicenter, randomized, double-blind, placebo-controlled trial assessing the use of a nasal spray containing I-C in the prophylaxis of COVID-19 in hospital personnel dedicated to care of COVID-19 patients.Clinically healthy physicians, nurses, kinesiologists and others medical providers were assigned in a 1:1 ratio to receive four daily doses of I-C spray or placebo for 21 days.The primary end point was clinical COVID-19, as confirmed by reverse-transcriptase–polymerase-chain-reaction testing, over a period of 21 days. The trial is registered at ClinicalTrials.gov (NCT04521322).FindingsA total of 394 individuals were randomly assigned to receive I-C or placebo. Both treatment groups had similar base...
... Reynaldo Smith and Julio Chertcoff: attending physicians. There is no conflict of interest. .... more ... Reynaldo Smith and Julio Chertcoff: attending physicians. There is no conflict of interest. ... A chest x-ray revealed a right upper lobe atelectasis with an approximately 6 cm in diameter round lesion as confirmed by a computerized tomography scan. ...
Objectives. To compare interfaces performance during home-based automatic titration (APAP). Metho... more Objectives. To compare interfaces performance during home-based automatic titration (APAP). Methods. Retrospective study based on APAP titration from Obstructive Sleep Apnea Syndrome (OSA) patients. Results. 707 patients, 513 men (70.6%), were titrated. Masks were 104 pillows (14.7%), group I (GI); 532 nasal (75.2%), group II (GII); and 71 oronasal masks (10%), group III (GIII). We found differences in effective pressure to the device (P90/P95) (GI: 7.13±1.9 vs. GII: 8.3±2.1 vs. GIII: 9.3±2.6 cmH2O, p <0.001) but not in final pressure titrated manually (GI: 7.9±1.4 vs. GII: 8.6±1.6 vs. GIII: 9.2±1.9 cm of H2O, p >0.5), where lower residual AHI for pillows was p <0.001 and leaks for nasal were p <0.001. No differences were found in compliance (hours) (GI: 6.3±1.2 vs. GII: 6.2±1.1 vs. GIII: 6.1±1.0, p <0.4). Conclusion. During auto-adjusting titration by CPAP-naïve patients, nasal masks had lower leak rates and nasal pillows presented a similar performance.
Hypertension (HT) and obstructive sleep apnea-hypopnea syndrome (OSA) are prevalent and frequentl... more Hypertension (HT) and obstructive sleep apnea-hypopnea syndrome (OSA) are prevalent and frequently related pathologies. The predictive value of screening questionnaires in cardiovascular settings is not totally clear and could be useful to select candidates for the sleep test. We performed a prospective study in adults with suspected HT referred to a day-care hospital. Epworth Sleepiness Scale (ESS), Berlin, and STOP-BANG (SBQ) questionnaire were checked against data from home-based respiratory polygraphy (RP). We calculated sensitivity (S) and specificity (Sp), positive and negative predictive values (PPV and NPV), and the area under the ROC curve (AUC-ROC) for each questionnaire and their combinations. We analyzed 382 patients; 234 men (61.3%) and 148 women, mean age: 54.5 ± 13.7 years, body mass index (BMI): 33.1 ± 7.8 kg/m, ESS: 7.4 ± 4.7. Seventy-eight percent had an apnea-hypopnea index (AHI) &gt;5 events per hour (eV/h) and 58% presented &gt;15 eV/h (mean: 17.5 ± 9.3 eV/h). With regard to clinically significant OSA (AHI &gt; 15 eV/h), 5 SBQ components showed S: 100% (CI: 97-100) and Sp: 98% (CI: 95-99) with a NPV of 100, a PPV of 97.8, and an AUC-ROC of 0.90 (p &lt; 0.0001). ESS &gt; 10 + high-risk Berlin did not perform as effectively. In a population of HT patients, SBQ &gt; 5 performed better at identifying patients with &gt;15 eV/hour with a high discrimination power.
To establish the prevalence of positional (PP) OSA patients using self-administered home-based re... more To establish the prevalence of positional (PP) OSA patients using self-administered home-based respiratory polygraphy (RP). 52 month retrospective study based on RP records. 200 PR records: 70.5% men 29.5% women. 76% were diagnosed with OSA and 54.6% with PP OSA. There were no significant differences in Epworth Sleepiness Scale, apnea hypopnea index and oxygen desaturation index. PP OSA patients were younger, had a lower BMI (30.3±0.9 vs. 35.3±1.2) (<0.0001), and the time they spent with oxygen saturation <90% (T<90) was lower (8.8 vs. 28.7±6.7, =0.0038). The PP OSA group spent 43% of total recording time in the supine position. The prevalence of PP OSA patients studied with RP is similar to the one described by sleep laboratories. They have lower BMI, present mostly mild OSA with less desaturation, and are less likely to receive CPAP therapy.
We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain ... more We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe communityacquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.
Relationship between Body Mass Index, Sex, Age and Respiratory Abnormalities during Sleep Introdu... more Relationship between Body Mass Index, Sex, Age and Respiratory Abnormalities during Sleep Introduction: Obesity, sex and age are factors that predispose to obstructive sleep apnea (OSA). In order to understand its impact on the indicators of respiratory polygraphy (RP), this study evaluated the relationship of the apnea/hypopnea index (AHI), the desaturation index (ODI) and time of less than 90% saturation (T < 90%) in patients classified by body mass index (BMI), sex and age. Methods: Retrospective study of 635 patients with OSA. The values of IAH, ODI and T <90% and their relationships in obese and non-obese patients were analysed using Kruskal-Wallis and Dunn's multiple comparisons tests. Results: We found an increase in the AHI, which was related to age in women and related to BMI in men. The T < 90% was associated with obesity in both, females and males. The agreement between IAH and IDO was higher in patients with BMI < 30 and it was decreasing proportionally w...
Home mechanical ventilation represents a standard of care in the insufficiency of the ventilatory... more Home mechanical ventilation represents a standard of care in the insufficiency of the ventilatory pump. The follow-up model could change the hospitalization rate. In order to study hospitalizations in patients with home mechanical ventilation, a descriptive study was designed on a systematic collection database. Participants were patients with non-invasive ventilation or invasive mechanical ventilation consecutively included in a day hospital program between July 2014 and December 2016. Hospitalizations and their modality one year before and after the program were analyzed. Ninety four patients participated; 52 men (55%), age 64.4 ± 15.9 years; mean body mass index; 28.60 ± 8.46 kg/m2; 50% had obesity. Eighty patients (85%) received home mechanical ventilation; non-invasive in 77 cases and invasive in three (4%). Thirty two patients were re-admitted to the hospital in one year of follow-up. There were significant differences between the global admission rate before and after the pro...
The six-minute walk-test (6mWT) is potentially useful to define prognosis in patients with idiopa... more The six-minute walk-test (6mWT) is potentially useful to define prognosis in patients with idiopathic pulmonary fibrosis (IPF). The objective of this study w...
Monitoring of chronic home ventilation. Experience based on a day hospital model Introduction: Ho... more Monitoring of chronic home ventilation. Experience based on a day hospital model Introduction: Home mechanical ventilation (HMV) represents a standard of care for chronic ventilatory pump failure. The care model could be determinant in deficiencies in the control of quality of HMV. Material and methods: In order to monitoring compliance during home mechanical ventilation and optimize its effectiveness, we proposed a program through a day hospital conducted by pulmonology doctors and respiratory physiotherapist. A descriptive study was designed on a systematic collection database. Participants were consecutive patients with NIV or mechanical invasive ventilation (MIV) assisted in the Pulmonology Service between July 2014 and December 2016. Results: During 30 months we included 94 patients; 52 men (55%), age 64.4 ± 15.9 years and BMI of 28.6 ± 8.46 kg / m2. Fifty percent were obese or overweight. 80 were found with HMV (84%) noninvasive (NIV) in 77 cases and invasive in three (4%). 15...
Introduction: The diagnosis of Sleep Apnea Hypopnea Obstructive Syndrome (SAHOS) requires confirm... more Introduction: The diagnosis of Sleep Apnea Hypopnea Obstructive Syndrome (SAHOS) requires confirmation by polysomnography (PSG) or respiratory polygraphy (R...
SummaryBackgroundIota-Carrageenan (I-C) is a sulfate polysaccharide synthesized by red algae, wit... more SummaryBackgroundIota-Carrageenan (I-C) is a sulfate polysaccharide synthesized by red algae, with demonstrated antiviral activity and clinical efficacy as nasal spray in the treatment of common cold. In vitro, I-C inhibits SARS-CoV-2 infection in cell culture.MethodsThis is a pragmatic multicenter, randomized, double-blind, placebo-controlled trial assessing the use of a nasal spray containing I-C in the prophylaxis of COVID-19 in hospital personnel dedicated to care of COVID-19 patients.Clinically healthy physicians, nurses, kinesiologists and others medical providers were assigned in a 1:1 ratio to receive four daily doses of I-C spray or placebo for 21 days.The primary end point was clinical COVID-19, as confirmed by reverse-transcriptase–polymerase-chain-reaction testing, over a period of 21 days. The trial is registered at ClinicalTrials.gov (NCT04521322).FindingsA total of 394 individuals were randomly assigned to receive I-C or placebo. Both treatment groups had similar base...
... Reynaldo Smith and Julio Chertcoff: attending physicians. There is no conflict of interest. .... more ... Reynaldo Smith and Julio Chertcoff: attending physicians. There is no conflict of interest. ... A chest x-ray revealed a right upper lobe atelectasis with an approximately 6 cm in diameter round lesion as confirmed by a computerized tomography scan. ...
Objectives. To compare interfaces performance during home-based automatic titration (APAP). Metho... more Objectives. To compare interfaces performance during home-based automatic titration (APAP). Methods. Retrospective study based on APAP titration from Obstructive Sleep Apnea Syndrome (OSA) patients. Results. 707 patients, 513 men (70.6%), were titrated. Masks were 104 pillows (14.7%), group I (GI); 532 nasal (75.2%), group II (GII); and 71 oronasal masks (10%), group III (GIII). We found differences in effective pressure to the device (P90/P95) (GI: 7.13±1.9 vs. GII: 8.3±2.1 vs. GIII: 9.3±2.6 cmH2O, p <0.001) but not in final pressure titrated manually (GI: 7.9±1.4 vs. GII: 8.6±1.6 vs. GIII: 9.2±1.9 cm of H2O, p >0.5), where lower residual AHI for pillows was p <0.001 and leaks for nasal were p <0.001. No differences were found in compliance (hours) (GI: 6.3±1.2 vs. GII: 6.2±1.1 vs. GIII: 6.1±1.0, p <0.4). Conclusion. During auto-adjusting titration by CPAP-naïve patients, nasal masks had lower leak rates and nasal pillows presented a similar performance.
Hypertension (HT) and obstructive sleep apnea-hypopnea syndrome (OSA) are prevalent and frequentl... more Hypertension (HT) and obstructive sleep apnea-hypopnea syndrome (OSA) are prevalent and frequently related pathologies. The predictive value of screening questionnaires in cardiovascular settings is not totally clear and could be useful to select candidates for the sleep test. We performed a prospective study in adults with suspected HT referred to a day-care hospital. Epworth Sleepiness Scale (ESS), Berlin, and STOP-BANG (SBQ) questionnaire were checked against data from home-based respiratory polygraphy (RP). We calculated sensitivity (S) and specificity (Sp), positive and negative predictive values (PPV and NPV), and the area under the ROC curve (AUC-ROC) for each questionnaire and their combinations. We analyzed 382 patients; 234 men (61.3%) and 148 women, mean age: 54.5 ± 13.7 years, body mass index (BMI): 33.1 ± 7.8 kg/m, ESS: 7.4 ± 4.7. Seventy-eight percent had an apnea-hypopnea index (AHI) &gt;5 events per hour (eV/h) and 58% presented &gt;15 eV/h (mean: 17.5 ± 9.3 eV/h). With regard to clinically significant OSA (AHI &gt; 15 eV/h), 5 SBQ components showed S: 100% (CI: 97-100) and Sp: 98% (CI: 95-99) with a NPV of 100, a PPV of 97.8, and an AUC-ROC of 0.90 (p &lt; 0.0001). ESS &gt; 10 + high-risk Berlin did not perform as effectively. In a population of HT patients, SBQ &gt; 5 performed better at identifying patients with &gt;15 eV/hour with a high discrimination power.
To establish the prevalence of positional (PP) OSA patients using self-administered home-based re... more To establish the prevalence of positional (PP) OSA patients using self-administered home-based respiratory polygraphy (RP). 52 month retrospective study based on RP records. 200 PR records: 70.5% men 29.5% women. 76% were diagnosed with OSA and 54.6% with PP OSA. There were no significant differences in Epworth Sleepiness Scale, apnea hypopnea index and oxygen desaturation index. PP OSA patients were younger, had a lower BMI (30.3±0.9 vs. 35.3±1.2) (<0.0001), and the time they spent with oxygen saturation <90% (T<90) was lower (8.8 vs. 28.7±6.7, =0.0038). The PP OSA group spent 43% of total recording time in the supine position. The prevalence of PP OSA patients studied with RP is similar to the one described by sleep laboratories. They have lower BMI, present mostly mild OSA with less desaturation, and are less likely to receive CPAP therapy.
Uploads
Papers by Alejandro Salvado