Introduction. Malnutrition is underdiagnosed in chronic obstructive pulmonary disease. Objectives. This study aimed to evaluate the nutritional status of COPD patients and the link between dyspnea and nutritional status. Methods. This longitudinal observational study included patients hospitalized with exacerbated COPD. Nutritional status was assessed using Nutrition Risk Screening 2002, anthropometric, and biochemical assessments, in the first 48 hours of hospitalization. Results. Thirty patients were evaluated. According to the Nutrition Risk Screening 2002, half of the patients were at increased risk of malnutrition. 36.7% were classified as malnourished if we only considered the body mass index. From the evaluation of the tricipital skin fold, 69.0% were classified as malnourished, with 48.3% having severe malnutrition. According to the serum albumin level, 29.6% had malnutrition criteria. A significant association between dyspnea and increasing age ( p = 0.037 ) was found. There was a strong association between the fold classification and the degrees of severity of dyspnea (Fisher exact test: 13.60, p = 0.001 , V Cramer = 0.826). Most patients were malnourished and had higher grades of dyspnea. Tricipital skinfold reflects subcutaneous adipose tissue; this anthropometric measurement seems to be a good method to classify the nutritional status of COPD patients. It classified the biggest portion of patients as malnourished. Conclusion. The number of patients classified as malnourished changed with the method under analysis. The tricipital skin fold parameter was strongly associated with the dyspnea score. Most patients had adipose tissue and muscular mass depletion.
To the Editor, Interstitial lung abnormalities (ILAs) are a radiological entity characterized by incidental findings in chest computed tomography (CT) scans, with specific patterns of modifications in lung density in patients with no prior history of interstitial lung disease. These radiologic changes are present in more than 5% of nondependent lung parenchyma areas. And they include reticular abnormalities or groundglass attenuation, lung distortion, traction bronchiectasis/bronchiolectasis, honeycombing, and nonemphysematous cysts. 1,2 In some cases, ILA may represent an early form of pulmonary fibrosis. [1][2][3] ILA affects about 7% of the general population. The prevalence varies with age and with smoking habits, being more prevalent in older and smoker individuals. 1,3,4 These patients present more respiratory symptoms and changes in respiratory function tests, particularly with a decrease in forced vital capacity. [5][6][7] This entity seems related to raised proinflammatory molecules that lead to radiological changes. 4 This radiological concept has clinical implica-
Pleuropulmonary Samonella infections are very rare and are associated with high mortality. We present a case of empyema to Salmonella in an 83-year-old male patient, with uncontrolled hematological disease. The patient presented with a one-week history of fever, productive cough with purulent sputum, dyspnea, and pleuritic pain localized to the right hemithorax. He denied having nausea, vomiting, and diarrhea. No history of smoking or respiratory diseases. Chest imaging showed a right loculated pleural effusion with adjacent parenchymal consolidation. Blood test revealed anemia without leukocytosis with elevated C-reactive protein (36.2 mg/dL). A chest tube was placed, with drainage of purulent fluid and empiric antibiotic therapy with ceftriaxone and clindamycin was started. Pleural fluid and blood cultures were positive for Salmonella serotype Enteritidis. The stool cultures were negative. Due to slow improvement, clindamycin was suspended and ciprofloxacin was initiated. The patient showed clinical and laboratory improvement. After seven weeks of antibiotic therapy, he presented with negative blood cultures and significant imaging improvement. The patient was discharged. This case describes a positive outcome in an unusual infection with a high mortality caused by non-typhoid Salmonella .
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