Leishmaniasis is a protozoan disease caused by species of genus Leishmania. Immunosuppression increases the risk of severe clinical forms and impairs response to treatment. The expansion of the use of immunomodulatory drugs for different conditions has raised the number of these cases. In this report, we present a case of visceral leishmaniasis in a patient with multiple sclerosis (MS) under fingolimod treatment. He presented with the triad of fever, visceromegaly, and pancytopenia and was diagnosed by the presence of amastigotes in a bone marrow sample. Furthermore, we discuss the previous published cases of MS patients under different immunosuppressant therapies to highlight its risk in endemic areas and suggest a therapeutic approach.

Early, mild and young COPD concepts are not clearly defined and are often used interchangeably to refer to the onset of the disease. Objective: To describe and compare the characteristics of mild, young and early COPD in a large sample of COPD from primary and secondary care. Methods: Pooled analysis of individual data from four multicenter observational studies of patients with stable COPD (≥40 years, FEV₁/FVC < 0.7, smoking ≥ 10 pack-years). Mild COPD was defined as FEV₁% ≥ 65%; young COPD as <55 years; and early COPD as <55 years and smoking ≤ 20 pack-years. The relationship between FEV₁(%), age and pack-years was analyzed with linear regression equations. Results: We included 5468 patients. Their mean age was 67 (SD: 9.6) years, and 85% were male. A total of 1158 (21.2%) patients had mild COPD; 636 (11.6%) had young COPD and 191 (3.5%) early COPD. The three groups shared common characteristics: they were more frequently female, younger and with less tobacco exposure compared with the remaining patients. Early COPD had fewer comorbidities and fewer COPD admissions, but no significant differences were found in ambulatory exacerbations. In linear regression analysis, the decline in FEV₁(%) was more pronounced for the first 20 pack-years for all age groups and was even more important in younger patients. Conclusions: Mild, young and early COPD patients were more frequently women. The steepest decline in FEV₁(%) was observed in individuals <55 years and smoking between 10 and 20 pack-years (early COPD), which highlights the importance of an early detection and implementation of preventive and therapeutic measures.

Although short-term CAT score variability has been associated with COPD exacerbations, evidence supporting its integration into virtual assistant-based monitoring remains limited. The aim of this study was to assess the short-term variability in CAT scores using a virtual management tool in patients with COPD and to examine its relationship with the prediction of exacerbations. A prospective observational single-center study was conducted in patients aged >35 with COPD and an exacerbator phenotype (≥2 outpatient exacerbations or ≥1 hospitalization in the previous year). Follow-up was performed weekly, including the CAT questionnaire, through calls were conducted by the virtual assistant Tucuvi Health Manager^® during a period of one year. A total of 106 patients were included; 64.2% were male, with a mean (SD) age of 66.8 (7.9) years and a median FEV₁(%) of 38.8 (30.1–45.0). The mean follow-up was 25 weeks [IQR 20–35], during which 73 (69%) patients experienced ≥1 exacerbation, accounting for 192 episodes (26% of which required hospitalization). A total of 2550 CAT scores were collected. The mean baseline CAT score was 17.9 (7.6), and scores increased significantly during exacerbations compared with non-exacerbation periods and according to exacerbation severity. Each one-point increase in absolute CAT score was associated with an 11.1% increase in the odds of exacerbation (OR: 1.11; 95% CI: 1.08–1.13), while a weekly variation of ≥2 points (MCID) was associated with more than sixfold higher odds (OR: 6.30; 95% CI: 4.28–9.27). The optimal cut-off for CAT change in the prediction of exacerbation risk was 3 points with a ROC curve of 0.773. Weekly deterioration in CAT scores was associated with increased exacerbation risk in patients with COPD. Short-term increases in CAT may serve as clinically useful warning signals for exacerbation.

Home mechanical ventilation (HMV) was traditionally initiated by titration during a hospital admission. Recent studies have shown efficiency when this adaptation is performed on an outpatient basis, with good acceptance and economic savings. The aim of this study was to describe the patients who started VMD in a reference hospital over a period of two years and to compare them, depending on whether they were started on an outpatient or inpatient basis, and to assess the results of the treatment after 6 months. Retrospective observational study of patients who started HMV from April 2020 to March 2022 in our centre. Outpatient adaptation was carried out in a day hospital, in a shared visit by nurses and doctors. Clinical and ventilatory support data were collected from the clinical history at baseline and 6 months after. Comparative analysis was performed using non-parametric tests. There were 79 patients included, 52% were male with a mean age of 67 (SD 14). HMV was initiated in 52 cases on an inpatient (65%) and 27 on an outpatient basis (35%). More frequent diagnosis of COPD and higher previous acute non-invasive ventilation use and higher baseline paCO2 were identified in the inpatient group. The ventilatory mode "pressure support" was always used, mostly with nasobuccal mask (98%). At 6 months, they showed good compliance (7h/day), with no differences amid the groups in transcutaneous CO2. In our centre, adaptation to HMV is mostly performed on an inpatient basis, especially in patients with COPD. Six months after treatment, hypoventilation control and compliance with therapy are similar in both groups.

Bronchodilator testing (BDT) is crucial to establish the reversibility of bronchial obstruction and/or the presence of bronchial hyperresponsiveness (BHR). BDT is considered positive, based on the 2005 ATS/ERS guideline, when there is an absolute and relative change in FEV1 and FVC ≥200 mL in absolute and ≥12% in percentage value. In contrast, the 2021 ATS/ERS guideline determines that BDT is positive if a change >10% of the theoretical FEV1 or FVC value is observed. The aim of the study was to establish which BDT interpretation option correlates best with the presence of BHR confirmed from a methacholine test(MT). Retrospective descriptive and cross-sectional study was designed in adults (18-75 years), in whom a nonspecific bronchoprovocation test with methacholine was done on suspicion of asthma, between 01/02/2018-31/12/2022. Sociodemographic data, MT, targeted therapy at the time of the test and lung function with BDT based on both interpretations were collected. Statistical analysis of quantitative variables was made with the mean and standard deviation (if normally distributed) or the median (if non-normally distributed). Qualitative variables with frequency and percentage. Comparative study between the percentages of the groups of patients was made using X² tests and fisher's test and the concordance study using the kappa test. 845 patients were studied of whom 73% had a positive MT. The BDT was positive according to 2005 criteria in 67% of MT positive and in 33% of MT negative patients. While in the 2021 criteria it was positive in 65% of MT positive and 35% of MT negative patients. The kappa index was 0.82. There is good concordance between the two methods for establishing BDT positivity based on the degree of BHR.

Background: Sexual health impairment, including erectile dysfunction (ED) and testosterone deficiency syndrome (TDS), is common in men and particularly prevalent in chronic obstructive pulmonary disease (COPD). Purpose: The aim of this study was to assess erectile dysfunction and biochemical testosterone deficiency in men with COPD and to explore their clinical correlates. Patients and Methods: Cross-sectional, multicenter study, including men aged 40– 75 years with stable moderate-to-severe COPD. ED was measured by the International Index of Erectile Function (IIEF). Biochemical testosterone deficiency and androgen deficiency-related symptoms were evaluated through serum testosterone levels and the Aging Males’ Symptom Scale (AMSS). Associations and predictors of severe ED were analyzed. Results: Forty-four men were included (mean age of 65.1 years and FEV1% 50.4%). ED was present in 81.8%, 54.5% severe ED. Biochemical testosterone deficiency was identified in 70.5%, while moderate-to-severe androgen deficiency-related symptoms were reported by 54.5%. ED affected all IIEF domains of sexual function. ED severity correlated strongly with COPD Assessment Test (CAT), comorbidities, psychological distress and systemic inflammation, but not with lung function or testosterone levels. Higher CAT, comorbidity burden and psychological distress independently predicted severe ED. Conclusion: ED, biochemical testosterone deficiency and androgen deficiency-related symptoms are highly prevalent in this cohort of COPD. ED relates more to symptom burden, comorbidities and psychological distress than to lung function or testosterone. Routine clinical indices, such as CAT, may help identify high risk patients, supporting the integration of routine sexual health assessment into COPD care.