Predictors of mediastinal staging and usefulness of pet in patients with stage IIIA (N2) or IIIB (N3) lung cancer.

OBJECTIVE: To analyze which factors predict mediastinal N2/N3 lymph node staging and diagnostic accuracy of PET and CT to determine it. PATIENTS AND METHODS: We analyzed data collected prospectively in a database that included patients with non-small cell lung cancer (NSCLC) who underwent EBUS-TBNA. Prior to EBUS-TBNA, CT and PET were used to define the radiographic N stage and lymph nodes with short axis ≥ 1 cm by CT or with ratio between maximum standardized uptake value (maxSUV), by PET, of lymph node and primary tumor greater than 0.56, were considered pathological. Definitive lymph node staging was established through EBUS-TBNA, mediastinoscopy or surgical lymph node dissection. RESULTS: One hundred and thirty four patients were included, in 88 of whom (65.6%), definitive lymph node staging was N2 or N3. Primary tumor of central location, lymph node size, maxSUV of lymph node and radiographic N stage by CT or PET were associated with N2/N3 in univariate analysis, but in logistic regression model it was only independently related with N stage by CT or PET. Negative predictive value and positive predictive value of CT were 0.81 and 0.74, respectively, and for PET 0.78 and 0.68. CONCLUSION: In NSCLC, in locoregional disease radiographic staging by CT or PET predict the existence of N2/N3 mediastinal disease, but negative and positive predictive values of both imaging techniques are not adequate, so EBUS-TBNA samples should be taken in all lymph nodes with a diameter greater than 5 mm, regardless of PET findings.

Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January-April 2020.

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.

Enfermedad de Lemierre, a propósito de un caso / Lemierre's Disease, Case Report

La enfermedad de Lemierre, descrita por primera vez en el año 1936 por el médico Francés André Lemierre, es una complicación inusual de una infección orofaríngea, que progresa con tromboflebitis séptica secundaria e infecciones embólicas frecuentes. Es producida por microorganismos anaerobios, siendo el Fusobacterium necrophorum el germen aislado con mayor frecuencia. Para su diagnóstico, además del estudio microbiológico, se emplean los estudios por imágenes como la ecografía Doppler y la tomografía computada (TC). La antibióticoterapia precoz y prolongada, a dosis altas, ha mejorado considerablemente el pronóstico; no obstante, en ocasiones, se hace necesario recurrir a la escisión quirúrgica de las venas yugulares. En la actualidad con la terapia antimicrobiana, casos como éste son cada vez más raros, incluso a veces olvidados, pero dada su gravedad deben sospecharse ante cuadros faríngeos de evolución tórpida

Tuberculosis Costs in Spain and Related Factors. / Costes de la tuberculosis en España: factores relacionados.

OBJECTIVE: To analyze the direct and indirect costs of diagnosis and management of tuberculosis (TB) and associated factors. PATIENTS AND METHODS: Prospective study of patients diagnosed with TB between September 2014 and September 2015. We calculated direct (hospital stays, visits, diagnostic tests, and treatment) and indirect (sick leave and loss of productivity, contact tracing, and rehabilitation) costs. The following cost-related variables were compared: age, gender, country of origin, hospital stays, diagnostic testing, sensitivity testing, treatment, resistance, directed observed therapy (DOT), and days of sick leave. Proportions were compared using the chi-squared test and significant variables were included in a logistic regression analysis to calculate odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: 319 patients were included with a mean age of 56.72±20.79 years. The average cost was €10,262.62±14,961.66, which increased significantly when associated with hospital admission, polymerase chain reaction, sputum smears and cultures, sensitvity testing, chest computed tomography, pleural biopsy, drug treatment longer than nine months, DOT and sick leave. In the multivariate analysis, hospitalization (OR=96.8; CI 29-472), sensitivity testing (OR=4.34; CI 1.71-12.1), chest CT (OR= 2.25; CI 1.08-4.77), DOT (OR=20.76; CI 4.11-148) and sick leave (OR=26,9; CI 8,51-122) showed an independent association with cost. CONCLUSION: Tuberculosis gives rise to significant health spending. In order to reduce these costs, more control of transmission, and fewer hospital admissions would be required.

[Chronic pulmonary histoplasmosis diagnosed in a nonimmunosuppressed patient 10 years after returning from an endemic area]. / Histoplasmosis pulmonar crónica en un paciente no inmunodeprimido, residente 10 años antes en una zona endémica.

We report the case of a Spanish nonimmunosuppressed patient who was a chronic alcoholic and who developed chronic cavitary pulmonary histoplasmosis. He had been living in Venezuela until 10 years ago. The diagnosis was established when Histoplasma capsulatum was cultured from bronchoscopy samples. The patient was treated with itraconazole and progressed favorably until cure. This case suggests that histoplasmosis can reactivate years after exposure, even when significant immunodeficiency is not present. In the absence of another immunosuppressive factor, alcoholism may have played a role in the development of the condition.