Lymphocyte Subsets in Defense Against New Pathogens in Patients with Cancer.

INTRODUCTION: Immunity in cancer patients is modified both by the cancer itself and by oncospecific treatments. Whether a patient's adaptive immunity is impaired depends on their levels of naive lymphocytes and other cell populations. During the COVID-19 pandemic, cancer patients are at greater risk of progressing to severe forms of the disease and have higher mortality rates than individuals without cancer, particularly while they are receiving cancer-specific therapies. An individual's protection against infection, their response to vaccines, and even the tests that determine the humoral immune response to SARS-CoV-2, depend on lymphocyte populations, meriting their study. OBJECTIVE: Estimate blood concentrations of lymphocytes involved in the immune response to new pathogens in cancer patients. METHODS: We carried out an analytical study of 218 cancer patients; 124 women and 94 men, 26-93 years of age, who were treated at the National Oncology and Radiobiology Institute in Havana, Cuba, March-June, 2020. Patients were divided into five groups: (1) those with controlled disease who were not undergoing cancer-specific treatment; (2) those undergoing debulking surgery; (3) patients undergoing chemotherapy; (4) patients undergoing radiation therapy and (5) patients currently battling infection. We evaluated the following peripheral blood lymphocyte subpopulations via flow cytometry: B lymphocytes (total, naive, transitional, memory, plasmablasts and plasma cells); T lymphocytes (total, helper, cytotoxic and their respective naive, activated, central memory and effector memory subsets); and total, secretory and cytotoxic natural killer cells and T natural killer cells. We also estimated neutrophil/lymphocyte ratios. Lymphocyte concentrations were associated with controlled disease and standard cancer therapy. For variables that did not fall within a normal distribution, ranges were set by medians and 2.5-97.5 percentiles. The two-tailed Mann-Whitney U test was used to measure the effect of sex and to compare lymphocyte populations. We calculated odds ratios to estimate lymphopenia risk. RESULTS: All cancer patients had lower values of naive helper and cytotoxic T lymphocyte populations, naive B lymphocytes, and natural killer cells than normal reference medians. Naive helper T cells were the most affected subpopulation. Memory B cells, plasmablasts, plasma cells, activated T helper cells, and cytotoxic central memory T cells were increased. Patients undergoing treatment had lower levels of naive lymphocytes than untreated patients, particularly during radiation therapy. The risk of B lymphopenia was higher in patients in treatment. The odds ratio for B lymphopenia was 8.0 in patients who underwent surgery, 12.9 in those undergoing chemotherapy, and 13.9 in patients in radiotherapy. CONCLUSIONS: Cancer and conventional cancer therapies significantly affect peripheral blood B lymphocyte levels, particularly transitional T helper lymphocytes, reducing the immune system's ability to trigger primary immune responses against new antigens.

La Medicina Interna en el ambiente hospitalario / The Internal Medicine in the hospitable environment

Introducción: los cambios del contexto de trabajo en los hospitales para los internistas exigen perfeccionar el funcionamiento de sus servicios. Objetivos: identificar problemas que afectan a la especialidad Medicina Interna y los cambios organizativos necesarios para su solución, en un hospital clínico-quirúrgico. Material y Métodos: se realizó investigación cualitativa, basada en la actividad de un grupo nominal que dio salida a tareas propias de la dirección estratégica. Resultados: se definió la misión, visión y líneas estratégicas de trabajo del Servicio de Medicina Interna, se caracterizó el contexto y definieron como problemas en orden de prioridad: Deterioro del método clínico; práctica de una Medicina biologicista; insuficiente disponibilidad de camas; limitaciones en los recursos humanos, materiales y financieros para la máxima calidad de la atención y sobrecarga de los servicios clínicos. Se definieron las fortalezas, debilidades, amenazas y oportunidades. De ellas se derivaron propuestas de acciones ofensivas, adaptativas, defensivas y de supervivencia para lograr un cambio positivo en el trabajo de esta especialidad. Conclusiones: la gestión del capital humano en Medicina Interna implica una estructura colaborativa más eficiente para el hospital, que depare mejor utilización de los internistas como médico generalista e integrador, lo que contribuiría a disminuir las fronteras físicas de las salas y centrar el trabajo en los enfermos.

Introduction: the work context changes of the internists demand to make perfect the functioning of their services. Objectives: identify problems that affect the Internal Medicine and the necessary organizative changes to solve them, at a clinical-surgical hospital. Material and Methods: it was a qualitative research based on the activity of a nominal group that gave vent to own tasks of the strategic direction. Results: the mission, vision and the Internal Medicine service's strategic lines of work were defined; the context was assigned priority to its problems: Deterioration of the clinical method; the practice of a biologist medicine; insufficient availability of beds; Limitations in human, materials and financiers resources for the maximum quality of attention; Overload of the clinical services. It was defined fortresses, weaknesses, threats and opportunities. The offensive, adjustatives, defensives and survival actions to achieve a positive change were derived. Conclusions: the management of the human capital in internal medicine implies a collaborative structure more efficient for the hospital, that better utilization of the internists like generalist and integrative doctor that would contribute to diminish the physical frontiers of the wards and centering the work in the sick persons.

La hipertensión arterial como causa de mortalidad / The high blood pressure as a cause of death

Introducción: la hipertensión arterial constituye el factor de riesgo mayor sobre la morbilidad y mortalidad de causa cardiovascular, estimado a través de los certificados de defunción. Objetivo: evaluar la repercusión de este factor de riesgo como causa de mortalidad. Métodos: se realizó un estudio descriptivo, retrospectivo de los pacientes fallecidos con hipertensión arterial entre el 2002 y 2007. Las variables estudiadas fueron: edad, sexo, color de la piel, causa directa de muerte, causa básica de muerte, causa contribuyente de muerte y correlación clínica/patológica. Resultados: se encontró que el 9,1 por ciento de los fallecidos eran hipertensos, el grupo de edad más afectado fue el de 65 a 74 años (23,4 por ciento) y la edad promedio fue de 65 años. En 248 fallecidos existió coincidencia diagnóstica total en la causa directa de muerte (74,6 por ciento) y en 236 en la causa básica de muerte (71,0 por ciento). La hipertensión arterial constituyó la causa básica de muerte en el 59,3 por ciento y la causa contribuyente de muerte en el 18,97 por ciento. En más de la mitad de los casos, la hipertensión arterial participó en los mecanismos de muerte a través de la causa básica de muerte y causa contribuyente de muerte. Conclusiones: la hipertensión arterial constituye un determinante causal en la mortalidad y progresión del daño vascular aterosclerótico

Introduction: high blood pressure is a major risk factor on the morbidity and mortality of cardiovascular origin according to the death certificate, Objective: to assess the repercussion of this risk factor as cause of death. Methods: a retrospective and descriptive study was conducted in patients deceased with high blood pressure between 2002 and 2007. Study variables were: age, sex, skin color, direct cause of death, basic cause of death, contributing cause of death and clinical/pathological correlation. Results: there found that the 9.1 percent of deceases were hypertensive, the more involved age group was that of 65-74 years (23.4 percent) and the mean age was of 65 years. In 248 deceased there was a total diagnostic coincidence in relation to the direct cause of death (74.6 percent) and in 236 deceased in the basic cause of death (71.0 percent). High blood pressure was the basic cause of death in the 59.3 percent and the contributing cause of death in the 18.97 percent. In more than a half of cases, high blood pressure was involved in the death mechanisms through the basic and the contributing cause of death. Conclusions: High blood pressure is a causal determinant factor in the mortality and the progression of atherosclerotic vascular damage

Coincidencia clínico-patológica en 403 autopsias de pacientes fallecidos por tromboembolismo pulmonar / Clinicopathological agreement in 403 autopsies of dead patients from pulmonary thromboembolism

Se realizó un estudio observacional descriptivo y retrospectivo. Se analizaron 403 autopsias de pacientes fallecidos por tromboembolismo pulmonar como causa directa de muerte en un hospital universitario desde 1999 al 2003. El propósito fue determinar la coincidencia clínico-patológica, de acuerdo con la clasificación del sistema automatizado de registro y control de anatomía patológica. La coincidencia total fue del 38,7 por ciento, la parcial del 4,9 por ciento y la discrepancia diagnóstica del 43.7 por ciento, mientras que el diagnóstico resultó insuficiente en el 12,7 por ciento. Los errores diagnósticos se hicieron más evidentes en los pacientes fallecidos mayores de 65 años de edad (72,2 por ciento), del sexo femenino (58,5 por ciento), que permanecieron hospitalizados en salas de atención al grave (74,4 por ciento), durante menos de 7 días (64,2 por ciento) de estadía hospitalaria. Al comparar las variables analizadas (edad, sexo, estadía hospitalaria y especialidad de egreso) con las categorías de la concordancia diagnóstica no hubo diferencias estadísticamente significativa.

A retrospective descriptive and observational study was carried out to analyze 403 autopsies of patients dying from pulmonary thromboembolism as a direct cause of death in a university hospital from 1999 to 2003. The purpose was to determine the clinicopathological agreement according to the classification of the automated pathological anatomy register and control. Total agreement was 38,7 percent, partial agreement 4,9 percent and diagnostic discrepancy was 43,7 percent whereas diagnosis was not complete in 12,7 percent of cases. Diagnostic errors were more evident in dead patients aged over 65 years, females (58,5 percent), hospitalized in critically-ill patient wards (74,4 percent) for less than seven days of hospital days (64,2 percent). When comparing the analyzed variables (age, sex, hospital stay and discharge specialty) with diagnostic coincidence categories, there were no statistically significant difference.