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1.
PLoS One ; 18(5): e0285541, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37167312

RESUMO

INTRODUCTION: Trimethoprim/sulfamethoxazole (TMP/SMX) is the antimicrobial of first choice in the treatment and prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients, particularly in people living with human immunodeficiency virus (HIV). TMP/SMX use entails different adverse effects, and its association with early neutropenia is minimally documented. This study aimed to identify the risk of early neutropenia associated with TMP/SMX use in adults living with HIV in Mexico. METHODS: A prospective cohort study was conducted in TMP/SMX-naïve adults living with HIV admitted to a third-level hospital between August 2019 and March 2020. Socio-demographic, clinical, and laboratory data were collected. According to patients' diagnostic, if they required treatment or prophylaxis against PCP, medical staff decided to prescribe TMP/SMX, as it is the first-line treatment. The risk of TMP/SMX induced early neutropenia, as well as associated factors were analyzed through a bivariate model and a multivariate Poisson regression model. The strength of association was measured by incidence rate ratio (IRR) with 95% confidence interval. RESULTS: 57 patients were enrolled in the study, of whom 40 patients were in the TMP/SMX treatment-group for treatment or prophylaxis of PCP (204.8 person-years of observation, median 26.5 days) and 17 patients were in the non-treatment group because they did not need the drug for treatment or prophylaxis of PCP (87.0 person-years of observation, median 21 days). The incidence rate of early neutropenia in the TMP/SMX-treatment group versus non-treatment group was 7.81 and 1.15 cases per 100 person-years, respectively. After adjusting for stage 3 of HIV infection and neutrophil count <1,500 cells/mm3 at hospital admission, the current use of TMP/SMX was not associated with an increase in the incidence rate ratio of early neutropenia (adjusted IRR: 3.46; 95% CI: 0.25-47.55; p = 0.352). CONCLUSIONS: The current use of TMP/SMX in Mexican adults living with HIV was not associated with an increase in the incidence rate ratio of early neutropenia.


Assuntos
Infecções por HIV , Neutropenia , Pneumonia por Pneumocystis , Humanos , Adulto , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Estudos de Coortes , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/complicações , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Estudos Prospectivos , México/epidemiologia , Estudos Retrospectivos , Neutropenia/induzido quimicamente , Neutropenia/epidemiologia , Neutropenia/complicações
2.
Pathogens ; 12(3)2023 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-36986283

RESUMO

BACKGROUND: Major depressive disorders (MDDs) occurs frequently in patients with tuberculosis (TB). Elevated serum pro-inflammatory cytokine levels in MDD patients is a well-established fact. Therefore, an integrated clinical practice should be considered. However, the inflammatory status of MDD-TB patients is unknown. In this study, we analyze cytokines in activated-cells and sera from MDD-TB, TB, MDD patients, and healthy controls. METHODS: Flow cytometry was used to evaluate the intracellular production of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-12, and IL-10 by peripheral blood mononuclear cells after a polyclonal stimulation. A Bio-Plex Luminex system was used to measure serum cytokine and chemokine levels in the study groups. RESULTS: We observed a 40.6% prevalence of MDD in TB patients. The proportion of IFN-gamma-producing cells was higher in MDD-TB patients than other pathological groups. Nevertheless, the percentage of TNF-alpha- and IL-12-producing cells was similar between MDD-TB and TB patients. Likewise, MDD-TB and TB patients showed similar serum pro-inflammatory cytokine and chemokine levels, which were significantly lower than those in MDD patients. By multiple correspondence analyses, we observed that low levels of serum IL-4, IL-10, and IL-13 were powerfully associated with TB comorbidities with MDD. CONCLUSIONS: A high frequency of IFN-γ-producing cells is associated with low levels of serum anti-inflammatory cytokines in MDD-TB patients.

3.
Salud Publica Mex ; 64(5, sept-oct): 530-538, 2022 Aug 26.
Artigo em Espanhol | MEDLINE | ID: mdl-36130340

RESUMO

OBJETIVO: Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos. RESULTADOS: Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.


Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Humanos , México , Encaminhamento e Consulta , Estudos Retrospectivos
4.
Oncologist ; 26(12): 1035-1043, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34498780

RESUMO

BACKGROUND: Accumulated evidence indicates that patients with lung cancer are a vulnerable population throughout the pandemic. Limited information is available in Latin America regarding the impact of the pandemic on medical care. The goal of this study was to describe the clinical and social effect of COVID-19 on patients with thoracic cancer and to ascertain outcomes in those with a confirmed diagnosis. MATERIALS AND METHODS: This cohort study included patients with thoracic neoplasms within a single institution between March 1, 2020, and February 28, 2021. All variables of interest were extracted from electronic medical records. During this period, the Depression Anxiety and Stress Scale 21 (DASS-2) was applied to evaluate and identify more common psychological disorders. RESULTS: The mean age for the total cohort (n = 548) was 61.5 ± 12.9 years; non-small cell lung cancer was the most frequent neoplasm (86.9%), advanced stages predominated (80%), and most patients were under active therapy (82.8%). Any change in treatment was reported in 23.9% of patients, of which 78.6% were due to the COVID-19 pandemic. Treatment delays (≥7 days) were the most frequent modifications in 41.9% of cases, followed by treatment suspension at 37.4%. Patients without treatment changes had a more prolonged progression-free survival and overall survival (hazard ratio [HR] 0.21, p < .001 and HR 0.28, p < .001, respectively). The mean DASS-21 score was 10.45 in 144 evaluated patients, with women being more affected than men (11.41 vs. 9.08, p < .001). Anxiety was reported in 30.5% of cases, followed by depression and distress in equal proportions (18%). Depressed and stressed patients had higher odds of experiencing delays in treatment than patients without depression (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.53-13.23, p = .006 and OR 3.18, 95% CI 1.2-10.06, p = .006, respectively). CONCLUSION: Treatment adjustments in patients with thoracic malignancies often occurred to avoid COVID-19 contagion with detrimental effects on survival. Psychological disorders could have a role in adherence to the original treatment regimen. IMPLICATIONS FOR PRACTICE: The pandemic has placed an enormous strain on health care systems globally. Patients with thoracic cancers represent a vulnerable population, with increased morbidity and mortality rates. In Mexico, treatment modifications were common during the pandemic, and those who experienced delays had worse survival outcomes. Most treatment modifications were related to a patient decision rather than a lockdown of health care facilities in which mental health impairment plays an essential role. Moreover, the high case fatality rate highlights the importance of improving medical care access. Likewise, to develop strategies facing future threats that may compromise health care systems in non-developed countries.


Assuntos
COVID-19 , Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Neoplasias Torácicas , Idoso , Ansiedade , Estudos de Coortes , Controle de Doenças Transmissíveis , Depressão/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2
5.
Biology (Basel) ; 10(8)2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34440025

RESUMO

Cigarette smoking is a known risk factor for the development of lung cancer. We investigated whether circulating microRNA expression levels and their potential diagnostic value are affected by cigarette smoking in adenocarcinoma (AD) patients and healthy (H) participants. In total, 71 female AD patients and 91 H individuals were recruited, including 42 AD never-smokers (AD/CS-), 29 AD smokers (AD/CS+), 54 H never-smokers (H/CS-), and 37 H smokers (H/CS+). PCR array (754 microRNAs) and qPCR were performed on sera from the discovery and validation cohorts, respectively. The expression levels of miR-532-5p, miR-25-3p, and miR-133a-3p were significantly higher in adenocarcinoma patients than in healthy participants, independent of their smoking status. Multivariate analysis showed that levels of miR-133a-3p were independently associated with smoking. ROC analysis showed that only miR-532-5p discriminated AD patients from H controls (AUC: 0.745). However, when making comparisons according to cigarette smoking status, miR-532-5p discriminated AD/CS- patients from H/CS- controls with a higher AUC (AUC:0.762); miR-25-3p discriminated AD/CS+ patients from H/CS+ controls (AUC: 0.779), and miR-133a discriminated AD/CS+ patients from H/CS+ controls with the highest AUC of 0.935. Cancer and lung-cancer-enriched pathways were significantly associated with the three miRNAs; in addition, nicotinate/nicotinamide metabolism, inflammation, and pulmonary hypertension were associated with miR-133a-3p. Our findings highlight how cigarette smoking affects the reliable identification of circulating miRNAs as diagnostic biomarkers in lung cancer and suggest a smoking-dependent pathogenic role of miR-133a-3p in smokers.

6.
Eur J Cancer Prev ; 30(6): 462-468, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34115693

RESUMO

INTRODUCTION: Exposure to biomass combustion products, particularly firewood, has been considered as a potential carcinogen for developing lung cancer. In this regard, current evidence is widely heterogeneous; besides, in most studies, wood smoke exposure is not appropriately quantified, which further complicates the analysis of wood smoke as a potential carcinogen. The aim of the present study was to estimate the risk of developing lung cancer according to the degree of exposure to wood smoke in patients who use firewood for cooking. MATERIAL AND METHODS: We performed a case-control study that included 482 patients with lung cancer (cases) and 592 hospital controls. Exposure to wood smoke was evaluated as a dichotomous variable (i.e. yes or no); in patients with prior wood smoke exposure, an index of exposure in hours per year was calculated (WSEI). Using bivariate and multivariate logistic regression analyses, the odds ratio (OR) between wood smoke exposure and lung cancer were calculated. RESULTS: The ORs for developing lung cancer (raw and adjusted) for a WSEI > 100 h/year were OR 1.55 [95% confidence interval (CI), 1.06-2.26) and OR 2.26 (95% CI, 1.50-3.40), respectively; the ORs (raw and adjusted) for WSEI >300 h/year were OR 1.76 (95% CI, 1.06-2.91) and OR 3.19 (95% CI, 1.83-5.55), respectively. CONCLUSIONS: Exposure to wood smoke is a risk factor for lung cancer; furthermore, this effect maintains a dose-response relationship which has a multiplicative effect with smoking.


Assuntos
Neoplasias Pulmonares , Fumaça , Carcinógenos , Estudos de Casos e Controles , Humanos , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/etiologia , Fumaça/efeitos adversos , Madeira/efeitos adversos
7.
Cir Cir ; 89(1): 63-70, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33498075

RESUMO

BACKGROUND: To date, information about the outcome of patients with parapneumonic effusion and empyema is limited. OBJECTIVE: To describe the clinical characteristics, the microbiological study and the frequency and type of surgical treatment in adult patients with parapneumonic effusion or empyema. METHOD: A prospective cross-sectional study of patients admitted with parapneumonic effusion or empyema, from August 2011 to July 2014, in a reference hospital for respiratory diseases in Mexico City, was conducted. Clinical characteristics, microbiology, risk categories for poor prognosis in empyema and frequency and type of surgical treatment were studied. RESULTS: We studied 284 patients whose median age was 47 years, 75% were men, and 57.7% were transferred from other hospitals. In 38.5% of the cases a microorganism was identified and there was a predominance of Gram negative. 153 (53.9%) required surgical treatment, of which 90% were thoracotomy with decortication. Hospital mortality was 5.63%. CONCLUSIONS: Most of the patients arrived in advanced stages of the disease, so more than half required surgery, of which 90% was decortication. It is desirable to favor mechanisms for early diagnosis and treatment to reduce the need for surgical treatment.


ANTECEDENTES: La información sobre el tipo y la frecuencia del tratamiento quirúrgico en los casos de empiema torácico es escasa. OBJETIVO: Describir las características clínicas, el estudio microbiológico y la frecuencia y el tipo de tratamiento quirúrgico en pacientes adultos con derrame pleural paraneumónico o empiema. MÉTODO: Estudio transversal prospectivo de pacientes con diagnóstico de derrame pleural paraneumónico o empiema, de agosto de 2011 a julio de 2014, en un hospital de referencia para enfermedades respiratorias en la Ciudad de México. Se estudiaron las características clínicas, las categorías de riesgo para mal pronóstico en empiema y la frecuencia y el tipo de tratamiento quirúrgico. RESULTADOS: Se estudiaron 284 pacientes cuya mediana de edad fue de 47 años y el 75% eran hombres. El 57.7% fueron traslados de otros hospitales. En el 38.8% de los casos se identificó un microorganismo, con predominio de gramnegativos. Requirieron tratamiento quirúrgico 153 pacientes (53.9%), de los cuales en el 90% fue toracotomía con lavado y decorticación. La mortalidad hospitalaria fue del 5.63%. CONCLUSIONES: La mayor parte de los pacientes llegaron en etapas avanzadas de la enfermedad, y por ello más de la mitad requirieron cirugía, de los cuales en el 90% fue lavado y decorticación. Es deseable favorecer mecanismos para realizar un diagnóstico y un tratamiento tempranos con el fin de disminuir la necesidad de tratamiento quirúrgico.


Assuntos
Empiema Pleural , Derrame Pleural , Adulto , Estudos Transversais , Empiema Pleural/epidemiologia , Empiema Pleural/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Estudos Prospectivos , Resultado do Tratamento
9.
Microbiol Immunol ; 63(8): 316-327, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31254409

RESUMO

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (Mtb) and remains a major cause of morbidity and mortality worldwide. In the host's immune response system, T cells play a critical role in mediating protection against Mtb infection, but the role of CD8+ T cells is still controversial. We evaluated the phenotypical characterization and cytotoxic ability of CD8+ T cells by flow cytometry-based assay. Cytokine levels in serum were measured by multiplex cytokine assay. Our data show that cells from TB patients have an increased percentage of peripheral blood CD8+ αß+ T (p = 0.02) and CD56+ CD8+ T (p = 0.02) and a decreased frequency of NKG2D+ CD8+ T (p = 0.02) compared with healthy donors. Unlike CD8+ T cells from healthy donors, CD8+ T cells from TB patients exhibit greater cytotoxicity, mediated by HLA class I molecules, on autologous monocytes in the presence of mycobacterial antigens (p = 0.005). Finally, TB patients have a proinflammatory profile characterized by serum high level of TNF-α (p = 0.02) and IL-8 (p = 0.0001), but, interestingly, IL-4 (p = 0.002) was also increased compared with healthy donors. Our data show evidence regarding the highly cytotoxic status of CD8+ T cells in Mtb infection. These cytotoxic cells restricted to HLA-A, B, and C could be used to optimize strategies for designing new TB vaccines or for identifying markers of disease progression.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Citotoxinas/toxicidade , Mycobacterium tuberculosis/imunologia , Tuberculose/imunologia , Adolescente , Adulto , Antígenos de Bactérias/imunologia , Citocinas/sangue , Feminino , Citometria de Fluxo , Antígenos HLA-A/imunologia , Antígenos HLA-B/imunologia , Antígenos HLA-C/imunologia , Humanos , Interleucina-4/sangue , Interleucina-8/sangue , Masculino , Pessoa de Meia-Idade , Vacinas contra a Tuberculose/imunologia , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
10.
J. bras. pneumol ; 43(6): 424-430, Nov.-Dec. 2017. tab
Artigo em Inglês | LILACS | ID: biblio-893883

RESUMO

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.


RESUMEN Objetivo: Estudios previos demuestran que la biopsia pleural cerrada (BPC) para diagnóstico de malignidad tiene una sensibilidad menor al 60%, por lo que recientemente ha despertado controversia su valor como prueba diagnóstica. Nuestro objetivo fue evaluar la exactitud de la BPC para diagnóstico de malignidad en pacientes con derrame pleural. Métodos: Estudio prospectivo de 8 años en individuos que se sometieron a la realización de BPC para establecer la etiología del derrame. La información de cada paciente se tomó de los registros de anatomopatología y del expediente clínico. Cuando el resultado de la BPC demostró malignidad o tuberculosis, esto se tomó como biopsia diagnóstica y quedó éste como diagnóstico definitivo. En los casos en que el resultado del estudio histopatológico de la biopsia resultó inespecífico, el diagnóstico definitivo se estableció en base a otros procedimientos diagnósticos, como toracoscopia, toracotomía, fibrobroncoscopia, estudio bioquímico y celular del líquido pleural y/o pruebas microbiológicas. Mediante una tabla de contingencia de 2 × 2 se midieron los indicadores para una prueba diagnóstica. Resultados: Se estudiaron 1034 biopsias de pacientes con derrame pleural, de las cuales se excluyeron 171 (16.54%) por muestra inadecuada o información insuficiente. El desempeño para malignidad fue: sensibilidad, 77%; especificidad, 98%; valores predictivos positivo y negativo, 99% y 66%, respectivamente; índices de probabilidad positivo y negativo, 38.5 y 0.23, respectivamente; probabilidad antes y después de la prueba, 2.13 y 82, respectivamente. Conclusión: La BPC es útil como prueba diagnóstica en la práctica clínica, debido a que produce un cambio importante de la probabilidad antes de la prueba a la probabilidad después de la prueba.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Biópsia/classificação , Biópsia/métodos , Derrame Pleural Maligno/patologia , Pleura/patologia , Toracoscopia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade
11.
Lung Cancer ; 113: 30-36, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29110845

RESUMO

BACKGROUND: A proportion of patients with NSCLC is diagnosed at 40 years or younger. These patients tend to be never-smokers, usually present with stage IV adenocarcinoma, and have somatic genomic alterations. Few studies have documented and analyzed epidemiological characteristics of this population. MATERIALS AND METHODS: We performed an international epidemiological analysis of 389 young patients with NSCLC. Data was collected from centers participating in the Latin American Consortium for Lung Cancer Research (AduJov-CLICaP). Patients were identified and data was retrospectively collected from different Latin American countries and Canada (Argentina=6, Canada=19, Colombia=29, Costa Rica=9, Mexico=219, Nicaragua=2, Panama=19, Perú=76 and Venezuela=10). The period of study was from 2012 to 2017. Inclusion criteria were: age 40 years or less and a histologically confirmed NSCLC. Clinical data was obtained, and EGFR mutation status and EML4-ALK translocation were collected. RESULTS: NSCLC patients aged 40 years or less accounted for approximately 4% of the total NSCLC population. Female patients accounted for 54.5%, while median age was of 37 years. Adenocarcinoma accounted for 86.1% (n=335/389), 72.5% (n=282/389; unknown=5) of patients were non-smokers, and 90.3% (n=351/389) had stage IV disease. Site of metastasis was obtained from 260/351 (unknown=91) stage IV patients (lung metastasis=40.0%, CNS metastasis=35.7%, and bone metastasis=31.5%). OS for the total population was 17.3 months (95%CI=13.9-20.7). OS for EGFRm(+)=31.4months (95%CI=11.6-51.3), EGFRm(-)=14.5months (95%CI=11.0-17.9) (p=0.005). OS for alk(+)=9.8months (95%CI=3.1-16.5) and alk(-)=5.6months (95%CI=3.9-7.3) (p=0.315). CONCLUSIONS: Patients aged 40 years or less account for a small but important proportion of NSCLC cases. Younger patients may have different characteristics compared to the older population. EGFRm and EML4-alk translocation frequency is higher than that of the general population.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , Receptores ErbB/genética , Neoplasias Pulmonares/genética , Mutação , Proteínas de Fusão Oncogênica/genética , Adolescente , Adulto , Fatores Etários , Canadá/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Feminino , Genótipo , Humanos , América Latina/epidemiologia , Neoplasias Pulmonares/epidemiologia , Masculino , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
12.
J Bras Pneumol ; 43(6): 424-430, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29340490

RESUMO

OBJECTIVE: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. METHODS: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. RESULTS: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. CONCLUSIONS: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.


Assuntos
Biópsia , Derrame Pleural Maligno/patologia , Biópsia/classificação , Biópsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Toracoscopia
13.
Rev. Fac. Med. UNAM ; 59(6): 43-57, nov.-dic. 2016. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-957116

RESUMO

Resumen La exploración adecuada del tórax tiene una secuencia que ayuda al clínico a seguir varios pasos e integrar sus hallazgos en síndromes, mismos que lo llevarán con más seguridad hacia el diagnóstico más adecuado. Al cumplirse los 200 años de la invención del estetoscopio por René Laënec, tomamos esta oportunidad para recordarlo y detallar los pasos de la exploración del tórax. El hecho de contar con más herramientas tecnológicas para el diagnóstico, no le resta importancia a esta etapa tan importante de la relación entre el médico y su paciente, que es la exploración.


Abstract Thoracic exploration has a sequence of steps that help the clinician to integrate its findings in syndromes, which will lead the physician to better diagnosis. This year the stethoscope, invented by René Laënec, turns 200 years old and we use this opportunity to remember him and provide a detailed description of the thoracic exploration. To have access to more sophisticated diagnostic tools should not diminish the relevance of a direct exploration of the patient, which is a very important step in the patient-physician relationship.

14.
Rev. Fac. Med. UNAM ; 58(5): 5-12, sep.-oct. 2015. graf
Artigo em Espanhol | LILACS | ID: biblio-957059

RESUMO

Resumen Actualmente, el cáncer pulmonar es un problema de salud importante a nivel mundial porque presenta una alta incidencia y mortalidad tanto en hombres como en mujeres. Su forma más común es el adenocarcinoma (ADC), que es una entidad patológica interesante ya que de todas las formas de cáncer pulmonar, es la que se asocia menos con el tabaquismo y un porcentaje importante de pacientes con adenocarcinoma son no fumadores. De modo que otros factores como la exposición al humo de leña, a los contaminantes del aire, la historia familiar de cáncer, entre otros, son importantes para el desarrollo del ADC pulmonar. Actualmente el ADC pulmonar es la principal forma de cáncer pulmonar en las mujeres y se ha reportado que las mujeres premenopáusicas presentan peor pronóstico y los tumores son más agresivos cuando se comparan con los hombres y las mujeres posmenopáusicas. Estos datos han sugerido el papel de los estrógenos en el cáncer pulmonar, principalmente en el ADC. Aunque existe vasta evidencia epidemiológica que demuestra esta relación, hay controversia en cuanto al papel de los estrógenos en esta patología. De igual manera no hay una opinión generalizada sobre los mecanismos por los cuales los estrógenos podrían favorecer la carcinogénesis. Sin embargo, cada vez es más clara la importancia de éstas hormonas en la carcinogénesis pulmonar. En esta revisión se muestran estos datos y se discute la relevancia de los estrógenos en el cáncer pulmonar, una patología cuya dependencia hormonal es cada vez más clara.


Abstract Lung cancer is currently a worldwide health issue because of the mortality and high incidence of this pathology in both men and women. The most common form of lung cancer is adenocarcinoma (ADC); It is an interesting disease entity because among every type of lung cancer it has the lower association with smoking and a significant percentage of patients with adenocarcinoma are not smokers. Hence other factors such as exposure to wood-smoke, air pollutants, family history of cancer, among others, are important in the development of lung ADC. Nowadays, lung ADC is the main form of lung cancer in women and reports show that premenopausal women have the worse prognosis and have more aggressive tumors compared to men and postmenopausal women. These data suggests that estrogens have a particular role in lung cancer physiopathology mainly in ADC. Although there is sufficient epidemiological evidence that indicates a relationship between sexual hormones and lung cancer, the role of estrogens in this pathology is still controversial. Furthermore there is no general consent regarding the known mechanisms by which these hormones could promote carcinogenesis and because the scarce information about the implication of these hormones in lung carcinogenesis more studies are needed. In this review we discuss the role and relevance of estrogens in lung cancer, a pathology whose hormonal dependency is becoming clearer.

15.
Lung Cancer ; 90(2): 161-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26358312

RESUMO

OBJECTIVE: Sixteen percent of US population is Hispanic, mostly Mexican. Recently, two independent American reports demonstrated a higher overall survival (OS) in Hispanic populations compared with non-Hispanic-white populations (NHW) with non-small-cell lung cancer (NSCLC), even when most Hispanic patients are diagnosed at advanced disease stages and have lower income status. We analyzed the clinical, pathological, and molecular characteristics as well as outcomes in a cohort of NSCLC Hispanic patients from the National Cancer Institute of Mexico that could explain this "Hispanic Paradox". MATERIAL AND METHODS: A cohort of 1260 consecutive NSCLC patients treated at the National Cancer Institute of Mexico from 2007 to 2014 was analyzed. Their clinical-pathological characteristics, the presence of EGFR and KRAS mutations and the prognosis were evaluated. RESULTS: Patients presented with disease stages II, IIIa, IIIb and IV at rates of 0.6, 4.8, 18.4 and 76.3%, respectively. NSCLC was associated with smoking in only 56.5% of the patients (76.7% of male vs. 33.0% of female patients). Wood smoke exposure (WSE) was associated with 37.2% of the cases (27.3% in men vs. 48.8% in women). The frequency of EGFR mutations was 27.0% (18.5% in males vs. 36.9% in females, p<0.001) and the frequency for KRAS mutations was 10.5% (10.3% men vs. 10.1% in women p=0.939). The median OS for all patients was 23.0 [95% CI 19.4-26.2], whereas for patients at stage IV, it was 18.5 months [95% CI 15.2-21.8]. The independent factors associated with the OS were the ECOG, disease stage, EGFR and KRAS mutation status. CONCLUSION: The high frequency of EGFR mutations and low frequency of KRAS mutations in Hispanic populations and different prevalence in lung cancer-related-developing risk factors compared with Caucasian populations, such as the lower frequency of smoking exposure and higher WSE, particularly in women, might explain the prognosis differences between foreign-born-Hispanics, US-born-Hispanics and NHWs.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Mutação/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Grandes/genética , Carcinoma de Células Grandes/patologia , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Receptores ErbB/genética , Feminino , Hispânico ou Latino , Humanos , Masculino , México , Pessoa de Meia-Idade , Prognóstico , Fumaça/efeitos adversos , Fumar/efeitos adversos , Adulto Jovem , Proteínas ras/genética
17.
Arch Med Res ; 45(2): 158-69, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24486245

RESUMO

BACKGROUND AND AIMS: Studies have reported differences in lung cancer behavior between sex and hormonal status that suggest a role of estrogens and estrogen receptor beta (ERß) in lung carcinogenesis. In some types of hormone-dependent cancer, estrogens may regulate CXCL12/CXCR4 expression through ERß signaling. High expression of CXCL12/CXCR4 is associated with poor prognosis in lung cancer because it promotes tumor growth and metastasis. Therefore, in this study we investigated whether lung adenocarcinoma tissues from pre- and postmenopausal women and from men exhibit different ERß, CXCR4/CXCL12 expression and whether this expression is associated with clinicopathological features. METHODS: Sixty primary tumor samples of lung adenocarcinoma from pre- and postmenopausal women and from men were collected for this study. Thirty samples of healthy lung tissue adjacent to the tumor site were used as controls. ERß and CXCL12/CXCR4 expression was analyzed by immunohistochemistry. Expression of these proteins was measured by digital image software and compared between sex and hormonal status. RESULTS: Lung adenocarcinomas overexpressed ERß, CXCR4 and CXCL12 compared to normal lung. Moreover, lung adenocarcinomas from premenopausal women exhibited higher signals for ERß, CXCL12 and CXCR4 compared to postmenopausal women and to men, who showed lower signals for these proteins. A multivariate analysis revealed a strong association between the immunoreactivity level of ERß, CXCL12/CXCR4 and both sex and hormonal status, but not with tumor stage and smoking. CONCLUSION: These results demonstrated that ERß and CXCL12/CXCR4 expression in lung adenocarcinoma depends on sex and hormonal status, which may partly explain the sex and hormonal differences in lung cancer behavior.


Assuntos
Adenocarcinoma/metabolismo , Quimiocina CXCL12/metabolismo , Receptor beta de Estrogênio/metabolismo , Estrogênios/metabolismo , Neoplasias Pulmonares/metabolismo , Receptores CXCR4/metabolismo , Adenocarcinoma de Pulmão , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Pulmão/metabolismo , Masculino , Pessoa de Meia-Idade , Pós-Menopausa , Pré-Menopausa , Fatores Sexuais , Transdução de Sinais
18.
J Infect Dis ; 209(11): 1693-9, 2014 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-24367038

RESUMO

BACKGROUND: With wild poliovirus nearing eradication, preventing circulating vaccine-derived poliovirus (cVDPV) by understanding oral polio vaccine (OPV) community circulation is increasingly important. Mexico, where OPV is given only during biannual national immunization weeks (NIWs) but where children receive inactivated polio vaccine (IPV) as part of their primary regimen, provides a natural setting to study OPV community circulation. METHODS: In total, 216 children and household contacts in Veracruz, Mexico, were enrolled, and monthly stool samples and questionnaires collected for 1 year; 2501 stool samples underwent RNA extraction, reverse transcription, and real-time polymerase chain reaction (PCR) to detect OPV serotypes 1, 2, and 3. RESULTS: OPV was detected up to 7 months after an NIW, but not at 8 months. In total, 35% of samples collected from children vaccinated the prior month, but only 4% of other samples, contained OPV. Although each serotype was detected in similar proportions among OPV strains shed as a result of direct vaccination, 87% of OPV acquired through community spread was serotype 2 (P < .0001). CONCLUSIONS: Serotype 2 circulates longer and is transmitted more readily than serotypes 1 or 3 after NIWs in a Mexican community primarily vaccinated with IPV. This may be part of the reason why most isolated cVDPV has been serotype 2.


Assuntos
Programas Nacionais de Saúde , Poliomielite/prevenção & controle , Vacina Antipólio Oral/imunologia , Poliovirus/isolamento & purificação , Adolescente , Adulto , Criança , Pré-Escolar , Fezes/virologia , Feminino , Humanos , Estudos Longitudinais , Masculino , México/epidemiologia , Poliomielite/virologia , População Rural , População Urbana , Eliminação de Partículas Virais , Adulto Jovem
19.
PLoS One ; 8(11): e78926, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24223865

RESUMO

BACKGROUND: Despite chemotherapy, patients with cured pulmonary tuberculosis may result in lung functional impairment. OBJECTIVE: To evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis. METHODS: One hundred and twenty seven patients with cured pulmonary tuberculosis were prospectively enrolled in a referral hospital specializing in respiratory diseases. Spirometry was performed and the extent of radiographic abnormalities was evaluated twice by each of two readers to generate a novel quantitative score. Scoring reproducibility was analyzed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Multiple linear regression models were performed to assess the association of the extent of radiographic abnormalities with spirometric values. RESULTS: The intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI:95%, 0.67-0.95) and 0.78 (CI:95%, 0.65-0.92), for reader 1 and 2, respectively. Inter-observer reproducibility for the first measurement was 0.83 (CI:95%, 0.71-0.95), and for the second measurement was 0.74 (CI:95%, 0.58-0.90). The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability. After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied. CONCLUSION: The extent of radiographic abnormalities, as evaluated through our novel scoring system, was inversely associated with spirometric values, and exhibited good reliability and reproducibility. As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.


Assuntos
Radiografia/métodos , Espirometria/métodos , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/fisiopatologia , Adulto , Feminino , Humanos , Modelos Lineares , Pulmão/diagnóstico por imagem , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Testes de Função Respiratória , Tuberculose Pulmonar/tratamento farmacológico
20.
Am J Respir Crit Care Med ; 188(9): 1137-46, 2013 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-24047412

RESUMO

RATIONALE: A hallmark of pulmonary tuberculosis (TB) is the formation of granulomas. However, the immune factors that drive the formation of a protective granuloma during latent TB, and the factors that drive the formation of inflammatory granulomas during active TB, are not well defined. OBJECTIVES: The objective of this study was to identify the underlying immune mechanisms involved in formation of inflammatory granulomas seen during active TB. METHODS: The immune mediators involved in inflammatory granuloma formation during TB were assessed using human samples and experimental models of Mycobacterium tuberculosis infection, using molecular and immunologic techniques. MEASUREMENTS AND MAIN RESULTS: We demonstrate that in human patients with active TB and in nonhuman primate models of M. tuberculosis infection, neutrophils producing S100 proteins are dominant within the inflammatory lung granulomas seen during active TB. Using the mouse model of TB, we demonstrate that the exacerbated lung inflammation seen as a result of neutrophilic accumulation is dependent on S100A8/A9 proteins. S100A8/A9 proteins promote neutrophil accumulation by inducing production of proinflammatory chemokines and cytokines, and influencing leukocyte trafficking. Importantly, serum levels of S100A8/A9 proteins along with neutrophil-associated chemokines, such as keratinocyte chemoattractant, can be used as potential surrogate biomarkers to assess lung inflammation and disease severity in human TB. CONCLUSIONS: Our results thus show a major pathologic role for S100A8/A9 proteins in mediating neutrophil accumulation and inflammation associated with TB. Thus, targeting specific molecules, such as S100A8/A9 proteins, has the potential to decrease lung tissue damage without impacting protective immunity against TB.


Assuntos
Calgranulina A/imunologia , Calgranulina B/imunologia , Granuloma do Sistema Respiratório/imunologia , Mediadores da Inflamação/imunologia , Neutrófilos/imunologia , Tuberculose Pulmonar/imunologia , Animais , Quimiocinas/imunologia , Fatores Quimiotáticos/imunologia , Citocinas/imunologia , Modelos Animais de Doenças , Humanos , Macaca mulatta , Camundongos , Camundongos Endogâmicos C57BL
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