Sexual dimorphism of colorectal cancer in humans and colorectal tumors in a murine model.

Introduction: In colorectal cancer, men exhibit a higher incidence than women, and there is a disturbance in the levels of sex steroids in serum in patients with this disease. Consistently, in animals, males have greater tumor growth than females in diverse models. Nevertheless, the role of sex steroids is not well established. For that, we analyzed the effect of the principal gonadal sex steroids in both sexes. We determined sex as a statistically risk factor for colorectal cancer with data obtained from GLOBOCAN database. Methods: To induce colorectal tumors, we used the gold standard chemical method of azoxymethane and dextran sulphate of sodium. To evaluate the role of sex steroids, we gonadectomized independent males and female animals, reconstituting and substituting them with 17ß estradiol and dihydrotestosterone. Finally, we determined, in vitro, the proliferation of a human cell line exposed to 17ß estradiol, testosterone, or dihydrotestosterone. Sex, as a risk factor for colorectal cancer, showed a statistically significant susceptibility of men over 50 years old. Results: In vivo, males develop a greater number of tumors and with a larger size than females. In males, orchiectomy prevents tumor growth, whereas in females, ovariectomy promotes the development of neoplasms. DHT acts as a protumoral agent in both sexes. 17ß estradiol reduces tumor growth in females but enhances it in males, showing a dimorphic effect. In vitro studies reveal that estradiol decreases the proliferation of the HCT-116 colon cancer cell line, while testosterone boosts proliferation in these cells. Interestingly, dihydrotestosterone does not influence proliferation.

Non-specific pleuritis: long-term follow-up outcomes.

BACKGROUND: The definitive etiology of nonspecific pleuritis (NSP), the influence of the type of pleural biopsy on clinical results and the minimum duration of follow-up is controversial. RESEARCH DESIGN AND METHODS: A retrospective, observational study of patients ≥ 18 years with NSP confirmed by closed pleural biopsy (CPB), local anesthesia pleuroscopy (LAP), or video-assisted thoracic surgery (VATS). RESULTS: A total of 167 patients were included (mean follow-up, 14.4 months), of which 25 (15%) were diagnosed within one month; [15 (60%) malignant]. Of the remaining 142 pleural effusions (PEf), 69 (48.6%) were idiopathic; 49 (34.5%) not-malignant and 24 (16.9%) malignant (4 mesotheliomas and 20 metastasic). The diagnosis of NSP was established by CPB (7; median time to diagnosis, 9.4 months), LAT (5; 15.8 months), and VATS (8; 13.5 months) (p = 0.606). Sixty-eight patients (40.7%) died during follow-up (mean time, 12 months). CONCLUSIONS: In a substantial percentage of patients diagnosed with NSP, a definitive diagnosis will not be obtained, a relevant number of patients will develop a malignant PEf. The diagnostic procedure used for the diagnosis of NSP does not seem to influence delay in the diagnosis of malignant PEf. The data obtained suggest that follow-up should be maintained for at least 24 months.

Hypersensitivity pneumonitis: application of a new diagnostic algorithm to a time series of the disease.

BACKGROUND: The diagnostic criteria for Hypersensitivity pneumonitis (HP) have changed over time. Our aim is to apply a recent diagnostic algorithm to a historical series of patients diagnosed with HP to assess its distribution according to current diagnostic criteria and the diagnostic confidence achieved. RESEARCH DESIGN AND METHODS: Application to each patient the algorithm criteria. The diagnosis was HP (≥90%), provisional high (70-89%) or low confidence (51-69%) or non-HP (unlikely) (≤50%); or HP, provisional or non-HP, if they had lung biopsy. RESULTS: 129 patients [mean age 64 ± 12 years; 79 (61.2%) women] were included of which 16 (12.4%) were diagnosed on the basis of high clinical suspicion. After applying the algorithm, 106 patients (82.2%) could be evaluated and 83 (78.3%) had a diagnosis of HP or high confidence. Lung biopsy was able to establish a diagnosis of certainty in another 21 patients and a provisional diagnosis in 9 more [total, 113 (87.6%)]. The 16 patients without strict diagnostic criteria for HP had a low confidence diagnosis. A total of 56 lung biopsies (64.4%) could have been avoided according to the new guidelines. CONCLUSIONS: The application of this algorithm achieves a high diagnostic yield in HP, significantly reducing the number of lung biopsies required.

Perceived stress in dental students of a private university in Acapulco, Mexico / Estrés percibido en estudiantes de Odontología de una universidad privada de Acapulco, México / Estresse percebido em estudantes de odontologia de uma universidade particular em Acapulco, México

ABSTRACT Stress is a common aspect of daily life, but its negative impact emerges when it disrupts normal daily functioning. It triggers physiological changes within the body's systems, influencing behavior and emotions. Objective: This study aims to assess the frequency of perceived stress among dental students attending a private institute in Acapulco, Guerrero, Mexico. Material and methods: A descriptive cross-sectional study was conducted in November 2020. The survey targeted seventy-one Dentistry students ranging from the first to seventh semester. The survey collected sociodemographic information and utilized the ten-item Perceived Stress Scale, developed by Cohen, which employs a Likert-type scale with five categorical values. The scores were analyzed using the R statistical program. Simple frequencies of variables were obtained, and Student's t-test was employed to compare students' stress levels. The odds ratio (OR), along with its 95 % confidence interval (CI 95%) using the Miettinen method, was calculated to quantify stress risk based on gender and semester. Results: Among the participants, 60 % (43/71) experienced high levels of stress. Specifically, female students accounted for a higher occurrence of stress at 70 % (30/43). The association of high stress was particularly prominent among students in the last semester (OR = 2.88; 95 % CI = 1.07-7.71). Conclusion: The findings suggest that a significant portion, at least six out of ten students, experience elevated stress levels. The study underscores the importance of dental educators identifying and addressing stressful situations among students, thereby facilitating the referral of cases in need of psychological support.

RESUMEN El estrés es una situación cotidiana normal, pero tiene repercusiones negativas cuando altera el funcionamiento diario en la vida humana. Implica cambios en los sistemas fisiológicos corporales del organismo, los cuales influyen en el comportamiento y los sentimientos. Objetivo: Estimar la frecuencia del estrés percibido en estudiantes de Odontología de un instituto privado de Acapulco, Guerrero, México. Material y métodos: Estudio transversal descriptivo realizado en noviembre de 2020. Se encuestaron a 71 estudiantes de primero a séptimo semestre de Odontología. El instrumento de medición obtuvo datos sociodemográficos y se utilizó la Escala de Estrés Percibido de diez ítems, propuesta por Cohen, la cual toma un escalamiento tipo Likert de cinco valores categoriales. Las puntuaciones fueron analizadas a través del programa estadístico de R, que obtuvo frecuencias simples de las variables, y se utilizó la prueba t de Student para comparar los niveles de estrés en los estudiantes. Fue estimada la razón de momios (RM) con su intervalo de confianza de Miettinen del 95 % (IC 95%) para cuantificar el nivel de riesgo del estrés, por género y semestre. Resultados: El 60 % (43/71) de los estudiantes presentó estrés alto. Respecto al sexo, las mujeres presentaron mayor ocurrencia del fenómeno con el 70 % (30/43). La fuerza de asociación del estrés alto se presentó en los estudiantes del último semestre (OR = 2,88; IC 95 % = 1,07-7,71). Conclusión: Al menos seis de cada diez estudiantes presentaron variaciones de estrés alto. Se sugiere que los educadores de odontología identifiquen las situaciones de estrés en los estudiantes con el fin de derivar los casos que requieren ayuda psicológica.

RESUMO O estresse é uma ocorrência comum no cotidiano, mas suas implicações negativas surgem quando afeta o funcionamento diário das vidas humanas. Isso envolve alterações nos sistemas fisiológicos do corpo, influenciando comportamentos e sentimentos. Objetivo: Estimar a frequência do estresse percebido entre estudantes de odontologia de uma instituição privada em Acapulco, Guerrero, México. Material e métodos: Realizou-se um estudo descritivo de corte transversal em novembro de 2020. Um total de 71 estudantes de Odontologia, do primeiro ao sétimo semestre, foram incluídos na pesquisa. O instrumento de medição coletou informações sociodemográficas e empregou a Escala de Estresse Percebido de dez itens, proposta por Cohen, utilizando uma escala Likert de cinco categorias. As pontuações foram analisadas através do software estatístico R, gerando frequências simples das variáveis e aplicando o teste t de Student para comparar o nível de estresse entre os alunos. A Razão de Chances (RC) com um intervalo de confiança de Miettinen de 95% (IC 95%) foi calculada para quantificar o risco de estresse por gênero e semestre. Resultados: Dos estudantes, 60% (43/71) apresentaram alto nível de estresse. No que se refere ao gênero, as mulheres tiveram uma maior incidência, com 70% (30/43). Observou-se uma associação significativa de alto estresse entre os alunos do último semestre (RC = 2,88, IC 95% = 1,07-7,71). Conclusão: Pelo menos seis em cada dez estudantes demonstraram níveis elevados de estresse. Recomenda-se que os educadores de Odontologia identifiquem situações estressantes nos alunos para encaminhar os casos que possam requerer apoio psicológico.

Characteristics of pleural effusion due to amyloidosis.

The characteristics of patients with pleural amyloidosis (PA) are poorly known. A systematic review was performed of studies reporting clinical findings, pleural fluid (PF) characteristics, and the most effective treatment of PA. Case descriptions and retrospective studies were included. The review included 95 studies with a total sample of 196 patients. The mean age was 63 years, male/female ratio was 1.6:1, and 91.9% of patients were >50 years. The most common symptom was dyspnea (88 patients). PF was generally serious (63%), predominantly lymphocytic, and with the biochemical characteristics of transudates (43.4%) or exudates (42.6%). Pleural effusion was generally bilateral (55%) and <1/3 of the hemithorax (50%), although in 21% pleural effusion (PE) exceeded 2/3. Pleural biopsy was performed in 67 patients (yield: 83.6%; 56/67) and was positive in 54% of exudates and 62.5% of unilateral effusions. Of the 251 treatments prescribed, only 31 were effective (12.4%). The combination of chemotherapy and corticosteroids was effective in 29.6% of cases, whereas talc pleurodesis was effective in 21.4% and indwelling pleural catheter in 75% of patients (only four patients). PA is more frequent in adults from 50 years of age. PF is usually bilateral, serous, and indistinctly a transudate or exudate. A pleural biopsy can aid in diagnosis if effusion is unilateral or an exudate. Treatments are rarely effective and there may be definitive therapeutic options for PE in these patients.

Advances in inhaled antibiotics for management of respiratory tract infections.

PURPOSE OF REVIEW: The incidence of bacterial respiratory tract infections is growing. In a context of increasing antibiotic resistance and lack of new classes of antibiotics, inhaled antibiotics emerge as a promising therapeutic strategy. Although they are generally used for cystic fibrosis, their use in other conditions is becoming more frequent, including no-cystic fibrosis bronchiectasis, pneumonia and mycobacterial infections. RECENT FINDINGS: Inhaled antibiotics exert beneficial microbiological effects in bronchiectasis and chronic bronchial infection. In nosocomial and ventilator-associated pneumonia, aerosolized antibiotics improve cure rates and bacterial eradication. In refractory Mycobacterium avium complex infections, amikacin liposome inhalation suspension is more effective in achieving long-lasting sputum conversion. In relation to biological inhaled antibiotics (antimicrobial peptides, interfering RNA and bacteriophages), currently in development, there is no still enough evidence that support their use in clinical practice. SUMMARY: The effective antimicrobiological activity of inhaled antibiotics, added to their potential to overcoming resistances to systemic antibiotics, make inhaled antibiotics a plausible alternative.

Estrategia de superación para desarrollar la competencia didáctica de los profesores de Cirugía Maxilofacial

Introducción: la educación médica superior requiere su propia didáctica, que permita la construcción del aprendizaje de los estudiantes. Por ello, los profesores de las diferentes especialidades médicas deben adquirir competencias profesionales pedagógicas, en especial la didáctica. Objetivo: diseñar una estrategia de superación para el desarrollo de la competencia didáctica de los profesores de la especialidad de Cirugía Maxilofacial. Materiales y métodos: el estudio se clasificó como investigación-acción, de tipo cualitativo-cuantitativo, y se realizó entre enero y septiembre de 2022. Se trabajó con 15 profesores de la especialidad de Cirugía Maxilofacial. La estrategia fue diseñada en cuatro etapas (diagnóstico, planeación, implementación y evaluación). Se utilizaron métodos teóricos y empíricos, en especial, el experimento. Los procedimientos estadísticos usados fueron las pruebas chi cuadrado de McNemar, la de Wilcoxon y el alfa de Cronbach. Resultados: se evaluó la competencia didáctica de los profesores y las dimensiones que la integran (conocimientos, habilidades, capacidades y motivaciones), arrojando un incremento significativo desde el punto de vista estadístico, con una buena confiabilidad de los instrumentos aplicados. Conclusiones: la estrategia permite determinar las pautas esenciales o relaciones que enriquecen la teoría de las ciencias de la educación médica, desde el posgrado, ofreciendo coherencia lógica interna a los procesos que se aplican en la estrategia y posibilitando que los profesores de la especialidad de Cirugía Maxilofacial logren mejorar la competencia didáctica.

Introduction: higher medical education requires its own didactics, which allows the construction of student learning. For this reason, teachers of the different medical specialties must acquire professional pedagogical competences, especially didactics. Objective: to design an improvement strategy for the development of the didactic competence of the professors of the specialty of Maxillofacial Surgery. Materials and methods: the study was classified as action-research, of a qualitative-quantitative type, and was carried out between January and September 2022. The authors worked with 15 professors from the specialty of Maxillofacial Surgery. The strategy was designed in four stages (diagnosis, planning, implementation and evaluation). Theoretical and empirical methods were used, especially the experiment. The statistical procedures used were McNemar's chi square, Wilcoxon's and Cronbach's alpha tests. Results: the didactic competence of the teachers and the dimensions that comprise it (knowledge, skills, abilities and motivations) were evaluated, showing a significant increase from the statistical point of view, with a good reliability of the applied instruments. Conclusions: the strategy makes it possible to determine the essential guidelines or relationships that enrich the theory of medical education sciences, from the postgraduate level, offering internal logical coherence to the processes that are applied in the strategy and enabling professors of the specialty of Surgery Maxillofacial manage to improve the didactic competence.

Response to inhaled ceftazidime in patients with non-cystic fibrosis bronchiectasis and chronic bronchial infection unrelated to Pseudomonas aeruginosa.

INTRODUCTION: Inhaled antibiotics reduce the frequency of exacerbations. The objective was to assess the efficacy of inhaled ceftazidime in patients with non-cystic fibrosis bronchiectasis (NCFB) and concomitant chronic bronchial infection (CBI) caused by potentially pathogenic microorganisms (PPM) other than Pseudomonas aeruginosa (PA). MATERIAL AND METHOD: Quasi-experimental study in 21 patients with exacerbations who developed CBI by a PPM other than PA. RESULTS: Bacterial infection was resolved in 85.7% patients. Rehospitalizations, length of hospital stay, moderate exacerbations and blood levels of CRP decreased significantly. In addition, SGRQ questionnaire also decreased more than 4 points in 57.1% of the patients. CONCLUSION: The results suggest that inhaled ceftazidime in NCFB unrelated to PA is a plausible alternative to the standard therapies used in clinical practice.

Sarcoidosis. Disease progression based on radiological and functional course: Predictive factors.

BACKGROUND: Sarcoidosis is a multiorgan granulomatous disease with a variable course. OOBJECTIVES: The purpose of this study is to identify the patients that are more likely to experience disease progression. METHODS: A retrospective study in patients ≥18 years. Pulmonary function and radiological stage (Scadding criteria) were assessed at diagnosis, and at 1, 3 and 5 years. Sarcoidosis progression was established based on deterioration of radiological or pulmonary function (decrease ≥10% of FVC and/or ≥15% of diffusing capacity of the lung (DLCO). RESULTS: The sample included 277 caucasian patients [mean age, 50±13.6; 69.7% between 31-60 years; 56.3% men]. In total, 65% had stage II sarcoidosis, whereas only 8.3% had stage III/IV disease. Mean pulmonary function (FVC, FEV1, FEV1/FVC and DLCO) at diagnosis was 103±21.8, 96±22.2, 76.2±8 and 81.7±21.7, respectively. The percentage of patients with normal FVC and DLCO was 72.2% and 51.8%, respectively. Radiological stage did not change significantly during follow-up (5 years; p=0.080) and only progressed in 13 patients (5.7%). At 3 years, FVC improved, whereas DLCO exacerbated significantly (p<0.001 for the two). Disease progressed in 34.5% of the patients (57/165) whose pulmonary function and radiological stage were available (both baseline and at 3 years). Age was associated with disease progression [OR=1.04 (95%CI=1.01, 1.06)]. Risk increased by 4% for each year older a patient was at diagnosis. CONCLUSIONS: At 3 years, a third of patients experienced sarcoidosis progression. Age was the only factor associated with disease prognosis.

Pulmonary Manifestations of Primary Humoral Deficiencies.

Primary immunodeficiencies are a group of conditions characterized by developmental or functional alterations in the immune system caused by hereditary genetic defects. Primary immunodeficiencies may affect either the innate or the adaptive (humoral and cellular) immune system. Pulmonary complications in primary humoral deficiencies are frequent and varied and are associated with high morbidity and mortality rates. The types of complications include bronchiectasis secondary to recurrent respiratory infections and interstitial pulmonary involvement, which can be associated with autoimmune cytopenias, lymphoproliferation, and a range of immunological manifestations. Early detection is key to timely management. Immunoglobulin replacement therapy reduces the severity of disease, the frequency of exacerbations, and hospital admissions in some primary humoral deficiencies. Therefore, the presence of pulmonary disease with concomitant infectious and/or autoimmune complications should raise suspicion of primary humoral deficiencies and warrants a request for immunoglobulin determination in blood. Once diagnosis is confirmed; early immunoglobulin replacement therapy will improve the course of the disease. Further studies are needed to better understand the pathogenesis of pulmonary disease related to primary humoral deficiencies and favor the development of targeted therapies that improve the prognosis of patients.

Pleuroparenchymal fibroelastosis: Clinical, radiological and histopathological features.

Pleuroparenchymal fibroelastosis (PPFE) is a rare, generally idiopathic form of interstitial pneumonia with unique clinical, radiological and histopathological features. It is named after the presence of upper lobe pleural and subjacent parenchymal fibrosis, with accompanying elastic fibers. Although it is usually an idiopathic disease, it has been linked to other co-existent diseases. Diagnostic suspicion of PPFE is based on the identification of typical abnormalities on chest CT scan, which are prevailingly located in the upper lobes, adjacent to the apex of the lungs. Diagnosis can be confirmed by histological analysis, although biopsy is not always feasible. The disease is generally progressive, but not uniformly. The course of the disease is frequently slow and involves a progressive loss of upper lobe volume, which results in platythorax, associated with a significant reduction of body mass. PPFE concomitant to other interstitial lung diseases is associated with a poorer prognosis. The disease occasionally progresses rapidly causing irreversible respiratory insufficiency, which leads to death. Currently, there is no effective pharmacological therapy available, and lung transplantation is the best therapeutic option. The purpose of this review is to draw the attention to PPFE, describe its clinical, radiological and histopathological features, analyze its diagnostic criteria, and provide an update on the management of the disease.

Magnetic resonance imaging for the study of mediastinal adenopathies in lung cancer: Comparison with standard tests.

BACKGROUND: Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude. PURPOSE: The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard. MATERIALS AND METHODS: An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests. RESULTS: As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97). CONCLUSIONS: The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging.

Development and validation of a prognostic model based on comorbidities to predict COVID-19 severity: a population-based study.

BACKGROUND: The prognosis of patients with COVID-19 infection is uncertain. We derived and validated a new risk model for predicting progression to disease severity, hospitalization, admission to intensive care unit (ICU) and mortality in patients with COVID-19 infection (Gal-COVID-19 scores). METHODS: This is a retrospective cohort study of patients with COVID-19 infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) in Galicia, Spain. Data were extracted from electronic health records of patients, including age, sex and comorbidities according to International Classification of Primary Care codes (ICPC-2). Logistic regression models were used to estimate the probability of disease severity. Calibration and discrimination were evaluated to assess model performance. RESULTS: The incidence of infection was 0.39% (10 454 patients). A total of 2492 patients (23.8%) required hospitalization, 284 (2.7%) were admitted to the ICU and 544 (5.2%) died. The variables included in the models to predict severity included age, gender and chronic comorbidities such as cardiovascular disease, diabetes, obesity, hypertension, chronic obstructive pulmonary disease, asthma, liver disease, chronic kidney disease and haematological cancer. The models demonstrated a fair-good fit for predicting hospitalization {AUC [area under the receiver operating characteristics (ROC) curve] 0.77 [95% confidence interval (CI) 0.76, 0.78]}, admission to ICU [AUC 0.83 (95%CI 0.81, 0.85)] and death [AUC 0.89 (95%CI 0.88, 0.90)]. CONCLUSIONS: The Gal-COVID-19 scores provide risk estimates for predicting severity in COVID-19 patients. The ability to predict disease severity may help clinicians prioritize high-risk patients and facilitate the decision making of health authorities.

Malignant Pleural Effusion: Diagnosis and Management.

Symptomatic malignant pleural effusion is a common clinical problem. This condition is associated with very high mortality, with life expectancy ranging from 3 to 12 months. Studies are contributing evidence on an increasing number of therapeutic options (therapeutic thoracentesis, thoracoscopic pleurodesis or thoracic drainage, indwelling pleural catheter, surgery, or a combination of these therapies). Despite the availability of therapies, the management of malignant pleural effusion is challenging and is mainly focused on the relief of symptoms. The therapy to be administered needs to be designed on a case-by-case basis considering patient's preferences, life expectancy, tumour type, presence of a trapped lung, resources available, and experience of the treating team. At present, the management of malignant pleural effusion has evolved towards less invasive approaches based on ambulatory care. This approach spares the patient the discomfort caused by more invasive interventions and reduces the economic burden of the disease. A review was performed of the diagnosis and the different approaches to the management of malignant pleural effusion, with special emphasis on their indications, usefulness, cost-effectiveness, and complications. Further research is needed to shed light on the current matters of controversy and help establish a standardized, more effective management of this clinical problem.

Impact of cardiovascular risk factors on the clinical presentation and survival of pulmonary embolism without identifiable risk factor.

BACKGROUND: The nature of pulmonary embolism (PE) without identifiable risk factor (IRF) remains unclear. The objective of this study is to investigate the potential relationship between cardiovascular risk factors (CVRFs) and PE without IRF (unprovoked) and assess their role as markers of disease severity and prognosis. METHODS: A case-control study was performed of patients with PE admitted to our hospital [2010-2019]. Subjects with PE without IRF were included in the cohort of cases, whereas patients with PE with IRF were allocated to the control group. Variables of interest included age, active smoking, obesity, and diagnosis of arterial hypertension, dyslipidemia or diabetes mellitus. RESULTS: A total of 1,166 patients were included in the study, of whom 64.2% had PE without IRF. The risk for PE without IRF increased with age [odds ratio (OR): 2.68; 95% confidence interval (CI): 1.95-3.68], arterial hypertension (OR: 1.63; 95% CI: 1.27-2.07), and dyslipidemia (OR: 1.63; 95% CI: 1.24-2.15). The risk for PE without IRF was higher as the number of CVRF increased, being 3.99 (95% CI: 2.02-7.90) for subjects with ≥3 CVRF. The percentage of high-risk unprovoked PE increased significantly as the number of CVRF rose [0.6% for no CVRF; 23.8% for a CRF, P<0.001 (OR: 9.92; 95% CI: 2.82-34.9); 37.5% for two CRFs, P<0.001 (OR: 14.8; 95% CI: 4.25-51.85); and 38.1% for ≥3, P<0.001 (OR: 14.1; 95% CI: 4.06-49.4)]. No significant differences were observed in 1-month survival between cases and controls, whereas differences in 24-month survival reached significance. CONCLUSIONS: A relationship was observed between CVRF and PE without IRF, as the risk for unprovoked PE increased with the number of CVRF. In addition, the number of CVRF was associated with PE without IRF severity, but not with prognosis.

Usefulness of Positron Emission Tomography in the Examination of Hilar and Mediastinal Lymphadenopathies in Patients with Suspicion of Lung Cancer.

Introduction: Lung cancer is a major health problem. Mediastinal staging performed with the aid of imaging techniques is essential for appropriate disease treatment and prognosis. Accordingly, this study aimed to ascertain the usefulness of positron emission tomography (PET) in mediastinal staging, establish the best maximum standardized uptake value (SUVmax) cutoff point, compare its usefulness to that of computed tomography (CT), and determine the influence of histological tumour subtype. Methods: We conducted a retrospective study across a period of 3 years on 128 patients with suspicion of lung cancer and analyzed their demographic and radiological characteristics using CT and PET to perform the mediastinal examination. Histology was regarded as the gold standard. Results: PET displayed a high sensitivity (95%) and negative predictive value (NPV) (92%), outperforming CT (89% and 85%, respectively). Percentage agreement with histology was also higher (0.207 and 0.241 for CT and PET, respectively; p < 0.001). Taking an SUVmax value of 0.5 as that which would ensure greatest diagnostic accuracy, S and NPV were 100%, though percentage agreement did not increase (0.189; p < 0.001). PET discriminatory power was not affected by histological tumour subtype. Conclusions: The results of our study indicate that PET might be a useful test for examination of the mediastinum in lung cancer patients. Its high NPV suggests that the absence of mediastinal uptake could be used to proceed to surgical treatment without the need for further tests or examinations. Nevertheless, studies directly aimed to answer this specific question are needed.

Advances in pleural effusion diagnostics.

Introduction: Pleural effusion is a common clinical problem. Yet, in a significant proportion of patients (~20%), the cause of pleural effusion remains unknown. Understanding the diagnostic value of pleural fluid tests is crucial for the development of accurate diagnostic models.Areas covered: This paper provides an overview of latest advances in the diagnosis of pleural effusion based on the best evidence available.Expert opinion: For pleural fluid tests to have a good diagnostic value, it is necessary that data obtained from clinical history, physical examination, and radiological studies are correctly interpreted. Thoracentesis and pleural biopsy should always be performed under image guidance to improve its diagnostic sensitivity and prevent complications. Nucleic acid amplification tests, pleural tissue cultures, and collection of pleural fluid in blood culture bottles improve the diagnostic yield of pleural fluid cultures. Although undiagnosed pleural effusions generally have a favorable prognosis, follow-up is recommended to prevent the development of a malignant pleural effusion.

Identification of Pleural Response Patterns: A Cluster Analysis.

BACKGROUND: Pleural effusion occurs as a response of the pleura to aggressions. The pleura reacts differently according to the type of injury. However, pleural reactions have not yet been characterized. The objective of this study was to identify homogeneous clusters of patients based on the analytical characteristics of their pleural fluid and identify pleural response patterns. METHODS: A prospective study was conducted of consecutive patients seen in our unit for pleural effusion. Principal component and cluster analyses were carried out to identify pleural response patterns based on a combination of pleural fluid biomarkers. RESULTS: A total of 1613 patients were grouped into six clusters, namely: cluster 1 (10.5% of the cohort, primarily composed of patients with malignant pleural effusions); cluster 2 (17.4%, pleural effusions with inflammatory biomarkers); cluster 3 (16.1%, primarily composed of patients with infectious pleural effusions); cluster 4 (2.5%, a subcluster of cluster 3, superinfectious effusions); cluster 5 (23.4%, paucicellular pleural effusions); and cluster 6 (30.1%, miscellaneous). Significant differences were observed across clusters in terms of the analytical characteristics of PF (p<0.001 for all), age (p<0.001), and gender (p=0.016). A direct relationship was found between the type of cluster and the etiology of pleural effusion. CONCLUSION: Pleural response is heterogeneous. The pleura may respond differently to the same etiology or similarly to different etiologies, which hinders diagnosis of pleural effusion.