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.

Molecular transition of SARS-CoV-2 from critical patients during the first year of the COVID-19 pandemic in Mexico City.

Background: The SARS-CoV-2 virus has caused unprecedented mortality since its emergence in late 2019. The continuous evolution of the viral genome through the concerted action of mutational forces has produced distinct variants that became dominant, challenging human immunity and vaccine development. Aim and methods: In this work, through an integrative genomic approach, we describe the molecular transition of SARS-CoV-2 by analyzing the viral whole genome sequences from 50 critical COVID-19 patients recruited during the first year of the pandemic in Mexico City. Results: Our results revealed differential levels of the evolutionary forces across the genome and specific mutational processes that have shaped the first two epidemiological waves of the pandemic in Mexico. Through phylogenetic analyses, we observed a genomic transition in the circulating SARS-CoV-2 genomes from several lineages prevalent in the first wave to a dominance of the B.1.1.519 variant (defined by T478K, P681H, and T732A mutations in the spike protein) in the second wave. Conclusion: This work contributes to a better understanding of the evolutionary dynamics and selective pressures that act at the genomic level, the prediction of more accurate variants of clinical significance, and a better comprehension of the molecular mechanisms driving the evolution of SARS-CoV-2 to improve vaccine and drug development.

First evidence of multiple paternity in the blue shark (Prionace glauca).

Multiple paternity (MP) is defined as the behaviour in which females successfully mate with multiple males leading to offspring from different sires within the same litter. MP seems to be frequent and an evolutionary advantage in elasmobranchs. Here the authors report for the first time the occurrence of MP in the cosmopolitan blue shark Prionace glauca L. The evidence, gathered via microsatellite genotyping of pregnant females and their embryos, suggests that MP is very frequent in this species. Knowledge of MP in P. glauca should help describe more precisely its reproductive biology and contribute to the management of its populations.

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.

The evolutionary outcomes of climate-change-induced hybridization in insect populations.

Rapid range shifts are one of the most frequent responses to climate change in insect populations. Climate-induced range shifts can lead to the breakdown of isolation barriers, and thus, to an increase in hybridization and introgression. Long-term evolutionary consequences such as the formation of hybrid zones, introgression, speciation, and extinction have been predicted as a result of climate-induced hybridization. Our review shows that there has been an increase in the number of published cases of climate-induced hybridization in insects, and that the formation of hybrid zones and introgression seems to be, at the moment, the most frequent outcomes. Although introgression is considered positive, since it increases species' genetic diversity, in the long term, it could lead to negative outcomes such as species fusion or genetic swamping.

Dynamic of Glucose Homeostasis in Virtual Patients: A Comparison between Different Behaviors.

This work presents a mathematical model of homeostasis dynamics in healthy individuals, focusing on the generation of conductive data on glucose homeostasis throughout the day under dietary and physical activity factors. Two case studies on glucose dynamics for populations under conditions of physical activity and sedentary lifestyle were developed. For this purpose, two types of virtual populations were generated, the first population was developed according to the data of a total of 89 physical persons between 20 and 75 years old and the second was developed using the Monte Carlo approach, obtaining a total of 200 virtual patients. In both populations, each participant was classified as an active or sedentary person depending on the physical activity performed. The results obtained demonstrate the capacity of virtual populations in the generation of in-silico approximations similar to those obtained from in-vivo studies. Obtaining information that is only achievable through specific in-vivo experiments. Being a tool that generates information for the approach of alternatives in the prevention of the development of type 2 Diabetes.

Next-generation sequencing, isolation and characterization of 14 microsatellite loci of Canthon cyanellus (Coleoptera: Scarabaeidae).

BACKGROUND: We used Illumina paired-end sequencing to isolate and characterize microsatellites of Canthon cyanellus, a Neotropical roller dung beetle, encompassing several lineages within its distribution range. METHODS AND RESULTS: We examined C. cyanellus specimens collected at eight different localities in Mexico (two or three specimens per locality). We initially performed amplification tests with 16 loci, but two of which were unsuccessful. The 14 remaining microsatellites were polymorphic, with 2-16 alleles each. The expected and observed heterozygosity ranged from 0.11 to 0.76 and from 0.20 to 0.78, respectively. CONCLUSIONS: These microsatellites will help to assess structure at the population and lineage levels, identify zones of potential hybridization between lineages, and draw a more precise geographic delimitation of C. cyanellus lineages.

Novel thiosemicarbazones induce high toxicity in estrogen-receptor-positive breast cancer cells (MCF7) and exacerbate cisplatin effectiveness in triple-negative breast (MDA-MB231) and lung adenocarcinoma (A549) cells.

Cis-diamminedichloroplatinum(II) (CDDP), known as cisplatin, has been extensively used against breast cancer, which is the most frequent cancer among women, and lung cancer, the leading cancer that causes death worldwide. Novel compounds such as thiazole derivatives have exhibited antiproliferative activity, suggesting they could be useful against cancer treatment. Herein, we synthesized two novel thiosemicarbazones and an aldehyde to combine with CDDP to enhance efficacy against ER-positive breast MCF7 cancer cells, triple-negative/basal-B mammary carcinoma cells (MDA-MB231) and lung adenocarcinoma (A549) human cells. We synthesized 2,3,5,6-tetrafluoro-4-(2-mercaptoetanothiolyl)benzaldehyde (ALD), 5-[(2,3,5,6-tetrafluoro-4-(trifluoromethyl)phenyl)thio]-2-furaldehyde thiosemicarbazone (TSC1) and 5-[(4-(trifluoromethyl)phenyl)thio]-2-furaldehyde thiosemicarbazone (TSC2) and used them alone or in combination with subtoxic CDDP concentrations to evaluate cytotoxicity, cytoskeleton integrity and mitochondrial function. We found that none of the synthesized compounds improved CDDP activity against MCF7 cell cultures; however, TSC2 was effective in enhancing the cytotoxicity of CDDP against MDA-MB231 and A549 cancer cell cultures. We demonstrated that the cytotoxic effect is related to the TSC2 capacity to induce disruption in the cytoskeleton network and to decrease mitochondrial function.

Vigilancia de laboratorio de dengue y otros arbovirus en Cuba, 1970-2017 / Laboratory surveillance of dengue fever and other arboviruses in Cuba, 1970-2017

Los arbovirus constituyen una de las principales causas de emergencia en salud por la morbilidad y mortalidad que producen y el estrés sanitario que conllevan. Cuba no ha estado excenta de riesgo, y el enfrentamiento del dengue inicialmente y de otros arbovirus después, ha sido, y es, una prioridad de las máximas autoridades del país. La vigilancia de laboratorio de dengue se estableció desde inicios de la década del 70 aunque sus objetivos y estrategias han cambiado según la situación epidemiológica nacional y regional y la tecnología de diagnóstico disponible. Se destacan cuatro etapas en su desarrollo. En este trabajo se resumen las estrategias desarrolladas para la vigilancia de laboratorio de dengue y de otros arbovirus en el periodo de 1970 a 2017. Se describe además el papel desempeñado por el Instituto de Medicina Tropical, ¨Pedro Kouri¨ (IPK) como Laboratorio Nacional de Referencia(AU)

Arboviruses are one of the leading causes of health emergencies due to their morbidity and mortality and the sanitary stress they bring about. Cuba has not been free from risk, and the response first to dengue fever and then to other arboviruses has been and still is a priority for the country's top authorities. Laboratory surveillance of dengue fever was implemented in the 1970s, though its aims and strategies have evolved in keeping with the national and regional epidemiological situation, and the available diagnostic technology. Four stages stand out in the development of dengue laboratory surveillance. The present paper summarizes the strategies developed for laboratory surveillance of dengue fever and other arboviruses in the period 1970-2017. A description is also provided of the role played by Pedro Kourí Tropical Medicine Institute (IPK) as a national reference laboratory(AU)

Manifestaciones bucales de la sífilis secundaria en una paciente adulta / Oral manifestations of secondary syphilis in an adult female patient

Se describe el caso clínico de una paciente de 38 años de edad, quien fue atendida en la consulta estomatológica del Policlínico Cuatro Caminos, por presentar múltiples lesiones indoloras en casi toda la mucosa bucal. Teniendo en cuenta estos síntomas se le diagnosticó una estomatitis aftosa recurrente, pero el tratamiento indicado no resultó satisfactorio. Luego se interconsultó con el especialista en Medicina Interna, quien le indicó exámenes complementarios y, según los criterios clínicos y de laboratorio, se confirmó la presencia de sífilis secundaria. Se efectuó el control de foco y se logró la remisión de la enfermedad.

The case report of a 38 year-old patient who was assisted in the stomatological department of Cuatro caminos polyclinic is described due to multiple painless lesions in almost all the oral mucous. Keeping in mind these symptoms a recurrent aphthous stomatitis was diagnosed, but the prescribed treatment was not satisfactory. Then a consultation with the specialist in Internal Medicine was carried out, who indicated her complementary exams and, according to the clinical and laboratory criteria, the presence of secondary syphilis was confirmed. The focus control was carried out and the remission of the disease was achieved.

Manifestaciones bucales del síndrome de Sjögren. Presentación de un caso / Oral manifestations of the Sjögren's syndrome. Presentation of a case

El síndrome de Sjögren es una enfermedad autoinmunitaria, caracterizada por la infiltración linfoplasmocitaria de las glándulas exocrinas con destrucción epitelial, provocando un síndrome seco. El objetivo de esta presentación de caso fue profundizar en el conocimiento de la enfermedad, ya que constituye la clave para su diagnóstico oportuno. Se presentó a una paciente femenina de 54 años, con antecedentes de lupus eritematoso sistémico. El interrogatorio, el examen clínico general y bucal, los estudios de laboratorio e histológico, así como la sospecha clínica de la enfermedad, permitieron realizar el diagnóstico del síndrome de Sjögren asociado a lupus eritematoso sistémico. En esta paciente concurrieron las siguientes manifestaciones bucales: xerostomía, halitosis, sensación de sed constante, dificultades para la deglución y para hablar, labios secos y pálidos, lengua depapilada, ardor bucal, intolerancia al uso de la prótesis, queilitis angular y candidiasis bucal. El manejo de la enfermedad tiene un enfoque multidisciplinario; el estomatólogo cumple un papel esencial en su diagnóstico y tratamiento, lo cual permite mejorar la calidad de vida de estos pacientes.

The Sjögren’s syndrome is an auto-immune disease, characterized by the limpho-plasmocytic infiltration of the exocrine glands with epithelial destruction, provoking a dry syndrome. The objective of this case presentation was deepening in this disease knowledge, because it is the key for its opportune diagnosis. We presented a female patient, aged 54 years, with antecedents of systemic lupus erythematosus. The anamnesis, oral and general examination, histological and laboratory studies, and also the clinical suspicion, allowed arriving to the diagnosis of Sjögren’s syndrome associated to systemic lupus erythematosus. This patient showed the following oral manifestations: xerostomia, halitosis, sensation of constant thirst, difficulties for deglutition and speaking, dry and pale lips, depapillated tongue, oral burning, intolerance to prosthesis usage, angular cheilitis and oral candidiasis. The disease management has a multidiscipline approach; the dentist plays an essential role in the disease’s diagnosis and treatment, allowing improving the life quality of these patients.

Virtual estimator for piecewise linear systems based on observability analysis.

This article proposes a virtual sensor for piecewise linear systems based on observability analysis that is in function of a commutation law related with the system's outpu. This virtual sensor is also known as a state estimator. Besides, it presents a detector of active mode when the commutation sequences of each linear subsystem are arbitrary and unknown. For the previous, this article proposes a set of virtual estimators that discern the commutation paths of the system and allow estimating their output. In this work a methodology in order to test the observability for piecewise linear systems with discrete time is proposed. An academic example is presented to show the obtained results.

La muerte voluntaria en Yucatán durante el porfiriato / Voluntary Death in Yucatan during the porfiriato

Este artículo se aboca al estudio del suicidio en Yucatán durante el porfiriato; su objetivo radica en entender las preconcepciones que se tenían acerca de los suicidas. El aporte de este trabajo consiste en interpretar la forma en la que eran percibidos y descritos estos personajes a partir de las notas de la prensa decimonónica y en las actas judiciales, pero analizados en relación con el auge industrializador de la época. En común había un sentimiento de lástima que despertaban los suicidas, pero antes de sentir tal pesar trataban de buscar alguna causa que hiciera entendible el porqué se habían suicidado. En este sentido se analizan los casos de muerte voluntaria con una previa ambientación del efecto modernizador de tal tiempo, todo ello con el objeto de entender mejor cómo se gestaban este tipo de eventos. (AU)

Auriculoterapia en los trastornos de la premenopausia / Auriculotherapy in premenopausal disorders

Se realizó un ensayo clínico fase II temprana para determinar la eficacia de la auriculoterapia en un grupo de mujeres que acudieron a la consulta de Medicina Natural y Tradicional, de la Sala de Rehabilitación del Municipio Céspedes, con síntomas relacionados con la etapa pre-menopáusica del climaterio, durante Julio-Diciembre del 2008, cuya cifra ascendió a 36 pacientes, extrayéndose una muestra de 21, según criterios de inclusión y exclusión. Se recogieron datos referidos a la etapa clínica en que se encontraban, síntomas presentes antes, durante y al finalizar el tratamiento. En la tercera semana de tratamiento el 90.48 por ciento de las pacientes señalaron mejoría sintomatológica, evaluándose su eficacia final como buena (66.67 por ciento). No se reportaron reacciones adversas relacionadas con la terapia empleada y el nivel de satisfacción con el resultado del tratamiento tradicional fue de un 90.5 por ciento

A phase II clinical trial early was carried out to determine the effectiveness of Auriculotherapy in a group of women who attended the consultation of Natural and Traditional Medicine, from Rehabilitation room in Céspedes city, with symptoms related to pre-menopausal stage of climacterium, during July-December 2008, whose number increased to 36 patients, extracting a sample of 21, according to inclusion and exclusion criteria. It was collected data regarding the clinical stage, symptoms present before, during and after the treatment. In the third week of treatment, 90.48 percent of patients reported symptomatic improvement, evaluating their ultimate effectiveness as good (66.67 percent). There were no reported adverse reactions related to the therapy used and the level of satisfaction with the results of traditional treatment was 90.5 percent

Evidence on impact of community-based environmental management on dengue transmission in Santiago de Cuba.

During the dengue outbreak that struck Santiago de Cuba in 2006-2007, we conducted an observational study in the Mariana Grajales district, the former setting of a community trial for Aedes aegypti control. In the trial, community working groups (CWG) had been created in 29 randomly selected intervention house blocks, and routine vector control activities alone were conducted in the remaining 30 control blocks. The CWG elaborated and implemented with the population plans and activities to reduce Aedes infestation. They were still functional in 2006 and continued organizing community-based environmental management activities. The attack rate of dengue fever during the outbreak was 8.5 per 1000 inhabitants in the former intervention blocks and 38.1 per 1000 inhabitants in the control blocks, which corresponds to a relative risk of 4.5 (95% CI 3.1-6.5). There was a significantly higher proportion of unaffected intervention blocks, and affected blocks had on average substantially less cases than affected control blocks. This study indicates that community-based environmental management inserted in the routine A. aegypti control programme can not only sustainably curb vector infestation but also have an impact on dengue transmission.

Tumor necrosis factor-alpha, transforming growth factor-ß1, and interleukin-10 gene polymorphisms: implication in protection or susceptibility to dengue hemorrhagic fever.

Dengue virus infection has emerged as one of the most important arthropod-borne viral diseases. Some dengue infected individuals develop the severe, life-threatening form of the disease, dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Host genetic factors may be relevant and may predispose some individuals to the severe illness. Human leukocyte antigen (HLA), FcγR, tumor necrosis factor (TNF)-α, and dendritic cell-specific intracellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN), among others genes have been associated with the pathogenesis of dengue. Little is known, however, about the predictive value of cytokine genotypes for the clinical outcome of dengue infection. In this study, the TNF-α, interleukin (IL)-6, interferon (IFN)-γ, IL-10 and transforming growth factor (TGF)-ß1 gene single nucleotide polymorphisms (SNP) were studied by polymerase chain reaction-sequence-specific primer in a group of individuals with the antecedent of DHF during a secondary infection in the sequence dengue 1/dengue 2. A control group was also included. TNF-α (-308) A allele and IL-10 (-1082/-819/-592) ACC/ATA haplotype were significantly associated with DHF. TNF-α (-308) GG and TGF-ß1 (c25) GG genotypes were associated with protection. Our results suggest that genetic predisposition to a high TNF-α production and a low IL-10 production seems to increase the susceptibility to DHF during a secondary dengue 2 infection, whereas TGF-ß1 high producers might be protected for developing DHF.

[Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease]. / La aspergilosis pulmonar invasiva en la enfermedad pulmonar obstructiva crónica.

Invasive pulmonary aspergillosis (IPA) is a severe disease, specially among immunocompromised patients. Its frequency increases in other patients such as those with Chronic Obstructive Pulmonary Disease (COPD), mainly when steroids are prescribed. The most common form of presentation is a respiratory tract infection with poor response to antimicrobial treatment. The delay in its diagnosis is one of the main causes of its high lethality. Once suspected, respiratory secretion cultures, chest X ray examination and computed tomography should be obtained and galactomannan, a marker of hematogenous dissemination of the microorganism, should be determined. Although the repeated isolation of Aspergillus spp is suggestive of invasive disease, the definitive diagnosis requires cytopathological confirmation. Further studies should be performed in these patients, since the available information was obtained from the observations made in immunocompromised patients, and may not be applicable accurately to API among COPD patients.