Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. OBJECTIVE: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. METHOD: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon's test. RESULTS: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. CONCLUSION: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. OBJETIVO: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. MÉTODO: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. RESULTADOS: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. CONCLUSIÓN: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment / Prevalencia de enfermedad pulmonar obstructiva crónica en pacientes con diagnóstico de VIH sin tratamiento antirretroviral previo

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD. Objective: To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital. Method: Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon’s test. Results: Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio. Conclusion: HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

Resumen Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es el problema respiratorio de mayor prevalencia en el mundo. Los pacientes con infección por virus de la inmunodeficiencia humana (VIH) tienen mayor prevalencia de tabaquismo e infecciones pulmonares recurrentes y mayor riesgo de EPOC. Objetivo: Determinar la prevalencia de la EPOC en pacientes con diagnóstico de VIH referidos a un hospital de infectología. Método: Se incluyeron individuos con infección por VIH sin tratamiento antirretroviral previo o actual, con sintomatología respiratoria crónica, con o sin antecedentes de exposición para desarrollar EPOC. Se realizó espirometría pre y posbroncodilatación, tomografía computarizada de alta resolución, determinación de carga viral y conteo de CD4. Las mediciones espirométricas se compararon con prueba de Wilcoxon. Resultados: Se incluyeron 66 pacientes con diagnóstico de VIH, con edad de 31.5 años; 64 hombres y dos mujeres. La prevalencia de EPOC fue de 7.6 %. El grupo con obstrucción presentó menor conteo de CD4 (27.3 versus 225.9) y mayor carga viral (165 000 versus 57 722), en comparación con el grupo sin obstrucción. Se observó correlación positiva entre menor carga viral y mayor relación de volumen espiratorio forzado al primer segundo/capacidad vital forzada. Conclusión: Los pacientes VIH-positivos con menor conteo de CD4 y mayor carga viral presentan disminución de los valores espirométricos.

Mesothelin, Calretinin, and Megakaryocyte Potentiating Factor as Biomarkers of Malignant Pleural Mesothelioma.

PURPOSE: Malignant pleural mesothelioma (MPM) is a highly lethal cancer caused by exposure to asbestos. Currently, the diagnosis is a challenge, carried out by means of invasive methods of limited sensitivity. This is a case-control study to evaluate the individual and combined performance of minimally invasive biomarkers for the diagnosis of MPM. METHOD: A study of 166 incident cases of MPM and 378 population controls of Mestizo-Mexican ethnicity was conducted. Mesothelin, calretinin, and megakaryocyte potentiating factor (MPF) were quantified in plasma by ELISA. The samples were collected from 2011 to 2016. RESULTS: Based on ROC analysis and a preset specificity of 95%, the combination of the three biomarkers reached an AUC of 0.944 and a sensitivity of 82% in men. In women, an AUC of 0.937 and a sensitivity of 87% were reached. In nonconditional logistic regression models, the adjusted ORs in men were 7.92 (95% CI 3.02-20.78) for mesothelin, 20.44 (95% CI 8.90-46.94) for calretinin, and 4.37 (95% CI 1.60-11.94) for MPF. The ORs for women were 28.89 (95% CI 7.32-113.99), 17.89 (95% CI 3.93-81.49), and 2.77 (95% CI 0.47-16.21), respectively. CONCLUSIONS: To our knowledge, this is the first study evaluating a combination of mesothelin, calretinin, and MPF, and demonstrating a sex effect for calretinin. The biomarker panel showed a good performance in a Mestizo-Mexican population, with high sensitivity and specificity for the diagnosis of MPM.

Biomarkers for Predicting Malignant Pleural Mesothelioma in a Mexican Population.

Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases. Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations. Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively. Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.

[Diagnostic strategies in the Tuberculosis Clinic of the Hospital General La Raza National Medical Center]. / Estrategias diagnósticas aplicadas en la Clínica de Tuberculosis del Hospital General Centro Médico Nacional la Raza.

In order to diagnose TB infection, tuberculin skin test and interferon gamma release assay are available. The tuberculin test has a sensitivity of 99 % and a specificity of 95 %. For the detection of interferon gamma in blood there are currently two tests available: TBGold QuantiFERON-In-Tube (with a sensitivity of 0.70 and a specificity of 0.90), and T-SPOT-TB (sensitivity 0.90 and specificity 0.93). To diagnose the disease, a microscopy of direct smears for acid-fast bacilli is used if the physician is facing an extensive cavitary lung disease due to M. tuberculosis (this test has a high sensitivity: 80-90 %). The most common staining techniques used are Ziehl-Neelsen and Kinyoun, and the fluorescent technique, auramine-rhodamine. The culture is the gold standard and it has a sensitivity of 80 % and a specificity over 90 %, but the results take weeks. The nucleic acid amplification test has an overall sensitivity and specificity of 0.85 and 0.97, respectively. In the presence of a pleural effusion is necessary to perform a pleural biopsy for culture with a sensitivity of 85 % if it is percutaneous and 98 % if it was taken by thoracoscopy. The adenosine deaminase can be determined in pleural fluid with a sensitivity and specificity of 95 %.

Para determinar la infección tuberculosa se dispone de pruebas como la tuberculina y el interferón gama. La prueba de la tuberculina tiene una sensibilidad de 99 % y una especificidad de 95 %. Para la detección de interferón gamma en sangre se dispone de 2 pruebas comercializadas: QuantiFERON-TBGold In-Tube (sensibilidad 0.70 y especificidad 0.90) y T-SPOT-TB (sensibilidad 0.90 y especificidad 0.93). Para el diagnóstico de la enfermedad se utiliza la baciloscopia en esputo (BAAR) con una sensibilidad elevada (80-90 %) si se está ante una tuberculosis con patrón cavitario. Las técnicas de tinción más empleadas son las clásicas (Ziehl-Neelsen y Kinyoun) y la fluorescente (Auramina-Rodamina). El cultivo es el estándar de oro y tiene una sensibilidad del 80 % y una especificidad de más del 90 %, pero sus resultados toman semanas. La técnica de amplificación de ácido nucleico (PCR) tiene una sensibilidad y especificidad global de 0.85 y 0.97, respectivamente. Ante la presencia de un derrame pleural, es necesario realizar una biopsia pleural para cultivo con una sensibilidad del 85 % si es percutánea y del 98 % si es tomada por toracoscopia. Se puede determinar en líquido pleural la ADA con una sensibilidad y especificidad del 95 %.

Malignant Pleural Mesothelioma: Accuracy of CT Against Immunohistochemical Test Among the Mexican Population.

BACKGROUND AND AIMS: Malignant pleural mesothelioma (MPM) is associated with occupational and environmental exposure to asbestos. The incidence is expected to increase as the use of asbestos is not prohibited in many countries, such as in Mexico. We undertook this study to determine sensitivity, specificity, predictive values and likelihood ratios of computed tomography (CT) in a sample from Mexican population with suspected MPM and other pleuropulmonary diseases. METHODS: CT films of 38 patients suspected of having MPM were analyzed. A single observer was blinded to MPM diagnoses. The frequencies of ten CT findings were identified. A cut-off point of ≥5 CT findings was established to determine high MPM probability. Sensitivity, specificity, predictive values and likelihood ratio of the CT against biopsy using immunohistochemical testing (IHC) for MPM were calculated. RESULTS: Of the 38 patients, 31 had MPM and seven had lung adenocarcinoma. The five key findings were mediastinal pleural thickening 96.7% (n = 30), nodular pleural thickening 93.3% (n = 29), pleural mass 83.9% (n = 26), diminished lung 70.9% (n = 22) and contracted hemithorax 70.9% (n = 22). Sensitivity 96.8% (83.2-99.4), specificity 85.7% (42.2-97.6), positive likelihood ratio 6.7 (1.1-41.6), and negative likelihood ratio of 0.04 (0.01-0.2) were reported. CONCLUSIONS: Sensitivity and specificity in this study was greater than previously reported, 96.8% and 85.7 vs. 93.2 and 65.6%, respectively. CT is an easily accessible and useful tool that should be incorporated into the medical education of general physicians to improve MPM diagnosis of suspected cases.

Development and validation of a questionnaire to identify patients with sleep apnea in Mexican population: Mexican questionnaire to identify sleep apnea.

PURPOSE: To develop and validate a questionnaire to identify patients with obstructive sleep apnea (OSA) in Mexican population. METHODS: We performed a cross-sectional study to develop and validate an instrument in Spanish language, consistent in an 18-item questionnaire. We enrolled patients seen from July 2008 to August 2009. We evaluated the internal consistency with the Kuder Richardson coefficient, a value greater than 0.70 was considered a good index correlation. Sensitivity, specificity, and positive and negative predictive factor was obtained with standard methods by comparison with polysomnographic results. Validity of Mexican questionnaire at baseline and follow-up was assessed using Pearson correlations coefficient. RESULTS: We enrolled 100 patients. The initial pool comprised 25 items, four items were considered confusing and they were omitted; then, a preliminary questionnaire comprising 21 items was obtained, and three items were removed by presenting a response rate lesser than 90%, yielding a total of 18 items for the final questionnaire. This evaluation was performed stratifying in groups related to severity of illness. Snoring was the question with the greatest sensitivity to detect OSA; and obesity class I was the criteria with greatest specificity to detect OSA. CONCLUSION: The screening tool proposed in this study has the advantages of being quick, inexpensive, easy to apply and reproducible, and the result has reliability with acceptable sensitivity; this is a symptom-based questionnaire with good predictive ability and it will avoid unnecessary sleep studies in the subjects who are not at high risk for having OSA.

[A H1N1 influenza infection in pregnant patients]. / Infección por virus influenza A H1N1 en pacientes embarazadas.

BACKGROUND: Despite the severity of infection with influenza virus, little has been reported about its presence in pregnant women. OBJECTIVE: To communicate our experience on influenza virus H1N1 in pregnant women. METHODS: We conducted a retrospective cohort study on 16 hospitalized patients with diagnosis of pregnancy and probable or confirmed case of infection with H1N1 influenza virus. SUSPECTED CASE: Sudden onset of respiratory infectious process, in 2009, in Mexico City. All cases underwent the fast detection test and subsequently confirmation by PCR test. Discharge criteria: clinical improvement, PaO(2) above 60 mm Hg and absence of bilateral consolidation on chest radiographs. Severity criteria: type I respiratory failure (PaO(2) < 50 mm Hg) who required mechanical ventilatory support, radiographic pattern compatible with multisegmental pneumonia and PaO(2)/FiO(2) < 200 mm Hg. RESULTS: The pregnant patient mortality was 4.25%. The average age was 25.8 years, with 24.13 weeks of gestation with 5.6 days average of hospital stay. The main co-morbidity was obesity. CONCLUSIONS: The fatal cases were those with longer time of evolution and late diagnosis.