Systemic lupus erythematosus/ANCA-associated vasculitis overlap: An explanation for atypical lupus manifestation.

The coexistence of systemic lupus erythematosus (SLE) and ANCA-associated vasculitis (AAV) as an overlapping syndrome is not common. Here, we report a case of a 33-year-old woman, with recent SLE diagnosis due to skin, kidney, articular, and immunologic compromise, in whom a chest CT scan showed bilateral nodules, consolidations, and tree-in-bud pattern; thoracoscopic lung biopsy revealed diffuse non-caseating granulomas, without other features of sarcoid, organizing pneumonia, or hypersensitivity pneumonitis with high positive p-ANCA titers. Overlap between SLE and AAV was a possible explanation for lupus granulomatous pneumonitis, and for this reason, a multidisciplinary meeting was held to evaluate complex patients with interstitial lung diseases patients.

Catéter pleural permanente, una opción para el manejo del derrame pleural maligno / Malignant pleural effusion and palliative care with tunneled pleural catheter

Resumen Revisión narrativa sobre cómo el cáncer altera la fisiología de la pleura, cómo se estudia el derrame pleural maligno y cómo se puede brindar paliación al paciente con derrame pleural mediante el catéter pleural permanente tunelizado, cuyo uso demuestra mayores beneficios en diferentes ámbitos clínicos, siendo utilizado principalmente para el tratamiento del derrame pleural tumoral recurrente, pero también en algunos casos de derrame pleural benigno repetitivo, convirtiéndolo en un recurso terapéutico útil en el cáncer avanzado.

Abstract This narrative review examines how cancer causes changes in pleural physiology, how to study malignant pleural effusion, and how to bring palliative care to patients with pleural effusion by means of indwelling tunneled pleural catheter. This catheter shows greater benefits in clinical practice, being used mainly for the treatment of recurrent malignant pleural effusion, but also in some cases of recurrent benign pleural effusion, making it a useful therapeutic tool in advanced cancer.

'An investigation into the occurrence and removal of pharmaceuticals in Colombian wastewater'.

In this work, the presence of 20 pharmaceuticals in wastewater from Colombia is investigated. Several widely consumed compounds have been detected in wastewater samples from different origins and geographical areas in Colombia. The studied pharmaceuticals included antibiotics, analgesics and anti-inflammatories, cholesterol lowering statin drugs, lipid regulators, and anti-depressants. The investigated samples were urban wastewater collected during one whole week before (influent) and after treatment (effluent) in the wastewater treatment plants (WWTPs) of Bogotá and Medellin. Raw wastewater from the Hospital of Tumaco and from the city of Florencia were also collected. Analyses performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed that most of the target analytes were present in all the wastewater samples. The highest concentrations (up to 50 µg/L) corresponded to acetaminophen, but several antibiotics, such as azithromycin, ciprofloxacin and norfloxacin, and antihypertensive drugs, such as losartan and valsartan, were commonly present in influent wastewater (IWW) at levels above 1 µg/L. Moreover, the treatment applied in WWTPs seemed to not efficiently remove the compounds under study, because most pharmaceuticals were also present in effluent wastewater (EWW) at concentrations close to those of the IWW. Special emphasis was made in this work on the quality of data reported, performing a detailed study of quality control (QC) samples. The analytical approach used -direct injection of 5-fold diluted samples without any additional treatment - is simpler and faster than the commonly applied solid phase extraction (SPE). The use of 12 isotope-labelled internal standards ensured the satisfactory correction of matrix effects for the corresponding analytes. For the remaining 8 compounds, no drastic matrix effects were observed, and only four compounds (cloxacillin, doxycycline, losartan, tetracycline) presented QC recoveries near or slightly below 60%, revealing ionization suppression, particularly in the IWW. Data on the occurrence of pharmaceuticals reported in this paper are the basis for current studies that aim to develop efficient systems for the degradation/removal of these compounds from the aquatic environment.

Case-control study of endoscopic polypectomy in clinic (EPIC) versus endoscopic sinus surgery for chronic rhinosinusitis with polyps.

INTRODUCTION: Endoscopic Polypectomy In Clinic (EPIC) is a recently described deescalated form of endoscopic sinus surgery (ESS) performed in the outpatient clinic for patients with chronic rhinosinusitis with polyps (CRSwNP). The quality of life benefit of EPIC in comparison to ESS is not known. The purpose of this study was to determine if the disease specific quality of life measured with the SNOT-22 attained with EPIC is similar to that attained with ESS for patients with CRSwNP. METHODS: A multi-institutional observational case-control study was performed to evaluate quality of life improvement in patients treated with ESS and EPIC for CRSwNP with a 3 month follow-up. Predicted probability of undergoing EPIC was calculated by fitting a logistic regression model using clinically relevant variables. EPIC patients were matched to ESS patients in a 1:1 fashion. RESULTS: 24 pairs were analyzed after matching. There was no statistical difference in the post-treatment SNOT-22 scores or proportion of patients achieving a minimal clinically important difference. CONCLUSIONS: In appropriate CRSwNP patients, the EPIC procedure may provide disease specific quality of life improvement similar to that seen with patients who undergo traditional ESS.

Long-term low-dose macrolides for chronic rhinosinusitis in adults - a systematic review of the literature.

BACKGROUND: Chronic rhinosinusitis is a very common inflammatory disease that impairs quality of life and is associated with high healthcare spending. Chronic rhinosinusitis treatment commonly involves the use of intranasal corticosteroids, oral antibiotics, and surgery. Macrolides have been identified as a potential treatment option for chronic rhinosinusitis due to their immunomodulatory effects; however, the evidence supporting their use is still conflicting. OBJECTIVE: The purpose of this systematic review was to evaluate new evidence along with previously reported studies of the use of macrolides in the treatment of chronic rhinosinusitis. SEARCH STRATEGY: Medline, EMBASE, Cochrane CENTRAL, LILACS, clinicaltrials.gov, and the International Clinical Trials Registry Platform were all searched (until June 2015 Medline and EMBASE searches were updated January 2016). Randomised controlled trials comparing low-dose macrolide antibiotics versus placebo, as an adjunct to other therapies, or low-dose macrolide therapy alone versus other therapies were included in this review. EVALUATION METHOD: Quality of the evidence was evaluated using the Cochrane risk of bias tool. Continuous outcomes were expressed as mean differences or standardised mean differences with 95% confidence interval. Data were pooled using fixed-effects models. RESULTS: Nine randomised controlled trials met the inclusion criteria. Studies were classified into three distinct comparisons: Low-dose macrolide therapy vs. placebo, low-dose macrolide +/- nasal steroids vs. nasal steroid and low-dose macrolides vs. other therapies. The overall quality of the evidence is low due to limitations in study design, imprecision, and indirectness. CONCLUSIONS: Positive results were seen with the use of macrolide therapy in the postoperative period in patients with nasal polyps. A firm conclusion with respect to the effectiveness of the use of macrolides for the treatment of chronic rhinosinusitis cannot be reached based on the available evidence. Further study using a placebo-controlled design evaluating the use of macrolides in clearly defined chronic rhinosinusitis populations is needed.

An outcomes analysis of anterior epistaxis management in the emergency department.

BACKGROUND: Many treatment options exist for the management of anterior epistaxis. However, little is known about treatment outcomes. The objective was to identify the currently utilised methods of management and outcomes for patients with anterior epistaxis presenting to the emergency department (ED) at a Canadian tertiary care center. METHODS: A retrospective review of ED visits from January 2012-May 2014 for adult patients with a diagnosis of anterior epistaxis was performed. Patient demographic data, comorbidities, and treatment methods were documented. The effectiveness of different treatment modalities was determined. RESULTS: Three hundred fifty-three primary anterior epistaxis cases were included. Mean patient age was 70 years and 49% of patients were female. Comorbidities included hypertension (56%), diabetes (19%), CAD (28%), and atrial fibrillation (27%). A large proportion of the cohort (61%) was on at least one anticoagulant or antiplatelet therapy. The most common utilised treatment modalities were silver nitrate cauterization, Merocel®, petroleum gauze packing, nasal clip and 15% were simply observed. Initial treatment success was achieved in 74% of cases. Of patients receiving specific treatment modalities, silver nitrate cauterization had the highest success rate at 80%. 26% of patients returned to the ED for recurrence of epistaxis with highest rates occurring in the nasal clip (59%), Merocel® (26%), and petroleum gauze packing (42%) groups. CONCLUSIONS: The differences in recurrence rate among the different treatment modalities observed may be due to true differences in effectiveness or differences in treatment selection by the ED physicians based on severity of epistaxis. Cauterization with silver nitrate, however, offers the added benefit of no need for follow up. Further study is needed to elucidate the most efficacious treatment modality based on epistaxis severity.

A prospective analysis of inter- and intrafractional errors to calculate CTV to PTV margins in head and neck patients

Purpose. To evaluate an institute-specific CTV–PTV margin for head and neck (HN) patients according to a 3-mm action level protocol. Methods/patients. Twenty-three HN patients were prospectively analysed. Patients were immobilized with a thermoplastic mask. Inter- and intrafractional set-up errors (in the three dimensions) were assessed from portal images (PI) registration. Digitally reconstructed radiographs (DRRs) were compared with two orthogonal PI by matching bone anatomy landmarks. The isocenter was verified during the first five consecutive days of treatment: if the mean error detected was greater than 2 mm the isocenter position was corrected for the rest of the treatment. Isocenter was checked weekly thereafter. Set-up images were obtained before and after treatment administration on 10, 20 and 30 fractions to quantify the intrafractional displacement. For the set-up errors, systematic (Σ), random (σ), overall standard deviations, and the overall mean displacement (M), were determined. CTV to PTV margin was calculated considering both inter- and intrafractional errors. Results. A total of 396 portal images was analysed in 23 patients. Systematic interfractional (Σinter) set-up errors ranged between 0.77 and 1.42 mm in the three directions, whereas the random (σ inter) errors were around 1–1.31 mm. Systematic intrafractional (Σintra) errors ranged between 0.65 and 1.11 mm, whereas the random (σ intra) errors were around 1.13–1.16 mm. Conclusions. A verification protocol (3-mm action level) provided by EPIDs improves the set-up accuracy. Intrafractional error is not negligible and contributes to create a larger CTV–PTV margin. The appropriate CTV–PTV margin for our institute is between 3 and 4.5 mm considering both inter- and intrafractional errors (AU)

No disponible

A prospective analysis of inter- and intrafractional errors to calculate CTV to PTV margins in head and neck patients.

PURPOSE: To evaluate an institute-specific CTV-PTV margin for head and neck (HN) patients according to a 3-mm action level protocol. METHODS/PATIENTS: Twenty-three HN patients were prospectively analysed. Patients were immobilized with a thermoplastic mask. Inter- and intrafractional set-up errors (in the three dimensions) were assessed from portal images (PI) registration. Digitally reconstructed radiographs (DRRs) were compared with two orthogonal PI by matching bone anatomy landmarks. The isocenter was verified during the first five consecutive days of treatment: if the mean error detected was greater than 2 mm the isocenter position was corrected for the rest of the treatment. Isocenter was checked weekly thereafter. Set-up images were obtained before and after treatment administration on 10, 20 and 30 fractions to quantify the intrafractional displacement. For the set-up errors, systematic (Σ), random (σ), overall standard deviations, and the overall mean displacement (M), were determined. CTV to PTV margin was calculated considering both inter- and intrafractional errors. RESULTS: A total of 396 portal images was analysed in 23 patients. Systematic interfractional (Σ(inter)) set-up errors ranged between 0.77 and 1.42 mm in the three directions, whereas the random (σ (inter)) errors were around 1-1.31 mm. Systematic intrafractional (Σ(intra)) errors ranged between 0.65 and 1.11 mm, whereas the random (σ (intra)) errors were around 1.13-1.16 mm. CONCLUSIONS: A verification protocol (3-mm action level) provided by EPIDs improves the set-up accuracy. Intrafractional error is not negligible and contributes to create a larger CTV-PTV margin. The appropriate CTV-PTV margin for our institute is between 3 and 4.5 mm considering both inter- and intrafractional errors.

Design and development of a mobile image overlay system for needle interventions.

Previously, a static and adjustable image overlay systems were proposed for aiding needle interventions. The system was either fixed to a scanner or mounted over a large articulated counterbalanced arm. Certain drawbacks associated with these systems limited the clinical translation. In order to minimize these limitations, we present the mobile image overlay system with the objective of reduced system weight, smaller dimension, and increased tracking accuracy. The design study includes optimal workspace definition, selection of display device, mirror, and laser source. The laser plane alignment, phantom design, image overlay plane calibration, and system accuracy validation methods are discussed. The virtual image is generated by a tablet device and projected into the patient by using a beamsplitter mirror. The viewbox weight (1.0 kg) was reduced by 8.2 times and image overlay plane tracking precision (0.21 mm, STD = 0.05) was improved by 5 times compared to previous system. The automatic self-calibration of the image overlay plane was achieved in two simple steps and can be done away from patient table. The fiducial registration error of the physical phantom to scanned image volume registration was 1.35 mm (STD = 0.11). The reduced system weight and increased accuracy of optical tracking should enable the system to be hand held by the physician and explore the image volume over the patient for needle interventions.

Evolución del tratamiento del cáncer de cérvix en Guipúzcoa, 1998-2002 / No disponible

Propósito: A partir de 1999, la evidencia disponible recomienda un cambio en el enfoque de lostratamientos. Nuestro propósito es describir las características de los tumores de cérvix tratados enGuipúzcoa durante 1998 y analizar las diferencias en los tratamientos entre 1998 y 2002 en los tumoresinvasivos.Material y métodos: La identificación de los casos se realizó a partir de los Registros de TumoresHospitalarios (RTH) y en su defecto de los Archivos del Servicio de Anatomía Patológica yAltas Hospitalarias. La recogida de información fue a partir de los RTH y RCPG (Registro de CáncerPoblacional de Guipúzcoa) y mediante revisión de historias clínicas para las variables no incluídas endichos registros.Resultados: En 1998 en Guipúzcoa se trataron 91 casos. El número de tumores invasivos diagnosticadosen residentes en Guipúzcoa fue de 25 en 1998 y 20 en 2002. En 1998 la clasificación porestadios de la totalidad de tumores tratados en Guipúzcoa fue: estadio 0, 41.8%; estadio I, 17.7%; estadioII, 17,6%; estadio III, 18,7%; y estadio IV, 4.4. La proporción de tumores tratados con radioterapiay quimioterapia con o sin cirugía en estadios II, III y IV aumenta significativamente del año 1998al 2002: 21.4% versus 72.7%; p=0.01.Conclusiones: Entre 1998 y 2002 el tratamiento del cáncer de cérvix invasivo cambia significativamenteadecuándose a la evidencia científica disponible

Purpose: Beginning in 1999, the available evidence recommended a change of focus in thetreatment of cervical cancer. We describe cervical tumours treated in Guipúzcoa during 1998 andanalyse the differences in the treatment of invasive tumours between 1998 and 2002.Material and methods: Cases were identified from the Hospital Tumour Registries (HTR)and, where not available, from the Archives of the Anatomic Pathology Service and HospitalDischarges. Information was collected from the HTR and the Guipúzcoa Population Cancer Registryand by review of clinical records for variables not included in these registries.Results: Ninety-one cases of cervical carcinoma diagnosed and/or treated in Guipúzcoa in 1998were included. The number of invasive tumours diagnosed in residents of Guipúzcoa was 25 in 1998and 20 in 2002. In 1998 the classification by stage of all such tumours treated in Guipúzcoa was: stage0, 41.8%; stage I, 17.7%; stage II, 17.6%; stage III, 18.7%; and stage IV, 4.4%. The proportion oftumours treated with radiation therapy and chemotherapy with or without surgery in stages II, III andIV increased significantly from 1998 to 2002: 21.4% versus 72.7%; p=0.01.Conclusion: Between 1998 and 2002 the treatment of invasive cervical cancer in Guipúzcoa changed significantly, in line with the available scientific evidence (AU)

Características asociadas a las prácticas de lactancia en madres asistentes a tres instituciones de salud de Pereira 2004 / Associated Characteristics of Breast Feeding Practices in Wet-Nurses in Three Health Care Institutions in Pereira

Durante el primer semestre de 2005 se realizó con recursos de la Secretaría Departamental de Salud de Risaralda, una investigación sobre características asociadas a las prácticas de lactancia materna de madres de niños menores de 2 años que asisten a los servicios de salud de la IPS Comfamiliar Centro y las Empresas Sociales del Estado Kennedy y Cuba del municipio de Pereira. Materiales y métodos: Se diseñó un estudio de casos y controles; para un tamaño de muestra de 55 casos y 106 controles (53 domiciliarios y 53 institucionales). La base de datos fue digitada en Epiinfo y a través de Stat transfer se procesó en SPSS, donde se realizó el análisis bivariado y multivariado y de todas las exposiciones con relación al desenlace lactancia materna. Resultados: El programa de Crecimiento y Desarrollo, espacio donde los organismos de salud llevan a cabo intervenciones para estimular la salud del niño, aparece asociado a la lactancia materna y se comporta como factor protector; igualmente el trabajar en casa, tener apoyo de la familia, una percepción favorable de los beneficios de la lactancia para la madre y la no hospitalización del niño, fueron características que permitieron la lactancia por parte de las madres. Se recomendó evaluar los procesos de hospitalización para que no sean una barrera hacia la lactancia; ser más explícitos en los programas de promoción de la salud en cuanto a los beneficios que trae ésta para las madres y fortalecer las redes sociales que acojan a las madres que no reciben apoyo que trabajan fuera de la casa.