Hypertrophic Cardiomyopathy Patients With Paroxysmal Atrial Fibrillation Have a High Burden of Left Atrial Fibrosis by Cardiac Magnetic Resonance Imaging.

OBJECTIVES: This study hypothesized that paroxysmal atrial fibrillation (PAF) reflects the presence of a more severe cardiac hypertrophic cardiomyopathy (HCM) phenotype. BACKGROUND: HCM is characterized by myocyte hypertrophy, fibrosis, and a high prevalence of PAF. It is currently unresolved whether atrial fibrillation (AF) is a marker or a mediator of adverse outcomes in HCM. METHODS: This study retrospectively examined 45 HCM patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm. The function of all 4 cardiac chambers was assessed, as well as late gadolinium enhancement (LGE) in the left atrium (LA) and left ventricle (LV), as indicators of fibrosis. A fat-saturated, 3-dimensional inversion recovery-prepared, fast-spoiled, gradient-recalled echo sequence, and the image intensity ratio method were used to measure LA-LGE; LGE in the LV was quantified using a semi-automated threshold technique. RESULTS: HCM patients (n = 45) were divided into 2 groups (PAF, no AF) based on history of PAF. All HCM patients had LGE in the LA posterior wall. The PAF group (n = 18) had higher LA volume, a lower LA ejection fraction, a lower global peak longitudinal LA strain (PLAS), and a higher amount of LA-LGE compared with the no AF group (n = 27). A modest inverse association was noted between the LA ejection fraction, PLAS, and LA-LGE; a positive association was present between LV-LGE and LA-LGE. The PAF group had lower ejection fractions in the LV, right atrium, and right ventricle compared with those in the no AF group. CONCLUSIONS: PAF is associated with a greater degree of structural LA remodeling and global myopathy, which suggests a more severe cardiac HCM phenotype.

Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. METHODS: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. RESULTS: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38 ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. CONCLUSION: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

Tumor infiltrating lymphocytes in triple negative breast cancer receiving neoadjuvant chemotherapy.

AIM: To determine influence of neoadjuvant-chemotherapy (NAC) over tumor-infiltrating-lymphocytes (TIL) in triple-negative-breast-cancer (TNBC). METHODS: TILs were evaluated in 98 TNBC cases who came to Instituto Nacional de Enfermedades Neoplasicas from 2005 to 2010. Immunohistochemistry staining for CD3, CD4, CD8 and FOXP3 was performed in tissue microarrays (TMA) sections. Evaluation of H/E in full-face and immunohistochemistry in TMA sections was performed in pre and post-NAC samples. STATA software was used and P value < 0.05 was considered statistically significant. RESULTS: Higher TIL evaluated in full-face sections from pre-NAC tumors was associated to pathologic-complete-response (pCR) (P = 0.0251) and outcome (P = 0.0334). TIL evaluated in TMA sections showed low level of agreement with full-face sections (ICC = 0.017-0.20) and was not associated to pCR or outcome. TIL in post-NAC samples were not associated to response or outcome. Post-NAC lesions with pCR had similar TIL levels than those without pCR (P = 0.6331). NAC produced a TIL decrease in full-face sections (P < 0.0001). Percentage of TIL subpopulations was correlated with their absolute counts. Higher counts of CD3, CD4, CD8 and FOXP3 in pre-NAC samples had longer disease-free-survival (DFS). Higher counts of CD3 in pre-NAC samples had longer overall-survival. Higher ratio of CD8/CD4 counts in pre-NAC was associated with pCR. Higher ratio of CD4/FOXP3 counts in pre-NAC was associated with longer DFS. Higher counts of CD4 in post-NAC samples were associated with pCR. CONCLUSION: TIL in pre-NAC full-face sections in TNBC are correlated to longer survival. TIL in full-face differ from TMA sections, absolute count and percentage analysis of TIL subpopulation closely related.

Tuberculosis abdominal en niños y adolescentes. Un desafío diagnóstico / Abdominal Tuberculosis in children and adolescents. A diagnostic challenge

Presentar nuestra experiencia con tuberculosis abdominal en niños y adolescentes tratados en nuestro hospital de 2003 a 2014. Material y Métodos: Es un estudio retrospectivo. Se revisaron las historias clínicas de los pacientes menores de 20 años, internados en el Hospital Nacional Hipólito Unanue de enero 2003 a julio 2014, con el diagnóstico de tuberculosis abdominal. Resultados: Del total de 30 pacientes 16 (53,33%) fueron mujeres y 14 (46,67%) fueron hombres. La edad media fue 16,5 años. Las características clínicas más frecuentes fueron dolor abdominal en 29 (96,67%), fiebre en 26 (86,67%), ascitis en 23 (76,67%), pérdida de peso en 21 (70%).El 63,33% fueron eutróficos, el 13,34% tuvieron sobrepeso u obesidad y solo el 23,33% eran desnutridos. Contacto un caso de tuberculosis fue en el 10 pacientes (33,33%).El test de tuberculina fue positivo en el 10% de los casos. Tuberculosis extra-abdominal fue encontrada en 22 pacientes (63,32%); en 12 pacientes había tuberculosis pulmonar asociada y 4 casos tuvieron derrame pleural. El 40% tuvo compromiso peritoneal; el 40% tuvo compromiso tanto intestinal como peritoneal y el 13% fue catalogado como localización intestinal únicamente. La confirmación bacteriológica de tuberculosis se obtuvo en 10 pacientes (33,33%). El tratamiento anti-tuberculosis por 6 meses fue efectivo en 29 pacientes. Un paciente falleció por tuberculosis multifocal asociada a VIH. Conclusiones: La tuberculosis abdominal es vista en el 4,37% de los pacientes con tuberculosis, de los cuales el 63,32% tienen manifestaciones extra-abdominales. La tuberculosis abdominal debe ser considerada en pacientes con dolor abdominal, fiebre pérdida de peso y una radiografía de tórax anormal. Estudios por imágenes puede ser útil para un diagnóstico temprano de tuberculosis abdominal...

To present our experience with abdominal tuberculosis in children and adolescents treated in our hospital from 2003 û 2014. Material and Methods: It is a retrospective study. We have collected clinical records of inpatients <20 years old who were admitted at Hipolito Unanue Hospital from January 2003 to July 2014, with diagnosis of abdominal tuberculosis. Results: Among the overall 30 patients, 16 (53.33%) were female and 14 (46.67%) were male. The mean age of all patients was 16.5 years. The most common clinical features were abdominal pain in 29 (96.67%), fever in 26 (86.67%), ascites in 23 (76.67%) and loss of weight in 21 (70%). 63.33% of the patients were eutrophics, 13.34% were overweight or obese and only 23.33% suffered of malnutrition. TB contact was present in 10 (33.33%). Positive tuberculin skin tests were seen in 10%. Extraabdominal tuberculosis was found in 22 patients (63.32%). 12 cases had coexisting pulmonary tuberculosis and 4 cases had pleural effusion. 12 patients (40%) had tuberculous peritonitis; 12 patients (40%) had intestinal tuberculosis and peritoneal tuberculosis and 4 patients (13.33%) had intestinal tuberculosis. Bacteriological confirmation of tuberculosis was achieved in 10 cases (33.33%). Antituberculous therapy for 6 months was effective in 29 cases. One patient died who multifocal tuberculosis with HIV had associated. Conclusions: Abdominal tuberculosis is seen in 4.37% of children affected with tuberculosis, of which over 63% will have extra abdominal manifestations. Abdominal tuberculosis should be considered in patients with abdominal pain, fever, weight loss and abnormal chest radiography. Imaging can be useful for early diagnosis of abdominal tuberculosis...

[Demographic characteristics of human papillomavirus detected by PCR-RFLP in peruvian women]. / Características sociodemográficas de mujeres peruanas con virus papiloma humano detectado por PCR-RFLP.

In order to determine the sociodemographic characteristics of human papillomavirus (HPV) in patients referred to the National Institute of Neoplastic Diseases (INEN) between 2012-2014, the detection of HPV in cervical cells was performed by polymerase chain reaction (PCR). In 465 cervical samples, 151 (32.5%) cases were HPV positive. The most common genotypes were HPV-16 (23.8%) and HPV-6 (11.9%). The presence of HPV was higher in women aged 17-29 years (OR = 2.64, 95% CI 1.14 to 6.13) and single women (OR = 2.31, 95% CI 1.37 to 3.91). The presence of genotypes of high-risk HPV was higher in single women (OR = 2.19, 95% CI 1.04 to 4.62). In conclusion, young and single women had a higher frequency of HPV-positive cases. Therefore participation by these groups should be emphasized in screening programs with combined molecular and cytological methods in order to detect the risk of developing cervical cancer in a timely manner.

[Clinical features and toxicity of tuberculosis treatment in patients with cancer]. / Características clínicas y toxicidad del tratamiento de tuberculosis en pacientes con cáncer.

OBJECTIVES: To assess the clinical and epidemiological characteristics of active tuberculosis in patients with malignancy and to assess the influence of TB treatment on cancer management at the National Institute of Neoplastic Diseases from 2008 to 2013. MATERIALS AND METHODS: Observational study of TB cases diagnosed by positive sputum microscopy in patients with cancer. Clinical information, evolution, and pathologic information of neoplasia was reviewed. RESULTS: 76 cases of active tuberculosis after being diagnosed with cancer were found. The median age was 51.3 years. Median follow-up was 2.1 years. The most common cancers were acute lymphocytic leukemia (14.5%), for the hematologic cancers; and cancer of the cervix (14.5%), breast (10.5%), and gastric (7.9%) for non-hematological cancers. 27.6% of patients had recurrence of the tumor; TB diagnosis confounded the initial staging by 6.9% and was initially stated as cancer recurrence in 11.1% (breast and colon cancers). The diagnosis of tuberculosis delayed or influenced the dose reduction of the antineoplastic treatment in 11.1% of the cases (acute lymphocytic leukemia and non-Hodgkin lymphoma). 8.3% of patients had toxicity to the TB treatment. CONCLUSIONS: Cancer patients may have active tuberculosis infection. The interference effect of diagnosis and treatment of tuberculosis on the assessment of cancer and cancer treatment in our series is minimal.

Características sociodemográficas de mujeres peruanas con virus papiloma humano detectado por PCR-RFLP / Demographic characteristics of human papillomavirus detected by PCR-RFLP in peruvian women

Con el objetivo de determinar las características sociodemográficas del virus de pacientes con papiloma humano (VPH) referidas al Instituto Nacional de Enfermedades Neoplásicas (INEN) durante los años 2012-2014, se realizó la detección del VPH en células cervicales por reacción en cadena de la polimerasa (PCR). En 465 muestras cervicales se detectaron 151 (32,5%) casos de VPH positivas. Los genotipos más frecuentes fueron VPH-16 (23,8%) y VPH-6 (11,9%). La presencia de VPH fue mayor en mujeres de 17 a 29 años (OR 2,64, IC 95%:1,14-6,13) y solteras (OR 2,31, IC 95%: 1,37-3,91), la presencia de genotipos de VPH de alto riesgo fue mayor en solteras (OR 2,19, IC 95%: 1,04-4,62). En conclusión, mujeres jóvenes y solteras presentaron mayor frecuencia de casos VPH-positivos a quienes se debe enfatizar la participación en programas de tamizaje con métodos moleculares y citológicos combinados, a fin de detectar oportunamente el riesgo de desarrollar cáncer de cuello uterino...

In order to determine the sociodemographic characteristics of human papillomavirus (HPV) in patients referred to the National Institute of Neoplastic Diseases (INEN) between 2012-2014, the detection of HPV in cervical cells was performed by polymerase chain reaction (PCR). In 465 cervical samples, 151 (32.5%) cases were HPV positive. The most common genotypes were HPV-16 (23.8%) and HPV-6 (11.9%). The presence of HPV was higher in women aged 17-29 years (OR = 2.64, 95% CI 1.14 to 6.13) and single women (OR = 2.31, 95% CI 1.37 to 3.91). The presence of genotypes of high-risk HPV was higher in single women (OR = 2.19, 95% CI 1.04 to 4.62). In conclusion, young and single women had a higher frequency of HPV-positive cases. Therefore participation by these groups should be emphasized in screening programs with combined molecular and cytological methods in order to detect the risk of developing cervical cancer in a timely manner...

Características cl¡nicas y toxicidad del tratamiento de tuberculosis en pacientes con cáncer / Clinical features and toxicity of tuberculosis treatment in patients with cancer

Objetivos. Evaluar las características clínico-epidemiológicas de la tuberculosis activa en pacientes portadores de neoplasia maligna y evaluar la influencia del tratamiento antituberculoso sobre el manejo de cáncer en el Instituto Nacional de Enfermedades Neoplásicas entre el 2008 y 2013. Materiales y métodos. Estudio observacional de casos de tuberculosis diagnosticados mediante baciloscopía positiva en pacientes con cáncer. Se revisó la información clínica, evolución, e información patológica de la neoplasia. Resultados. Se encontraron 76 casos de tuberculosis activa luego del diagnóstico de cáncer. La mediana de edad fue 51,3 años. La mediana de seguimiento fue 2,1 años. Las neoplasias más frecuentes fueron leucemia linfática aguda (14,5%) para las hematológicas y cáncer de cérvix (14,5%), mama (10,5%) y gástrico (7,9%) para las no hematológicas. El 27,6% de los pacientes presentó recurrencia de la neoplasia; el diagnóstico de tuberculosis confundió el estadiaje inicial en 6,9% y se planteó inicialmente como recurrencia del cáncer en 11,1% (neoplasias de mama y colon). El diagnóstico de tuberculosis retrasó o influyó en la reducción de dosis del tratamiento antineoplásico en 11,1% de los casos (leucemia linfática aguda y linfoma no Hodgkin). El 8,3% de los pacientes presentó toxicidad al tratamiento antituberculoso. Conclusiones. Los pacientes con cáncer pueden presentar infección activa por tuberculosis. El efecto de interferencia del diagnóstico y tratamiento de tuberculosis sobre la evaluación del cáncer y el tratamiento antineoplásico en nuestra serie es mínimo.

Objectives. To assess the clinical and epidemiological characteristics of active tuberculosis in patients with malignancy and to assess the influence of TB treatment on cancer management at the National Institute of Neoplastic Diseases from 2008 to 2013. Materials and methods. Observational study of TB cases diagnosed by positive sputum microscopy in patients with cancer. Clinical information, evolution, and pathologic information of neoplasia was reviewed. Results.76 cases of active tuberculosis after being diagnosed with cancer were found. The median age was 51.3 years. Median follow-up was 2.1 years. The most common cancers were acute lymphocytic leukemia (14.5%), for the hematologic cancers; and cancer of the cervix (14.5%), breast (10.5%), and gastric (7.9%) for non-hematological cancers. 27.6% of patients had recurrence of the tumor; TB diagnosis confounded the initial staging by 6.9% and was initially stated as cancer recurrence in 11.1% (breast and colon cancers). The diagnosis of tuberculosis delayed or influenced the dose reduction of the antineoplastic treatment in 11.1% of the cases (acute lymphocytic leukemia and non-Hodgkin lymphoma). 8.3% of patients had toxicity to the TB treatment. Conclusions. Cancer patients may have active tuberculosis infection. The interference effect of diagnosis and treatment of tuberculosis on the assessment of cancer and cancer treatment in our series is minimal.

Prognostic factors for patients with newly diagnosed brain metastasis from breast cancer.

AIM: This retrospective study determined features associated with brain metastasis (BM) in women with breast cancer. PATIENTS & METHODS: A total of 215 initially early breast cancer cases were included. We reviewed files and CT scan images of BM. RESULTS: Median age was 47 years and most of our cases were stage III (58.6%), grade III (62.8%), ER negative (62.3%) and nonluminal (59.1%). Median survival after BM was 4 months. Nonluminal, extracranial disease, time to CNS shorter than 15 months, >three brain lesions and poor breast-graded prognostic assessment and recursive partitioning analysis scores were associated with shorter survival. Adding extracranial disease to breast-graded prognostic assessment score also predicted survival after BM. Radiation response was assessed in 57 patients and response tended to be associated with nonluminal phenotype but not with survival. CONCLUSION: Factors associated with both initial tumor and clinical features at BM time are associated with shorter survival in our Latinas population.

Exercise heart rates in patients with hypertrophic cardiomyopathy.

The exercise heart rate (HR) profile and its relation to cardiac function and arrhythmias were investigated in patients with hypertrophic cardiomyopathy (HC). Chronotropic response (CR) and heart rate recovery (HRR) were computed during and after treadmill exercise testing in 273 patients with HC and 95 age-matched healthy controls. Patients with HC had higher prevalence of chronotropic incompetence and lower HRR1-5min compared with controls. Exercise capacity, diastolic function (assessed by E/e') and left atrial volume index were associated with HRR1min and CR in HC. Septal myectomy was associated with reduction in chronotropic incompetence but did not affect HRR1min. In conclusion, impaired CR and HRR1min are associated with advanced disease and do not appear to be independent clinical markers indicating high-risk status in HC. Improving CR by titrating doses of negative chronotropic agents, myectomy, and atrial pacing may be useful to increase exercise capacity in patients with HC.

[Abdominal Tuberculosis in children and adolescents. A diagnostic challenge]. / Tuberculosis abdominal en niños y adolescentes. Un desafío diagnóstico.

OBJECTIVE: To present our experience with abdominal tuberculosis in children and adolescents treated in our hospital from 2003 - 2014. MATERIAL AND METHODS: It is a retrospective study. We have collected clinical records of inpatients <20 years old who were admitted at Hipolito Unanue Hospital from January 2003 to July 2014, with diagnosis of abdominal tuberculosis. RESULTS: Among the overall 30 patients, 16 (53.33%) were female and 14 (46.67%) were male. The mean age of all patients was 16.5 years. The most common clinical features were abdominal pain in 29 (96.67%), fever in 26 (86.67%), ascites in 23 (76.67%) and loss of weight in 21 (70%). 63.33% of the patients were eutrophics, 13.34% were overweight or obese and only 23.33% suffered of malnutrition. TB contact was present in 10 (33.33%). Positive tuberculin skin tests were seen in 10%. Extra-abdominal tuberculosis was found in 22 patients (63.32%). 12 cases had coexisting pulmonary tuberculosis and 4 cases had pleural effusion. 12 patients (40%) had tuberculous peritonitis; 12 patients (40%) had intestinal tuberculosis and peritoneal tuberculosis and 4 patients (13.33%) had intestinal tuberculosis. Bacteriological confirmation of tuberculosis was achieved in 10 cases (33.33%). Antituberculous therapy for 6 months was effective in 29 cases. One patient died who multifocal tuberculosis with HIV had associated. CONCLUSIONS: Abdominal tuberculosis is seen in 4.37% of children affected with tuberculosis, of which over 63% will have extra abdominal manifestations. Abdominal tuberculosis should be considered in patients with abdominal pain, fever, weight loss and abnormal chest radiography. Imaging can be useful for early diagnosis of abdominal tuberculosis.