Genetic susceptibility, residential radon, and lung cancer in a radon prone area

INTRODUCTION: Radon exposure has been classified as the second cause of lung cancer, after tobacco, and the first in never smokers. GSTM1 and GSTT1 genes deletion increase the risk of lung cancer. We aim to know whether the risk of lung cancer because of residential radon is modulated by these genetic polymorphisms. METHODS: Hospital-based, case-control study where cases had confirmed lung cancer. Cases and controls did not have previous neoplasm and were older than 30. Controls attended hospital for noncomplex surgery. We analyzed the results for the whole sample and separately for never/light smokers and moderate/heavy smokers. RESULTS: Seven-hundred and ninety-two participants were analyzed. GSTM1 and GSTT1 deletion conferred an odds ratio (OR) of 1.38 (95% confidence interval [CI] 0.93-2.04) and 1.13 (95% CI 0.70-1.82), respectively. Individuals with GSTM1 present and residential radon concentrations higher than 148 Bq/m had an OR of 1.48 (95% CI 0.73-3.00), whereas those with GSTM1 deleted had an OR of 2.64 (95% CI 1.18-5.91) when compared with participants with GSTM1 present and radon concentrations below 50 Bq/m3. Similar results were observed for GSTT1 deletion. These results were basically the same for the moderate/heavy smokers' subgroup. CONCLUSIONS: The absence of GSTM1 and GSTT1 genes increases the risk of lung cancer because of radon exposure. These genes might modulate the carcinogenic pathway of alpha radiation. Further studies are warranted analyzing this association in never smokers

Tuberculosis en Ourense

INTRODUCCIÓN: La tuberculosis es la enfermedad infecciosa más prevalente en el mundo. La Organización Mundial de la Salud (OMS) estima que un 33% de la población mundial está infectada por Mycobacterium tuberculosis. PACIENTES Y MÉTODOS: Estudio observacional, retrospectivo de una cohorte de pacientes diagnosticados de tuberculosis en la provincia de Ourense en el 2006. Los casos se obtuvieron del Registro Gallego de Tuberculosis. Se recogieron variables clínicas y epidemiológicas referentes a liación, antecedentes personales, clínica, hallazgos radiográ cos, diagnóstico y tratamiento. RESULTADOS: Se incluyeron 100 pacientes, con un porcentaje mayor de hombres (59%). El tipo más frecuente de tuberculosis fue la pulmonar (58%) y la principal alteración radiográ ca fue el in ltrado pulmonar no cavitado (45%). El diagnóstico se hizo sobre todo por cultivo de esputo (45%). No se registró ningún caso de resistencia primaria y la pauta de tratamiento más frecuente fue 2 meses de Isonizida (I), Rifampicina (R) y Pirazimamida (P) y 4 meses de los 2 primeros (I+R). CONCLUSIONES: La tuberculosis es una enfermedad bastante frecuente en nuestro medio, siendo su principal forma la tuberculosis pulmonar. Hay un bajo porcentaje de inmigrantes y VIH. El tratamiento más empleado fue el de 3 fármacos (2IRZ + 4IR) y el efecto adverso más frecuente fue la hepatotoxicidad. El número de tratamientos directamente observados ha aumentado en nuestra provincia. La evolución fue favorable en la mayoría de los casos

Impact of a home telehealth program after a hospitalized COPD exacerbation: a propensity score analysis

[Abstract] Introduction: Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. Objective: To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. Methods: This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. Results: The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56-0.91] 0.71 [95% CI=0.56-0.91; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50-0.86]) are analyzed separately. Conclusion: Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting

Lung cancer survival in never-smokers and exposure to residential radon: results of the LCRINS study

We aimed to evaluate lung cancer survival in never-smokers, both overall and specifically by sex, exposure to residential-radon, age, histological type, and diagnostic stage. We included lung cancer cases diagnosed in a multicentre, hospital-based, case-control-study of never-smoker patients, diagnosed from January-2011 to March-2015 (Lung Cancer Research In Never Smokers study). 369 never-smokers (79% women; median age 71 years; 80% adenocarcinoma; 66% stage IV) were included. Median overall survival, and at one, 3 and 5 years of diagnosis was 18.3 months, 61%, 32% and 22%, respectively. Higher median survival rates were obtained for: younger age, adenocarcinoma, actionable mutations, and earlier-stage at diagnosis. Higher indoor radon showed a higher risk of death in multivariate analysis. Median lung cancer survival in never-smokers seems higher than that in ever-smokers. Patients with actionable mutations have a significantly higher survival. Higher indoor-radon exposure has a negative effect on survivalThis paper was funded by the following competitive research grants awarded to the individual case-control studies, which are part of this pooled study: Galician Regional Authority (Xunta de Galicia): 10CSA208057PR “Risk factors of lung cancer in never smokers: a multicentre case-control study in the Northwest of Spain.” 2010. Spain; Carlos III Institute of Health (Instituto de Salud Carlos III), Ministry of Science and Innovation of Spain, grant number PI03/1248. 2003. Spain; Carlos III Institute of Health (grant FIS 92/0176) and the Galician Regional Health Authority (grant XUGA 91010). 1992. Spain; Galician Regional Authority: grant number XUGA 208001B93. 1993; Carlos III Institute of Health, Ministry of Science and Innovation of Spain, grant number PI13/01765. 2013. Spain; ISCIII - PI15/01211 - Cofinanciado FEDER. Spain.This paper was funded by the following competitive research grants awarded to the individual case-control studies, which are part of this pooled study: • Galician Regional Authority (Xunta de Galicia): 10CSA208057PR “Risk factors of lung cancer in never smokers: a multicentre case-control study in the Northwest of Spain.” 2010. Spain. • Carlos III Institute of Health (Instituto de Salud Carlos III), Ministry of Science and Innovation of Spain, grant number PI03/1248. 2003. Spain. • Carlos III Institute of Health (grant FIS 92/0176) and the Galician Regional Health Authority (grant XUGA 91010). 1992. Spain. • Galician Regional Authority: grant number XUGA 208001B93. 1993. • Carlos III Institute of Health, Ministry of Science and Innovation of Spain, grant number PI13/01765. 2013. Spain. • ISCIII - PI15/01211 - Cofinanciado FEDER. Spain