Comparación de la prueba de tuberculina contra la prueba de liberación de interferón gamma (QuantiFERON®) en la detección de tuberculosis en pacientes oncológicos de la consulta de neumología de la Universidad Nacional de Colombia

Antecedentes: La tuberculosis es un importante problema de salud pública a nivel mundial, se puede desarrollar en 5% a 10% de las personas con infección latente, especialmente en poblaciones a riesgo como los pacientes con cáncer. La tamización oportuna de la tuberculosis latente podría ser crucial para el control de la enfermedad. Objetivo: Determinar la concordancia entre la prueba cutánea de tuberculina y una prueba de liberación de interferón-gamma (QuantiFERON®) para el diagnóstico de tuberculosis latente en pacientes con cáncer. Materiales y métodos: Se realizó un estudio de corte transversal en adultos con diagnóstico de cáncer sin evidencia de tuberculosis activa. Evaluamos de forma simultánea ambas pruebas. Determinamos la prevalencia de positividad de las pruebas, la concordancia entre las mismas y realizamos una regresión logística para determinar los predictores de discordancia. Resultados: Se incluyeron 88 pacientes con diferentes tipos de cáncer, la mayoría fueron neoplasias de piel y tejidos blandos (23.86%) y del tiroides (19.32%). La prevalencia de tuberculosis latente fue de 26.14%. La concordancia entre las pruebas fue moderada (κ= 0.47, IC 95% 0.23 a 0.7). Tuvimos resultados discordantes en siete pacientes con tuberculina positiva/QuantiFERON® negativo y en siete pacientes con tuberculina negativa/QuantiFERON® positivo. En el análisis univariado ninguna variable se asoció con la posibilidad de tener un resultado discordante. Conclusión: Encontramos una concordancia moderada entre las pruebas para la detección de tuberculosis latente, por lo que sus resultados no son asimilables. Los datos actuales se deben tener presentes para realizar nuevos estudios que evalúen el desempeño de estas pruebas.Abstract: Background: Tuberculosis is a major public health problem worldwide; it can develop in 5% to 10% of persons with latent infection, especially in populations such as patients with cancer. Early screening for latent tuberculosis could be crucial for the control of the disease. Objective: To determine the concordance between tuberculin skin test and an interferon-gamma release assay (QuantiFERON®) for diagnosing latent tuberculosis in patients with cancer. Materials and methods: We conducted a cross-sectional study in adults diagnosed with cancer with no evidence of active tuberculosis. We evaluate simultaneously both tests. We determined the prevalence of positive tests, the correlation between them, and performed a logistic regression to determine predictors of discordance. Results: We included 88 patients with different types of cancer, most were skin and soft tissue (23.86%) and thyroid (19.32%) malignancies. Prevalence of latent tuberculosis was 26.14%. Agreement between tests was moderate (κ= 0.47, CI 95% 0.23 to 0.7). We had discordant results in seven patients with positive tuberculin/negative QuantiFERON® and in seven patients with negative tuberculin/positive QuantiFERON®. In univariate analysis, no variable was associated with the possibility of having a discordant result. Conclusion: We found moderate agreement between tests for detection of latent tuberculosis infection, so its results are not comparable. Current data must be present for further studies to evaluate the performance of these tests.Otr

Usual interstitial pneumonia

El patrón histológico de neumonía intersticial usual (NIU) fue descrito por primera vez en 1969 por Averill Liebow como una forma común de fibrosis pulmonar en adultos mayores (1). Por muchos años se identificó en biopsias qui-rúrgicas como una fibrosis del pulmón con la característica particular de presen-tar heterogeneidad geográfica (áreas de fibrosis alternadas con un parénquima sano) y temporal (áreas de fibrosis antigua de colágeno denso y zonas de nueva fibrosis expresadas en focos fibroblásticos) (1). Estos criterios se mantuvieron en la definición histológica del patrón NIU en el primer consenso multidiscipli-nario de clasificación de las neumonías intersticiales de 2002.https://orcid.org/0000-0002-0084-0339https://orcid.org/0000-0003-3187-1434https://orcid.org/0000-0001-5540-3980https://orcid.org/0000-0001-8405-4513N/

Secondary erythrocytosis due to hypoxemia as prognosis in exacerbated chronic pulmonary diseases

Introduction: Even though exacerbations are the main cause of emergency consultation in patients suffering from lung diseases, erythrocyte parameters are not assessed in their prognosis. Thus, determining the implications of erythrocyte parameters might contribute to define the usefulness of phlebotomy or red blood cells transfusion in these patients.Objective: To establish a possible relationship between the different hematocrit levels with a 30-day prognosis in patients admitted with exacerbated chronic lung disease and hypoxemia.Materials and methods: A study based on a 30-day follow-up was conducted. Variables were described using an additional categorization by hematocrit levels and an adjustment in a multivariate model through logistic regression.Results: Follow-up was completed for 110 Patients. The frequency of anemia was 7.3% and of erythrocytosis, 14.5%. A significant association to the outcome using Anthonisen score (OR=10.45, 95%CI: 1.11-98.48, p=0.04), hypertension (OR=11.02, 95%CI: 1.32-91.75, p=0.026) and heart failure (OR=0.09, 95%CI: 0.01-0.82, p=0.032) was found.Conclusion: This research could not determine any relationship between erythrocyte parameters and prognosis of patients suffering from pulmonary diseases; nevertheless, extreme values of hematocrits tended to have adverse outcomes.Introducción. Aunque las exacerbaciones de las neumopatías crónicas son las principales causas de consulta a urgencias de los pacientes que las padecen, los parámetros eritrocitarios no son evaluados en su pronóstico. Por tanto, determinar las implicaciones de los parámetros eritrocitarios podría ayudar a definir la utilidad de la flebotomía o la transfusión de eritrocitos en estos pacientes.Objetivo. Establecer si hay relación entre los distintos niveles de hematocrito con pronóstico a 30 días en pacientes con neumopatía crónica exacerbada e hipoxemia.Materiales y métodos. Estudio de seguimiento a 30 días. Se realizó la descripción de las variables con una categorización adicional por niveles de hematocrito y un ajuste en un modelo multivariado por regresión logística.Resultados. Se completó el seguimiento en 110 pacientes. La frecuencia de anemia fue de 7.3% y de eritrocitosis de 14.5%. Se encontró asociación significativa al desenlace con la clasificación Anthonisen (OR=10.45, IC95%: 1.11-98.48; p=0.04), hipertensión arterial (OR=11.02, IC95%: 1.32-91.75; p=0.026) y falla cardiaca (OR=0.09, IC95%: 0.01-0.82; p=0.032).Conclusión. Este estudio no pudo determinar relación alguna entre los parámetros eritrocitarios y el pronóstico de pacientes con enfermedades pulmonares crónicas; sin embargo, hubo una tendencia a que los valores extremos del hematocrito presentaran desenlaces adversos

Velcro type rales

En su libro De l’auscultation médiate ou Traité du diagnostic des maladies des poumons et du cœur, René Laennec definió y caracterizó a los crepitantes o estertores como sonidos cortos, discontinuos, explosivos y no musicales que predominan durante la inspiración, que se escuchan mejor en regiones pulmo-nares dependientes y durante respiraciones lentas y profundas; estos ruidos ad-venticios se producen por la apertura repentina de vías respiratorias pequeñas anormalmente cerradas (1-3).https://orcid.org/0000-0003-3187-1434N/

Eritrocitosis secundaria a hipoxemia en neumopatías crónicas: de la reología a la práctica clínica

La eritrocitosis es una condición infrecuente en las enfermedades pulmonares crónicas que cursan con hipoxemia; su adecuada aproximación fisiopatológica y clínica no es bien conocida. Aunque la eritrocitosis es una respuesta compensatoria frente a la hipoxemia, sus efectos en la microcirculación pueden afectar parámetros cardiovasculares con deterioro de la sintomatología de pacientes con esta patología.La corrección por medio de la flebotomía puede ser una medida terapéutica útil, pero no hay claridad sobre su indicación en consideración a la evidencia actualmente disponible; de igual forma, existen preocupaciones sobre los desenlaces adversos que podrían generarse con su uso en la reología y en la ferrocinética. Es también desconocida la pertinencia de la flebotomía ante el aparente pronóstico benigno de quienes presentan eritrocitosis en el contexto de una neumopatía crónica.Con la escasa información actual, se hace necesaria la ampliación de la investigación en los tópicos relacionados con la eritrocitosis debida a hipoxemia.Erythrocytosis is a rare condition in chronic lung diseases associated to hipoxemia. It's proper clinical and pathophysiological approach is not very well known. Although erythrocytosis is a compensatory response against hypoxemia, its effects on microcirculation may affect cardiovascular parameters with symptomatic disrepair in patients with this disease.Correction of erythrocytosis through phlebotomy may be a useful therapeutic approach, but there is no clearness about its indication considering the current evidence available; likewise, there are concerns about adverse outcomes that could be generated with its use in rheology and ferrokinetics.It is also unknown the relevance of phlebotomy with regard to the apparent benign prognosis of patients presenting with erythrocytosis in chronic lung diseases.With the scarce current information it is necessary to expand the research on issues related to erythrocytosis due hypoxemia

Colombian Forest Monitoring System: Assessing Deforestation in an Environmental Complex Country

Colombia is a key actor related with the adoption of the relevant UNFCC provisions referred in the context of obtaining result-based payments for REDD+ actions. Since 2012, the Colombian Forest Monitoring System (SMByC, Spanish acronym) has generated wall-to-wall historical information about the deforestation process over the last 27 years at national and regional levels. The SMByC generates a methodology that integrates tools for the preprocessing and semi-automated processing of satellite imagery to detect and quantify the loss of forest cover by deforestation. Also, the SMByC has done an extensive literature review, collecting qualitative and quantitative information to identify how the drivers of deforestation (illicit crops, illegal mining and postconflict scenario) could result in an increased forest lost during a postconflict scenario. Given that Colombia is a country conformed by regions that have differentially socioeconomic and environmental conditions, the study shows how the methods could generate official information and specifies the context of deforestation process of those regions

Blood eosinophils levels in a Colombian cohort of biomass-and tobacco-related COPD patients

IntroductionChronic obstructive pulmonary disease (COPD) is a major cause of illness and death among adults. In 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy incorporated blood eosinophils as a biomarker to identify patients at increased risk of exacerbations which, with the history of exacerbations during the previous year, allows identification of patients who would benefit from anti-inflammatory treatment to reduce the risk of future exacerbations. The aim of this study was to describe demographic and clinical characteristics, eosinophil counts, and exacerbations in a cohort of COPD patients stratified by clinical phenotypes (non-exacerbator, frequent exacerbator, asthma-COPD overlap) in a Colombian cohort at 2600 meters above sea level.MethodsA descriptive analysis of a historical cohort of patients with a confirmed diagnosis of moderate to severe COPD (FEV1/FVC < 0.7 and at least one risk factor for COPD) from two specialized centers with comprehensive disease management programs was performed from January 2015 to March 2019. Data were extracted from medical records 1 year before and after the index date.Results200 patients were included (GOLD B: 156, GOLD E: 44; 2023 GOLD classification); mean age was 77.9 (SD 7.9) years; 48% were women, and 52% had biomass exposure as a COPD risk factor. The mean FEV1/FVC was 53.4% (SD 9.8), with an FEV1 of 52.7% (20.7). No differences were observed between clinical phenotypes in terms of airflow limitation. The geometric mean of absolute blood eosinophils was 197.58 (SD 2.09) cells/μL (range 0 to 3,020). Mean blood eosinophil count was higher in patients with smoking history and frequent exacerbators. At least one moderate and one severe exacerbation occurred in the previous year in 44 and 8% of patients, respectively; during the follow-up year 152 exacerbations were registered, 122 (80%) moderate and 30 (20%) severe. The highest rate of exacerbations in the follow-up year occurred in the subgroup of patients with the frequent exacerbator phenotype and eosinophils ≥300 cells/μL.DiscussionIn this cohort, the frequency of biomass exposure as a risk factor is considerable. High blood eosinophil count was related to smoking, and to the frequent exacerbator phenotype

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6+/-9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; pPeer reviewe

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Enabling planetary science across light-years. Ariel Definition Study Report

Ariel, the Atmospheric Remote-sensing Infrared Exoplanet Large-survey, was adopted as the fourth medium-class mission in ESA's Cosmic Vision programme to be launched in 2029. During its 4-year mission, Ariel will study what exoplanets are made of, how they formed and how they evolve, by surveying a diverse sample of about 1000 extrasolar planets, simultaneously in visible and infrared wavelengths. It is the first mission dedicated to measuring the chemical composition and thermal structures of hundreds of transiting exoplanets, enabling planetary science far beyond the boundaries of the Solar System. The payload consists of an off-axis Cassegrain telescope (primary mirror 1100 mm x 730 mm ellipse) and two separate instruments (FGS and AIRS) covering simultaneously 0.5-7.8 micron spectral range. The satellite is best placed into an L2 orbit to maximise the thermal stability and the field of regard. The payload module is passively cooled via a series of V-Groove radiators; the detectors for the AIRS are the only items that require active cooling via an active Ne JT cooler. The Ariel payload is developed by a consortium of more than 50 institutes from 16 ESA countries, which include the UK, France, Italy, Belgium, Poland, Spain, Austria, Denmark, Ireland, Portugal, Czech Republic, Hungary, the Netherlands, Sweden, Norway, Estonia, and a NASA contribution