La falta d’expressió de MICA en pacients amb càncer de bufeta significa un pitjor pronòstic

Antecedents: el càncer de bufeta urinària i de pulmó es troben entre els deu tipus de càncer més comuns en ambdós sexes. El receptor NKG2D i un dels seus lligants, MICA, s’associen amb el tabaquisme i la susceptibilitat de patir malaltia pulmonar obstructiva crònica i càncer de pulmó. Objectiu: esbrinar si el sistema NKG2D-MICA s’associa amb altres càncers epitelials relacionats amb l’hàbit de fumar com el càncer de bufeta. Disseny, Escenari i Participants: 70 casos primaris de càncer de bufeta no múscul invasiu van ser examinats per detectar l’expressió de MICA i CD8 +, CD4 + i la infiltració de cèl·lules NK. La majoria dels pacients (n = 55, 78,6%) eren fumadors actuals o anteriors. Metodologia: la tecnologia de microarrays (TMA) va ser triada per avaluar MICA i l’infiltració tumoral de limfòcits en les mostres de càncer de bufeta. Es varen utilitzar Curves de Kaplan-Meier i l’anàlisi univariant de Cox per avaluar la recaiguda, mortalitat total per càncer i la mortalitat específica per càncer de bufeta. Resultats i limitacions: MICA es va expressar en la majoria dels espècimens de càncer examinats (és a dir, 70%). La recaiguda del càncer de bufeta no es va associar amb l’estat d’expressió de MICA (log rank p = 0,1123). No obstant això, ha existit una associació significativa entre l’expressió de MICA i l’alta mortalitat per càncer de bufeta (HR = 0,25; IC95% = 0,06-0,97). Limfòcits CD4 + i CD8 + es van trobar a la majoria (64%) de les mostres de tumors infiltrants. Les cèl·lules que expressen el receptor NKG2D es van trobar només en el 3% de les mostres. No hi havia cap funció lineal entre les cèl·lules NKG2D +, el nombre o proporció de cèl·lules CD4 + i CD8 + TIL. Conclusions: MICA s’expressa només en una proporció significativa de carcinomes de bufeta. L’expressió de MICA s’associa amb avantatges significatius en la supervivència davant el càncer de bufeta. El sistema NKG2D-MICABackground: Bladder and lung cancer are among the ten most common cancers in both genders. The NKG2D receptor and one of its ligands, MICA, are associated with smoking and susceptibility to both chronic obstructive pulmonary disease and lung cancer. Objective: We hypothesized that NKG2D-MICA system was associated with other smok- ing-related epithelial cancers such as bladder cancer. Design, Setting, and Participants: 70 cases of primary non-muscle invasive bladder cancer were screened for the MICA expression and CD8+, CD4+ and NK cell infiltration. Most patients (n = 55, 78.6%) were current or former smokers. Measurements: Tissue microarray (TMA) technology was chosen to evaluate MICA and tumor infiltrating lymphocytes in samples with confirmed bladder cancer. Kaplan- Meier curves and univariate Cox analysis was used to assess relapse, all-cancer mortality and specific bladder cancer mortality. Results and Limitations: MICA was expressed in most cancer specimens examined (i.e., 70%). Relapse of bladder cancer was not associated with the status of MICA expression (log rank p = 0.1123). Nevertheless, a signifi- cant association existed between high MICA expression and bladder cancer mortality (HR = 0.25; CI95% = 0.06 - 0.97). Tumor infiltrating CD4+ and CD8+ lymphocytes were found in the majority (64%) of samples. Cells expressing the NKG2D receptor were found in only 3% of the samples. There was no linear function between NKG2D+ cells and number or ratio of CD4+ and CD8+ TIL. Conclusions: MICA is expressed in a significant proportion of bladder carci- nomas. MICA expression associates with significant survival advantages in the face of both all-cancer and bladder can- cer. The NKG2D-MICA system could represent a common mechanism involved in the immunopathology and natural history of bladder neoplasms

Factors affecting the relationship between psychological status and quality of life in COPD patients

<p>Abstract</p> <p>Background</p> <p>This study aims to (i) evaluate the association between anxiety and depressive symptoms and health-related quality of life (HRQoL); and (ii) identify the effect modifiers of this relationship in patients with chronic obstructive pulmonary disease (COPD).</p> <p>Methods</p> <p>A total of 337 clinically stable COPD patients answered the St. George's Respiratory Questionnaire (SGRQ) (assessing HRQoL) and the Hospital Anxiety and Depression Scale (HADS). Socio-demographic information, lung function, and other clinical data were collected.</p> <p>Results</p> <p>Most patients (93%) were male; they had a mean (SD) age of 68 (9) years and mild to very severe COPD (post-bronchodilator FEV₁52 (16)% predicted). Multivariate analyses showed that anxiety, depression, or both conditions were associated with poor HRQoL (for all SGRQ domains). The association between anxiety and total HRQoL score was 6.7 points higher (indicating a worse HRQoL) in current workers than in retired individuals. Estimates for patients with "both anxiety and depression" were 5.8 points lower in stage I-II than in stage III-IV COPD, and 10.2 points higher in patients with other comorbidities than in those with only COPD.</p> <p>Conclusions</p> <p>This study shows a significant association between anxiety, depression, or both conditions and impaired HRQoL. Clinically relevant factors affecting the magnitude of this association include work status, COPD severity, and the presence of comorbidities.</p

Calidad de vida en adultos mayores con enfermedad pulmonar obstructiva crónica

Introduction.&nbsp;Chronic obstructive pulmonary disease is one the most significant causes of mortality and morbidity worldwide. It has psychosocial and pathophysiological effects that impact in a significant way to those who suffer from it. Objective.&nbsp;To evaluate quality of life from patients suffering from chronic obstructive pulmonary disease through the SF-36 survey (Spanish version for Colombia (SF-36 v2)) made during an external medical appointment made in Floridablanca, Colombia in 2015. Methodology.&nbsp;Descriptive cross sectional study performed to 40 patients diagnosed with chronic obstructive pulmonary disease. These patients attended to external pulmonology medical appointments between February and November of 2015 and filled out the short form SF-36 v2 after signing informed consent. The database was created under license using QualityMetric Health Outcomes™ Scoring Software 4.0. Results.&nbsp;40 patients, with an average age of 73 years (DE ± 8.4), participated in this study. When analyzing data, it was found that the physical functioning dimensions were values lower than 50. On the other hand, it was found that dimensions related to social functioning and emotional role had higher values and close to the ones reported by healthy population. Conclusions.&nbsp;Patients diagnosed with chronic obstructive pulmonary disease showed a decrease in quality of life, in both of its dimensions:&nbsp;physical and mental, compared to healthy population’s reference values. It is ratified that this disease impacts all sub-scales of this construct, specially the ones related to the physical component. [Cáceres-Rivera DI, Roa-Díaz ZM, Domínguez CL, Carreño-Robayo JH, Orozco-LeviMA. Quality of life in older adults with chronic obstructive pulmonary disease. MedUNAB. 2018;21(1):46-58. doi: 10.29375/01237047.2512].Introducción.&nbsp;La enfermedad pulmonar obstructiva crónica es una importante causa de mortalidad y morbilidad a nivel mundial y tiene efectos psicosociales y fisiopatológicos que repercuten de manera significativa en la calidad de vida de quienes la padecen. Objetivo.&nbsp;Evaluar la calidad de vida de pacientes con enfermedad&nbsp;pulmonar obstructiva crónica a través del instrumento SF-36, versión en español para Colombia (SF-36 v2), en un servicio de consulta externa de Floridablanca, Colombia, durante el año 2015. Metodología.&nbsp;Estudio de corte transversal descriptivo realizado en 40 pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica que asistieron al servicio de consulta externa por Neumología entre los meses de febrero y noviembre de&nbsp;2015. El cuestionario SF-36 v2 fue diligenciado por todos los participantes; previamente, se firmó el consentimiento informado. La base de datos fue digitada, bajo licencia, en QualityMetric Health Outcomes™ Scoring Software 4.0. Resultados.&nbsp;Participaron 40 pacientes, con una edad media de 73 (DE ± 8.4) años. En las dimensiones de funcionamiento físico se encontraron valores inferiores a 50; por otra parte, las dimensiones Funcionamiento Social y Rol Emocional presentaron valores superiores y cercanos a los reportados por población sana. Conclusiones.&nbsp;Los pacientes con enfermedad pulmonar obstructiva crónica mostraron una disminución en la calidad de vida comparado con los valores de referencia en población en general en sus dos componentes: físico y mental. Se ratifica el impacto que tiene esta enfermedad en todas las subescalas que componen este constructo, especialmente en el componente físico. [Cáceres-Rivera DI, Roa-Díaz ZM, Domínguez CL, Carreño-Robayo JH, Orozco-Levi MA. Calidad de vida en adultos mayores con enfermedad pulmonar obstructiva crónica. MedUNAB. 2018;21(1):46- 58. doi: 10.29375/01237047.2512]

Complicações associadas à traqueostomia em pacientes adultos em unidades de terapia intensiva no período 2015-2020. Revisão sistemática

Introduction:Tracheostomy procedures in intensive care units are on the rise; however, they can lead to both perioperative and postoperative complications, with a variable incidence from 5 to 40% and even death in up to 1.4% of individuals. Despite this, few studies address causal concepts or mechanical and nonmechanical risk factors about this important topic.&nbsp;Objetive:&nbsp;To review the scope of the available scientific literature on complications of mechanical and non-mechanical origin associated with a tracheostomy.&nbsp;Materials and Methods:The research question and inclusion criteria were established to conduct the search in PubMed and EBSCO databases between 2015 and 2020. The PRISMA-ScR checklist was used in the present study as a methodological and quality guideline.&nbsp;Results:The most frequent complications were bleeding 61%, tracheal stenosis 28.5%, decannulation 23.6% (5/21) , stoma infection 19%, death 19%, and difficult tracheostomy tube insertion 19%. Regarding mechanical risk factors, only the use of the Bjork flap (OR=0.4) was identified as a protective factor. Among the non-mechanical factors, obesity (OR=5.15), tube diameter &gt;6 (OR=2.6), and preoperative mechanical ventilation (OR=3.14) were found.&nbsp;Conclusions:&nbsp;It was possible to identify that the highest incidence of tracheostomy-related complications were bleeding, tracheal stenosis, accidental decannulation, and death; however, it is still unknown whether they originate from a mechanical or non-mechanical cause during intensive care management. How to cite this article: Reyes Pulido Mabel Magoth, Orozco Levi Mauricio, Ramírez Sarmiento Alba Lucía, Nariño Gamboa Angelica Julieth, Fragozo Ibarra Andry Giseth. Complicaciones en pacientes usuarios de traqueostomía en unidades de cuidados intensivos. Scoping Review. Revista Cuidarte. 2022;13(3):e2281.&nbsp;http://dx.doi.org/10.15649/cuidarte.2281&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Las complicaciones asociadas a las cánulas de traqueostomía han sido sub-reportadas y sub-valoradas. Dado el incremento de las traqueostomías en las unidades de cuidado intensivo merece su revisión. Se requiere mayor investigación de los efectos deletéreos de las fuerzas mecánicas ejercidas por tracción de otros dispositivos de ventilación mecánica y la movilización sobre las cánulas de traqueostomía Complicaciones asociadas a la traqueostomía como sangrado, estenosis traqueal, decanulación accidental, infección de la estoma y muerte no son problemas menores y requieren acciones correctivas y preventivas. La mal-posición de las cánulas de traqueostomía es una complicación mecánica frecuente en la clínica que requiere investigación para determinar rangos permisibles y métodos de corrección de la misma. Introducción:&nbsp;Los procedimientos de traqueostomía van en aumento en las unidades de cuidados intensivos en el adulto, por lo que las complicaciones asociadas a este procedimiento también incrementan. Se ha identificado que la traqueostomía puede conllevar a complicaciones tanto preoperatorias como postoperatorias, que varían ampliamente entre un 5-40%, entre las más frecuentes están, estenosis traqueal, fístula traqueoesofágica, hemorragia, lesión peristomal, decanulación, infecciones, entre otras, que podrían causar la muerte hasta en 1,4% de las personas. Sin embargo, a nivel mundial muy pocos estudios abordan los conceptos causales o factores de riesgo mecánicos y no mecánicos de este importante tema.&nbsp;Objetivo:&nbsp;Revisar el alcance de la literatura científica disponible sobre las complicaciones de origen mecánico y no mecánico asociadas a la traqueostomía en pacientes adultos en las unidades de cuidados intensivos entre el periodo 2015-2020.&nbsp;Materiales y métodos:&nbsp;se establecieron la pregunta de investigación con metodología “Patient, Intervention, Comparation, Outcome, Time (PICOT)” y los criterios de inclusión para la búsqueda de los referentes bibliográficos de estudios observacionales y experimentales. La información fue consultada en las bases de datos PubMed y EBSCO y los artículos científicos seleccionados fueron los publicados entre los años 2015-2020. Como guía metodológica y de calidad para el presente estudio se utilizó la lista de chequeo PRISMA-ScR.&nbsp;Resultados:&nbsp;las complicaciones con mayor frecuencia son: sangrado 61% presentada (13/21 artículos), estenosis traqueal 28,5% (5/21 artículos), decanulación 23,6% (5/21 artículos), infección de la estoma 19% (4/21 artículos) muerte 19% (4/21) y la dificultad en la inserción de la cánula 19% (4/21 artículos), en cuanto a factores de riesgo mecánicos para éstas sólo se identifica el uso de la técnica Bjork flap (OR=0,4). Entre los no mecánicos se encontraron, obesidad (OR=5,15), diámetro de cánula &gt;6 (OR= 2,6) y ventilación mecánica preoperatoria (OR=3,14).&nbsp;Conclusión:Se logró identificar que las complicaciones relacionadas con la traqueostomía con mayor incidencia son sangrado, estenosis traqueal, decanulación accidental y la muerte. Sin embargo, aún se desconoce si se originan por una causa mecánica o no mecánica durante su manejo en UCI. Como citar este artículo:&nbsp;Reyes Pulido Mabel Magoth, Orozco Levi Mauricio, Ramírez Sarmiento Alba Lucía, Nariño Gamboa Angelica Julieth, Fragozo Ibarra Andry Giseth. Complicaciones en pacientes usuarios de traqueostomía en unidades de cuidados intensivos. Scoping Review. Revista Cuidarte. 2022;13(3):e2281.&nbsp;http://dx.doi.org/10.15649/cuidarte.2281&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Introdução:&nbsp;Os procedimentos de traqueostomia estão aumentando nas unidades de terapia intensiva, entretanto, podem levar a complicações perioperatórias e pós-operatórias com uma incidência variável entre 5-40% e até a morte em até 1,4% dos indivíduos, apesar disso, poucos estudos abordam os conceitos causais ou fatores de risco mecânicos e não-mecânicos sobre este importante tópico.&nbsp;Objetivo:&nbsp;Rever o escopo da literatura científica disponível sobre complicações mecânicas e não mecânicas associadas à traqueostomia.&nbsp;Materiais e Métodos:&nbsp;a questão da pesquisa e critérios de inclusão foram estabelecidos para a pesquisa nas bases de dados PubMed e EBSCO entre os anos 2015-2020, como guia metodológico e de qualidade para o presente estudo foi utilizada a lista de verificação PRISMAScR.&nbsp;Resultados:&nbsp;As complicações com maior freqüência foram, sangramento 61%, estenose traqueal 28,5%, decanulação 23,6% (5/21, infecção por estoma 19%, morte 19% e dificuldade na inserção da cânula 19%, em relação aos fatores de risco mecânico, apenas o uso da técnica de Bjork Flap (OR=0,4) foi identificado como fator de proteção, entre os fatores não mecânicos foram encontrados: obesidade (OR=5,15), diâmetro da cânula &gt;6 (OR= 2,6) e ventilação mecânica pré-operatória (OR=3,14).&nbsp;Conclusões:&nbsp;Conseguimos identificar que as complicações relacionadas à traqueostomia com maior incidência foram sangramento, estenose traqueal, decanulação acidental e morte, no entanto, ainda não se sabe se elas se originam de uma causa mecânica ou não mecânica durante a gestão dos cuidados intensivos. Como citar este artigo: Reyes Pulido Mabel Magoth, Orozco Levi Mauricio, Ramírez Sarmiento Alba Lucía, Nariño Gamboa Angelica Julieth, Fragozo Ibarra Andry Giseth. Complicaciones en pacientes usuarios de traqueostomía en unidades de cuidados intensivos. Scoping Review. Revista Cuidarte. 2022;13(3):e2281.&nbsp;http://dx.doi.org/10.15649/cuidarte.2281&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp

Influence of Pretransplant Restrictive Lung Disease on Allogeneic Hematopoietic Cell Transplantation Outcomes

We conducted a 15-year retrospective cohort study to determine the prevalence of restrictive lung disease prior to allogeneic hematopoietic cell transplant (HCT), and to assess whether this was a risk factor for poor outcomes. 2545 patients were eligible for the analysis. Restrictive lung disease was defined as a total lung capacity (TLC) <80% of predicted normal. Chest x-rays and /or computed tomography scans were reviewed for all restricted patients to determine whether lung parenchymal abnormalities were unlikely or highly likely to cause restriction. Multivariate Cox-proportional hazard and sensitivity analyses were performed to assess the relationship between restriction and early respiratory failure and nonrelapse mortality. Restrictive lung disease was present in 194 subjects (7.6%) prior to transplantation. Among these cases, radiographically apparent abnormalities were unlikely to be the cause of the restriction in 149 (77%) subjects. In unadjusted and adjusted analyses, the presence of pulmonary restriction was significantly associated with a 2-fold increase in risk for early respiratory failure and nonrelapse mortality, suggesting that these outcomes occurring in the absence of radiographically apparent abnormalities may be related to respiratory muscle weakness. These findings suggest that pulmonary restriction should be considered as a risk factor for poor outcomes after transplant

Influence of Diaphragmatic Mobility on Hypercapnia in Patients with Chronic Obstructive Pulmonary Disease

A reduction in diaphragm mobility has been identified in patients with chronic obstructive pulmonary disease (COPD) and has been associated with a decline in pulmonary function parameters. However, little information exists regarding the potential role of diaphragm mobility on hypercapnia in COPD. A new method of assessing the mobility of the diaphragm, using ultrasound, has recently been validated. The purpose of the present study was to investigate the relationship between diaphragm mobility and pulmonary function parameters, as well as that between arterial blood gas values and diaphragm mobility, in COPD patients. Thirty seven COPD patients were recruited for pulmonary function test, arterial blood gas analysis and diaphragm mobility using ultrasound to measure the craniocaudal displacement of the left branch of the portal vein. There were significant negative correlations between diaphragmatic mobility and PaCO2 (r = -0.373, P = 0.030). Diaphragmatic mobility correlated with airway obstruction (FEV1, r = 0.415, P = 0.011) and with ventilatory capacity (FVC, r = 0.302, P = 0.029; MVV, r = 0.481, P = 0.003). Diaphragmatic mobility also correlated significantly with pulmonary hyperinflation. No relationship was observed between diaphragm mobility and PaO2 (r = -0.028, P = 0.873). These findings support a possibility that the reduction in diaphragm mobility relates to hypercapnia in COPD patients

Detection of Plant DNA in the Bronchoalveolar Lavage of Patients with Ventilator-Associated Pneumonia

BACKGROUND: Hospital-acquired infections such as nosocomial pneumonia are a serious cause of mortality for hospitalized patients, especially for those admitted to intensive care units (ICUs). Despite the number of the studies reported to date, the causative agents of pneumonia are not completely known. Herein, we found by molecular technique that vegetable and tobacco DNA may be detected in the bronchoalveolar lavage from patients with ventilator-associated pneumonia (VAP). METHODOLOGY/PRINCIPAL FINDINGS: In the present study, we studied bronchoalveolar lavage (BAL) from patients admitted to ICUs with ventilator-associated pneumonia. BAL fluids were assessed with molecular tests, culture and blood culture. We successfully identified plant DNA in six patients out of 106 (6%) with ventilator-associated pneumonia. Inhalation was confirmed in four cases and suspected in the other two cases. Inhalation was significantly frequent in patients with plant DNA (four out of six patients) than those without plant DNA (three out of 100 patients) (P<0.001). Nicotiana tabacum chloroplast DNA was identified in three patients who were smokers (cases 2, 3 and 6). Cucurbita pepo, Morus bombycis and Triticum aestivum DNA were identified in cases 1, 4 and 5 respectively. Twenty-three different bacterial species, two viruses and five fungal species were identified from among these six patients by using molecular and culture techniques. Several of the pathogenic microorganisms identified are reported to be food-borne or tobacco plant-associated pathogens. CONCLUSIONS/SIGNIFICANCE: Our study shows that plants DNA may be identified in the BAL fluid of pneumonia patients, especially when exploring aspiration pneumonia, but the significance of the presence of plant DNA and its role in the pathogenesis of pneumonia is unknown and remains to be investigated. However, the identification of these plants may be a potential marker of aspiration in patients with pneumonia