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PURPOSE: Breast cancer is an important health problem, like obesity and dyslipidemia, with a strong association between body mass index (BMI) and breast cancer incidence and mortality. The risk of breast cancer is also high in women with high mammographic breast density (MBD). The purpose of this study was to analyze the association between BMI and MBD according to breast cancer molecular subtypes. METHODS: This transversal, descriptive, multicenter study was conducted at three Spanish breast cancer units from November 2019 to October 2020 in women with a recent diagnosis of early breast cancer. Data were collected at the time of diagnosis. RESULTS: The study included 162 women with a recent diagnosis of early breast cancer. The median age was 52 years and 49.1% were postmenopausal; 52% had normal weight, 32% overweight, and 16% obesity. There was no association between BMI and molecular subtype but, according to menopausal status, BMI was significantly higher in postmenopausal patients with luminal A (p = 0.011) and HER2-positive (p = 0.027) subtypes. There was no association between MBD and molecular subtype, but there were significant differences between BMI and MBD (p < 0.001), with lower BMI in patients with higher MBD. Patients with higher BMI had lower HDL-cholesterol (p < 0.001) and higher insulin (p < 0.001) levels, but there were no significant differences in total cholesterol or vitamin D. CONCLUSIONS: This study showed higher BMI in luminal A and HER2-positive postmenopausal patients, and higher BMI in patients with low MBD regardless of menopausal status.
Assuntos
Índice de Massa Corporal , Densidade da Mama , Neoplasias da Mama , Obesidade , Humanos , Feminino , Neoplasias da Mama/patologia , Pessoa de Meia-Idade , Espanha/epidemiologia , Obesidade/complicações , Adulto , Estudos Transversais , Pós-Menopausa , Idoso , Receptor ErbB-2/metabolismo , Mamografia , Sobrepeso/complicaçõesRESUMO
BACKGROUND: The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. METHODS: Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. RESULTS: From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). CONCLUSIONS: Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation.
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Linfadenopatia , Tuberculose Pulmonar , Criança , Estudos Transversais , Humanos , Variações Dependentes do Observador , Radiografia Torácica/métodos , Reprodutibilidade dos Testes , Tuberculose Pulmonar/diagnóstico por imagem , Raios XRESUMO
Anodic layers have been grown on 304L stainless steel (304L SS) using two kinds of fluoride-free organic electrolytes. The replacement of NH4F for NaAlO2 or Na2SiO3 in the glycerol solution and the influence of the H2O concentration have been examined. The obtained anodic layers were characterized by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and potentiodynamic polarization tests. Here, it was found that, although the anodic layers fabricated within the NaAlO2-electrolyte and high H2O concentrations presented limited adherence to the substrate, the anodizing in the Na2SiO3-electrolyte and low H2O concentrations allowed the growth oxide layers, and even a type of ordered morphology was observed. Furthermore, the electrochemical tests in chloride solution determined low chemical stability and active behavior of oxide layers grown in NaAlO2-electrolyte. In contrast, the corrosion resistance was improved approximately one order of magnitude compared to the non-anodized 304L SS substrate for the anodizing treatment in glycerol, 0.05 M Na2SiO3, and 1.7 vol% H2O at 20 mA/cm2 for 6 min. Thus, this anodizing condition offers insight into the sustainable growth of oxide layers with potential anti-corrosion properties.
RESUMO
Traumatic brain injury is caused by mechanical forces impacting the skull and its internal structures and constitutes one of the main causes of morbidity and mortality in the world. Clinically, severe traumatic brain injury is associated with the development of acute lung injury and so far, few studies have evaluated the cellular, molecular and immunological mechanisms involved in this pathophysiological process. Knowing and investigating these mechanisms allows us to correlate pulmonary injury as a predictor of cerebral hypoxia in traumatic brain injury and to use this finding in decision making during clinical practice. This review aims to provide evidence on the importance of the pathophysiology of traumatic brain injury-acute lung injury, and thus confirm its role as a predictor of cerebral hypoxia, helping to establish an appropriate therapeutic strategy to improve functional outcomes and reduce mortality.
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Lesão Pulmonar Aguda , Lesões Encefálicas Traumáticas , Hipóxia Encefálica , Lesão Pulmonar Aguda/complicações , Humanos , Hipóxia Encefálica/complicaçõesRESUMO
BACKGROUND: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION: PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.
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Infecções por HIV , Desnutrição , Composição Corporal , Impedância Elétrica , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/etiologia , Avaliação Nutricional , Estado Nutricional , Sensibilidade e EspecificidadeRESUMO
Dada la respiración nasal preferencial que tiene la población pediátrica en los primeros meses de vida, la obstrucción nasal tiene más repercusiones a nivel clínico a diferencia de un adulto, lo cual hace más prioritario su diagnóstico y manejo. Una de las principales causas de obstrucción nasal en niños son las masas nasales, las cuales debido a sus múltiples etiologías causan bastante incertidumbre diagnóstica en el equipo médico. En este artículo se presenta el caso de una paciente de 10 meses con una masa en el ala nasal de crecimiento rápido; se realiza un rápido diagnóstico de rabdomiosarcoma que requiere un adecuado manejo. El rabdomiosarcoma con patrón alveolar se presenta de forma inusual en esta ubicación, es por esto por lo que se considera importante presentar este caso para mantenerlo en el algoritmo diagnóstico como una posibilidad y que, así como en el caso presentado, se pueda tener un diagnóstico temprano, un tratamiento adecuado y un resultado estético y funcional favorable.
Given preferential nasal breathing in the first months of life in the pediatric population, nasal obstruction has more clinical repercussions than it would have in adults, hence the need to give higher priority to its diagnosis and management. One of the main causes of nasal obstruction in children is the presence of nasal masses, which cause considerable diagnostic uncertainty in the medical team, because of their multiple etiologies. In this article, the case of a 10-month-old patient with a rapidly growing mass in the nasal ala is presented. A rhabdomyosarcoma was promptly diagnosed and adequately managed. Rhabdomyosarcoma with an alveolar pattern occurs in an unusual way in this location; for this reason, this case is important in order to include this possibility in the diagnostic algorithm and, as was the case in this patient, reach an early diagnosis and institute adequate treatment resulting in favorable aesthetic and functional results.
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Humanos , Rabdomiossarcoma , Seios Paranasais , Rabdomiossarcoma AlveolarRESUMO
BACKGROUND: Craniosynostosis is an underdiagnosed complication associated with hypophosphatemic rickets. The study aims to describe the clinical and auxological characteristic of children with hypophosphatemic rickets and craniosynostosis, describe the usual treatment, and compare the characteristics with those of children without craniosynostosis. METHODS AND PATIENTS: An observational and retrospective cohort study was conducted. Clinical notes and cranial images were reviewed. Out of 96 children, only the 50 patients who had skull images were included. RESULTS: Out of 50 patients, 26 (15 males) had craniosynostosis (52%). No differences were observed in birth size, age, height, body proportions, alkaline phosphatase, serum phosphate, or percent tubular reabsorption of phosphate at first appointment among children with or without craniosynostosis. Among patients with craniosynostosis, dolichocephaly was prevalent. The sagittal suture was affected in all patients with craniosynostosis, with 19 of 26 children (73%) affected with isolated scaphocephaly. Pan-sutural craniosynostosis was present in 7 children (27%). None of the children had microcephaly, 7 of them presented macrocephaly and, in the remaining subjects, head circumference was normal. Five patients had undergone at least 1 cranial remodeling surgery. One patient with craniosynostosis was diagnosed with a Chiari I malformation. Molecular characterization of PHEX gene was performed in 14 cases. CONCLUSIONS: Craniosynostosis is an underdiagnosed complication of hypophosphatemic rickets. Many patients with normal head size and growth may go undiagnosed, thus it is important to consider this association for early diagnosis and possible surgical treatment. A multidisciplinary approach is necessary for a correct long-term follow-up.
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Craniossinostoses/patologia , Raquitismo Hipofosfatêmico Familiar/complicações , Predisposição Genética para Doença , Mutação , Endopeptidase Neutra Reguladora de Fosfato PHEX/genética , Criança , Pré-Escolar , Craniossinostoses/etiologia , Craniossinostoses/metabolismo , Craniossinostoses/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
Introducción: los tumores en la cavidad nasal y los senos paranasales son un problema serio en la población pediátrica, principalmente por la inespecificidad de los síntomas que lleva a que pasen de meses a años antes de la sospecha de una patología neoplásica, con un impacto en la calidad de vida del paciente y su entorno. Al sospechar de la presencia de un tumor nasosinusal se requiere la realización de imágenes diagnósticas como la resonancia magnética y la tomografía computarizada de los senos paranasales. Cuando se tiene un diagnóstico etiológico, siempre se debe realizar un abordaje multidisciplinario. Materiales y métodos: realizamos un estudio retrospectivo de corte transversal de la cohorte de pacientes con tumores de nariz y senos paranasales atendidos en un hospital pediátrico de cuarto nivel en Bogotá, Colombia, entre 2013-2018. Resultados: se incluyeron un total de 54 pacientes con tumores malignos y benignos de nariz y senos paranasales, la mayoría fueron hombres con un promedio de edad de ocho años. Generalmente se presentaron con síntomas nasosinusales, el principal fue obstrucción nasal en el 80 % de los pacientes. El diagnóstico mas común fue craneofaringioma en un tercio de los pacientes, seguido por angiofibroma nasofaríngeo y linfoma de Burkitt. Conclusión: es importante conocer los síntomas y características clínicas de los pacientes pediátricos con tumores nasofaríngeos. Por esta razón, se considera importante presentar la casuística y características de los tumores de nariz y senos paranasales recogida durante 5 años, en un hospital pediátrico de cuarto nivel en la ciudad de Bogotá, Colombia
Introduction: Tumors in the nasal cavity and paranasal sinuses in children is a serious problem in the pediatric population, mainly due to the non-specificity of the symptoms that leads to years or months passing before the suspicion of a neoplastic pathology. With an important impact in quality of life not only in the patient but also in its family environment. When suspecting a sinonasal tumor, diagnostic images such as magnetic resonance and computed tomography of the paranasal sinuses are required. When you have an etiological diagnosis always do a multidisciplinary approach. Methods: We conducted a cross-sectional study of the cohort of patients that had been diagnose with tumors of the nasal cavity or paranasal sinuses in a fourth level pediatric hospital in Bogota, Colombia between 2013 - 2018. Results: 54 patients were included, the majority of them were men, with an average age of eight years. They mainly presented with nasal symptoms, the main one being nasal obstruction in 80% of patients. The most common diagnosis was cranipharyngioma in one third of the patients, followed by nasopharyngeal angiofibroma and Burkitt lymphoma. Conclusion: We present this article with the objective of presenting the tumors of nose and paranasal sinuses casuistry collected during 5 years in a fourth level pediatric hospital in the city of Bogotá and the imaging characteristics for the diagnosis of these are reviewed with some clinical cases as examples.
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Humanos , Pediatria , Neoplasias NasaisRESUMO
Numerosas investigaciones demuestran que existe alteración del metabolismo lipídico en pacientes con VIH/SIDA, caracterizada por un aumento en la concentración de triglicéridos y la disminución de las lipoproteínas de alta y baja densidad y del colesterol total. La dislipidemia en personas VIH/SIDA depende de la supresión viral en el momento del estudio, de la respuesta al agente antirretroviral específico que se relaciona con la susceptibilidad genética, además de otros factores entre los cuales se encuentra el empleo de medicamentos, el peso y el estilo de vida. Los pacientes que conviven con esta infección tienen por esta razón un riesgo incrementado de accidente cardiovascular y diabetes. El objetivo fue determinar si existían diferencias en el perfil lipídico en una cohorte de pacientes que reciben esquemas de tratamientos diferentes en la población enfocada. Este fue un diseño observacional de cohorte prospectivo (24) con componente analítico que incluyó pacientes con diagnóstico de HIV y con tratamiento que concurrieron al Programa Regional de Control VIH-SIDA en el Hospital Regional de Encarnación-VII Región Sanitaria de Itapúa de abril a septiembre de 2016. Se encontraron diferencias significativas en la mayoría de los analitos componentes del perfil lipídico. Es necesario realizar un control periódico del perfil lipídico en estos grupos de pacientes, pues ello contribuirá a un mejor seguimiento del estado de salud así como a la prevención de accidentes cardiovasculares en los pacientes que conviven con VIH/SIDA y que están en tratamiento con antirretrovirales
Numerous research studies show that there is an impaired lipid metabolism in patients with HIV/AIDS, characterized by an increase in triglyceride concentration and decreased high- and low-density lipoproteins and total cholesterol. Dyslipidemia in HIV/AIDS people depends on viral suppression at the time of the study, response to the specific antiretroviral agent that relates to genetic susceptibility, as well as other factors including the use of medications, weight and lifestyle. Therefore, patients living with this infection have an increased risk of cardiovascular accident and diabetes. The objective was to determine whether there were differences in lipid profile in a cohort of patients receiving different treatment schemes in the targeted population. This was a prospective cohort design research with analytical component that included patients with HIV diagnosis and treatment that attended the Regional HIV-AIDS Control Programme at the Regional Hospital of Encarnacion - VII Itapúa Health Region from April to September 2016. Significant differences were found in most analytes components of the lipid profile. A periodic control of the lipid profile is necessary in these patient groups as this will contribute to a better monitoring of the health status as well as to the prevention of cardiovascular accidents in patients living with HIV/AIDS, and who are being treated with antiretrovirals