RESUMO
OBJECTIVE: Lung cancer is one the leading causes of mortality worldwide. Symptomatic manifestations of the disease generally occur in the advanced-stage setting, and therefore an important number of patients have advanced or metastatic disease by the time they are diagnosed. This situation contributes to a poor prognosis in the treatment of lung cancer. Evidencebased clinical recommendations are of great value to support decision-making for daily practice, and thus improving health care quality and patient outcomes. MATERIALS AND METHODS: This document was an initiative of the Mexican Society of Oncology (SMEO) in collaboration with Mexican Center of Clinical Excellence (Cenetec) according to Interna- tional Standards. Such standards included those described by the IOM, NICE, SIGN and GI-N. An interdisciplinary Guideline Development Group (GDG) was put together which included medical oncologists, surgical oncologistsc, radiation therapists, and methodologists with expertise in critical appraisal, sys- tematic reviews and clinical practice guidelines development. RESULTS: 62 clinical questions were agreed among members of the GDG. With the evidence identified from systematic reviews, the GDG developed clinical recommendations using a Modified Delphi Panel technique. Patients' representatives validated them. CONCLUSIONS: These Clinical Practice Guideline aims to support the shared decision-making process for patients with different stages of non-small cell lung cancer. Our goal is to improve health-care quality on these patients.
OBJETIVO: El cáncer de pulmón es una de las principales causas de mortalidad alrededor del mundo. Su historia natural, con la manifestación de síntomas en etapas avanzadas y el retraso en su diagnóstico hacen que una gran proporción de pacientes se diagnostiquen en estadios tardíos de la enfermedad, lo que hace muy complicado el tratamiento exitoso de la misma. De esto deriva la importancia de dar origen a recomendaciones basadas en evidencia para soportar la toma de decisiones clínicas por parte de los grupos interdisicplinarios que se encargan del manejo de este padecimiento. MATERIAL Y MÉTODOS: Este documento se desarrolló por parte de la Sociedad Mexicana de Oncología en colaboración con el Centro Nacional de Excelencia Tec- nológica de México (Cenetec) a través de la dirección de integración de Guías de Práctica Clínica en cumplimiento a estándares internacionales como los descritos por el Ins- tituto de Medicina de EUA (IOM, por sus siglas en inglés), el Instituto de Excelencia Clínica de Gran Bretaña (NICE, por sus siglas en inglés), la Red Colegiada para el Desarrollo de Guías de Escocia (SIGN, por sus siglas en inglés), la Red Internacional de Guías (G-I-N, por sus siglas en inglés); entre otros. Se integró en representación de la Sociedad Mexicana de Oncología un Grupo de Desarrollo de la Guía (GDG) de manera interdisciplinaria, considerando oncólogos médicos, cirujanos oncólogos, cirujanos de tórax, radio-oncólogos, y metodólogos con experiencia en revisiones sistemáticas de la literatura y guías de práctica clínica. RESULTADOS: Se consensuaron 62 preguntas cllínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente la misma, antes de ser incorporada en el cuerpo de evidencia de la Guía. El GDG acordó mediante la técnica de consenso formal de expertos Panel Delphi la redacción final de las recomendaciones clínicas. C. CONCLUSIONES: Esta Guía de Práctica Clínica pretende proveer recomendaciones clínicas para el manejo de los distintos estadios de la enfermedad y que asistan en el proceso de toma de decisiones compartida. El GDG espera que esta guía contribuya a mejorar la calidad de la atención clínica en las pacientes con cáncer de pulmón de células no pequeñas.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Algoritmos , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Intervenção Médica Precoce , Humanos , Neoplasias Pulmonares/patologia , Estadiamento de NeoplasiasRESUMO
Abstract Introduction: In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective: To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods: In a cross-sectional study, forty-four patients were evaluated (aged 7-19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results: Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions: Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.
Resumo Introdução: Em adolescentes com rinite alérgica perene, a exposição à fumaça do cigarro de tabaco aumenta a contagem de eosinófilos na mucosa nasal. O recrutamento de eosinófilos surge da ação combinada de alguns sinais celulares e moleculares, inclusive a eotaxina. Objetivo: Avaliar o efeito da exposição à fumaça do cigarro de tabaco na contagem de células imunorreativas a eotaxina-1 e eosinófilos na mucosa nasal de crianças e adolescentes com rinite alérgica perene. Método: Em um estudo transversal, 44 pacientes foram avaliados (entre sete e 19 anos): 22 com e 22 sem exposição à fumaça do cigarro de tabaco. Depois de responder a dois questionários validados, sobre asma e alergias na infância e sobre a gravidade dos sintomas nasais, as amostras de mucosa nasal foram obtidas por meio de raspagem do terço médio das conchas inferiores. Em seguida, as contagens de células imunorreativas para eotaxina-1 e eosinófilos foram avaliadas por imuno-histoquímica. Resultados: Os pacientes com exposição à fumaça do cigarro de tabaco apresentaram contagens de células mais elevadas tanto para eotaxina-1 como para eosinófilos em comparação com os pacientes sem exposição à fumaça, sem correlação entre as duas variáveis. No entanto, ambas as contagens, de eotaxina-1 e eosinófilos foram relacionadas com a razão cotinina/creatinina. Conclusões: A exposição à fumaça do cigarro de tabaco pode aumentar a eotaxina-1 e a contagem de eosinófilos na mucosa nasal de pacientes jovens com rinite alérgica perene.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Poluição por Fumaça de Tabaco/efeitos adversos , Rinite Alérgica Sazonal/imunologia , Eosinófilos/imunologia , Quimiocina CCL11/imunologia , Mucosa Nasal/imunologia , Índice de Gravidade de Doença , Imuno-Histoquímica , Contagem de Células , Rinite Alérgica Sazonal/patologia , Estudos Transversais , Eosinófilos/citologia , Quimiocina CCL11/análise , Mucosa Nasal/citologia , Mucosa Nasal/químicaRESUMO
INTRODUCTION: In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. OBJECTIVE: To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. METHODS: In a cross-sectional study, forty-four patients were evaluated (aged 7-19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. RESULTS: Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. CONCLUSIONS: Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.
Assuntos
Quimiocina CCL11/imunologia , Eosinófilos/imunologia , Mucosa Nasal/imunologia , Rinite Alérgica Sazonal/imunologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Contagem de Células , Quimiocina CCL11/análise , Criança , Estudos Transversais , Eosinófilos/citologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Mucosa Nasal/química , Mucosa Nasal/citologia , Rinite Alérgica Sazonal/patologia , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVE. In children aged less than 10 years, to assess whether adenotonsillectomy has some permanent or transitory effect on middle ear pressure. MATERIAL AND METHODS. 20 children aged 4 to 9 years old (13 girls and 7 boys) participated in the study. The day before surgery and on days 1, 7, 14 and 21 after adenotonsillectomy both tympanometry and pure tone audiometry were performed. During surgery, medication consisted in dexamethasone, atropine, propofol and sevoflurane. RESULTS. Before surgery, the middle ear pressure was within the range of 0 ± 99 daPa. On day 1 of the followup study, the average right and left middle ear pressure decreased less than -99 daPa in 6 patients aged 4 to 9 years old (2 girls and 4 boys), with a body mass index from 11.9 to 16.6. At day 7 of follow-up, the middle ear pressure increased and none of the patients showed a pressure less than -99 daPa. Before surgery and during the 21 days of follow-up, hearing thresholds were always ≤ 20 dB nHL. No significant difference was observed between children with or without an average middle ear pressure lower than -99 daPa on their age, weight, height, body mass index or duration of the surgery. CONCLUSIONS. After adenotonsillectomy, children aged 4 to 9 years old who received dexamethasone, atropine and sevoflurane might develop negative middle ear pressure with no hearing loss, which may resolve in 1 week. After adenotonsillectomy, in patients with otalgia or risk factors for middle ear disease, closer evaluation of middle ear pressure may be advisable.
Assuntos
Adenoidectomia , Orelha Média/fisiologia , Pressão , Tonsilectomia , Testes de Impedância Acústica , Fatores Etários , Audiometria de Tons Puros , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
OBJECTIVE: To assess apoptosis frequency in the nasal mucosa of patients with perennial allergic rhinitis. PATIENTS AND METHODS: Eleven patients and five healthy subjects accepted to participate, from 10 to 16 years old. None of them had evidence of acute infectious disease, tobacco exposure or use of corticosteroids, antileukotrienes, antihistamines or immunotherapy. After a clinical evaluation and a skin prick testing, a nasal symptoms questionnaire was applied and a nasal washing was performed. Two hundred cells were examined (Giemsa and eosin yellowish) and apoptosis was identified by immunohistochemistry (Active-Caspase-3) (p20L18, sc-1225. Santa Cruz Biothecnology, Inc. Santa Cruz). RESULTS: The most common allergen was Dermatophagoides sp in 10 patients (91%). The total score of the nasal symptom questionnaire was 3 to 8 (median 6) in patients and 1 to 4 (median 2) in healthy subjects (p < 0.05, Mann Whitney U test). Frequency of eosinophils was 11 to 80% in patients and 0 to 1% in healthy subjects (p < 0.05, Z for proportions). Apoptosis was less frequent in patients (0 to 5, median 2) than in healthy subjects (4 to 16, median 8) (p < 0.01, Mann Whitney U test). CONCLUSIONS: Perennial allergic rhinitis may be associated with decreased apoptosis in the nasal mucosa.
Assuntos
Apoptose , Mucosa Nasal/patologia , Rinite Alérgica Perene/patologia , Adulto , Alérgenos/efeitos adversos , Animais , Estudos Transversais , Dermatophagoides pteronyssinus/imunologia , Eosinofilia/etiologia , Eosinofilia/patologia , Células Epiteliais/patologia , Feminino , Humanos , Masculino , México/epidemiologia , Índice de Gravidade de Doença , Testes Cutâneos , Inquéritos e Questionários , Irrigação TerapêuticaRESUMO
BACKGROUND: Skin tests are the most used diagnostic method of allergic rhinitis, which, in addition to identify specific allergen, can determine the relative sensitivity of one patient to the allergen. OBJECTIVE: To assess the association between skin test reactivity and total and specific serum IgE levels on the diagnosis of patients with perennial allergic rhinitis. MATERIAL AND METHODS: We measured the response to skin test reactivity and total and specific serum IgE levels in 69 patients with perennial allergic rhinitis. RESULTS: The skin test reactivity showed responses to: Dermatophagoides pt in 62 patients (90%), house dust in 57 (83%), cat in 41 (59%), dog in 23 (33%), and Lolium p in 16 (23%). The mean level of total IgE was of 378 UI (19 to 4,036) and that of specific IgE was of 39.2 UI (0.2 to 98.6). Total IgE > 200 UI was observed in fifty two patients (75%), which was significantly lesser than the frequency of specific IgE > 0.35 UI (at least for an allergen), which was 94% (p < 0.05, Z). At least two tests of skin reactivity were positive for 90% of the patients. This frequency was similar to the 95% for the specific IgE but different to the 75% for the total IgE (p < 0.05, X2). The correlation between the results of the skin test reactivity and the specific seric IgE showed Spearman r from 0.23 to 0.35 (p < 0.05). The correlation between the total IgE and the specific IgE showed a Spearman r of 0.08 (p < 0.05) and between the total IgE and the skin test reactivity an r of 0.15 (p < 0.05). CONCLUSION: In the diagnosis of perennial allergic rhinitis, the results of the skin test reactivity and the specific serum IgE are correlated but these two results are non consistent with the results of the total serum IgE.
Assuntos
Imunoglobulina E/sangue , Rinite Alérgica Perene/diagnóstico , Alérgenos/efeitos adversos , Animais , Animais Domésticos/imunologia , Especificidade de Anticorpos , Gatos , Criança , Cães , Feminino , Fungos/imunologia , Humanos , Masculino , Ácaros/imunologia , Pólen/efeitos adversos , Valor Preditivo dos Testes , Rinite Alérgica Perene/imunologia , Testes CutâneosRESUMO
BACKGROUND: For the assessment of nasal symptoms in allergic rhinitis patients, most of the questionnaires evaluate the impact of symptoms on patient's quality life. OBJECTIVE: To assess the consistent and reliability of a nasal symptom questionnaire in patients with allergic rhinitis. MATERIAL AND METHODS: 224 patients (10 to 19 years old) accepted to participate in the study. All the patients completed a questionnaire, which evaluates the severity and frequency of four nasal symptoms using a maximum total score of 12 points. The consistent was studied after the questionnaire was administered to 62 patients with allergic rhinitis and 62 patients without it. The reliability after one to four weeks was studied on 100 healthy subjects with the Bland and Altman's method. RESULTS: The total score of patients with allergic rhinitis was significantly different to the score of the patients without it (7.1 +/- 2 and 1.9 +/- 1, respectively). The alpha coefficient for the total score was 0.86. The repeated measures showed a repeatability of 96% with a repeatability coefficient of 2. CONCLUSION: The nasal symptom questionnaire is a reliable tool for the follow up of allergic rhinitis during periods of one to four weeks.