Lung cancer screening with low-dose CT integrated with pulmonary care in a public hospital in southern Brazil: results from the first 712 patients / Rastreamento de câncer de pulmão com TC de baixa dose integrada à assistência pulmonar em um hospital público no sul do Brasil: resultados dos primeiros 712 pacientes

ABSTRACT Objective: To describe the performance of a pulmonologist-led lung cancer screening program using low dose CT (LDCT) in a cohort of outpatients with stable respiratory diseases in the Brazilian public health care system. Methods: This was a retrospective analysis of the first two rounds of lung cancer screening of patients enrolled in the program. Inclusion criteria were being between 55 and 80 years of age, being a current or former smoker (smoking cessation ≤ 15 years), and having a smoking history ≥ 30 pack-years. LDCT results were interpreted in accordance with the Lung CT Screening Reporting and Data System, and those with a score of 3 or 4 were considered positive screening. Incidental pleuropulmonary findings were sought in all reports. Results: LDCTs were requested for 791 patients during the study period, and 712 patients (90%) met the screening criteria. The mean patient age was 63 years, and most participants were current smokers (56%) with emphysema (78.5%) and other pleuropulmonary findings on CT (64%). Screening was positive in 14.0% and 5.6% of the cases in the first and second screening rounds, respectively. Lung cancer was detected in 1.5% of the patients in both first and second rounds (positive predictive value: 11.0% and 26.6%, respectively). The rate of early-stage (TNM I or II) screen-detected non-small cell carcinoma was 64.3%. Of the patients with positive screening, 19% were lost to follow-up before investigation was complete. Conclusions: The results of this screening program suggest its adequate performance in a cohort of patients with significant respiratory morbidity. The loss to follow-up rate highlights the need for constant monitoring and interventions to ensure adherence.

RESUMO Objetivo: Descrever o desempenho de um programa de rastreamento de câncer de pulmão conduzido por pneumologistas usando TC de baixa dose (TCBD) em uma coorte de pacientes ambulatoriais com doença respiratória estável no sistema público de saúde brasileiro. Métodos: Análise retrospectiva das duas primeiras rodadas de rastreamento de câncer de pulmão em pacientes inscritos no programa. Os critérios de inclusão foram ter idade entre 55 e 80 anos, ser fumante atual ou ex-tabagista (cessação do tabagismo ≤ 15 anos) e carga tabágica ≥ 30 anos-maço. Os resultados do TCBD foram interpretados de acordo com o Lung CT Screening Reporting and Data System, e aqueles com pontuação 3 ou 4 foram considerados exames positivos. Achados pleuropulmonares incidentais foram verificados em todos os relatórios. Resultados: TCBD foram solicitadas para 791 pacientes durante o período do estudo, e 712 pacientes (90%) preencheram os critérios de rastreamento. A média de idade dos pacientes foi de 63 anos, e a maioria dos participantes era fumante atual (56%) com enfisema (78,5%) e outros achados pleuropulmonares na TC (64%). O rastreamento foi positivo em 14,0% e 5,6% dos casos na primeira e segunda rodada, respectivamente. O câncer de pulmão foi detectado em 1,5% dos pacientes tanto na primeira quanto na segunda rodada (valor preditivo positivo: 11,0% e 26,6%, respectivamente). A taxa de carcinoma de células não pequenas detectado em estágio inicial (TNM I ou II) foi de 64,3%. Dos pacientes com rastreamento positivo, 19% foram perdidos no seguimento antes da conclusão da investigação. Conclusões: Os resultados deste programa de rastreamento sugerem um desempenho adequado em uma coorte de pacientes com morbidades respiratórias significativas. A taxa de perda de seguimento destaca a necessidade de monitoramento constante e intervenções para garantir a adesão.

Percutaneous ethanol injection versus conservative treatment for benign cystic and mixed thyroid nodules

ABSTRACT Objective To evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in reducing the volume of cystic and mixed thyroid nodules. Materials and methods A total of 36 patients with nodules treated with PEI and 13 individuals who declined PEI and were followed clinically or received other non surgical treatment (control group). Assessments were performed at baseline (immediately before treatment in the PEI group or evaluation of the nodule on ultrasonography in the control group) at short-term (on average 30 days after the last injection in the PEI group), and long-term (on average 14 months after baseline in the PEI group or 26 months after baseline in the control group). Results In the PEI group, the mean baseline volume of 10.4 ± 9.8 cm3 reduced at short-term follow-up to 2.9 ± 3.1 cm3 (67.7 ± 19.9%, p < 0.001) and at long-term follow-up to 2.0 ± 2.5 cm3 (78.2 ± 19.5%, p < 0.01 versus baseline and p = 0.009 versus short-term follow-up). Both types of nodules showed similar degrees of reduction. In the control group, mean volume was 5.8 ± 3.4 cm3 at baseline and 6.2 ± 3.0 cm3 at long-term follow-up (p = 0.507). Compared with the control group, the PEI group showed larger reduction (p < 0.001). Conclusions PEI is effective in reducing the volume of cystic and mixed benign thyroid nodules, with sustained long-term efficacy and better outcome when compared with conservative therapies. Treatment with PEI is a safe alternative, with minimal, transient and self-limited adverse events.

Clinical variables associated with depression in patients with type 2 diabetes / Características clínicas associadas à depressão em pacientes com diabetes tipo 2

SummaryBackground:the aim of the study was to evaluate the relationship between type 2 diabetes (T2DM), depression and depressive symptoms and their clinical impact on T2DM.Methods:the authors evaluated 214 outpatients, 105 with diabetes (T2DM group) and 109 non-diabetics (control group), with ages ranging between 50 and 75 years (T2DM group 65.1 ± 5.6 years, control group 63.4 ± 5.8 years). Use of antidepressant treatment or score ≥ 16 on the Beck depression inventory (BDI) was considered depression. Complications of diabetes and total symptom score (TSS) for peripheral neuropathy were reported by patients.Results:diabetes group had a higher frequency of depression (35.2%) compared to controls (21.1%) (p=0,021), with 2.4 times increased risk of depression. The presence of depressive symptoms was also higher in T2DM group (mean BDI 9.5 ± 8.8 versus 6.9 ± 6.2; p=0.039). Symptoms of diabetic neuropathy were higher in depressed subjects. The metabolic control and presence of complications in T2DM group were not associated with depression.Conclusion:T2DM led to an increased risk of depression, but this did not influence the metabolic control or the presence of other complications.

ResumoObjetivo:avaliar a relação entre diabetes mellitus tipo 2 (DM2), depressão e sintomas depressivos e seu impacto no controle clínico do DM2.Métodos:foram avaliados 214 pacientes ambulatoriais, 105 com DM2 e 109 não diabéticos, com idade entre 55 e 75 anos (grupo DM2 65,1±5,6 anos e grupo controle 63,4±5,8 anos). Considerou-se depressão o uso de tratamento antidepressivo ou escore ≥16 no inventário de Beck (BDI). Complicações do DM2 e escore total de sintomas (TSS) para neuropatia periférica foram questionados aos pacientes.Resultados:o grupo DM2 apresentou maior frequência de depressão (35,2%) em relação aos controles (21,1%) (p=0,021), com um risco 2,4 vezes maior de apresentar depressão. A presença de sintomas depressivos também foi superior no grupo DM2 (média BDI 9,5±8,8 versus 6,9±6,2; p=0,039). Os sintomas de neuropatia diabética foram superiores nos depressivos. O controle metabólico e a presença de complicações no grupo DM2 não foram associados à depressão.Conclusão:o DM2 determinou um maior risco de depressão; porém, essa associação não influenciou o controle metabólico e a presença de outras complicações da doença.