Rendimiento del Positron Emission Tomography/Computed Tomography (PET/CT) en etapificación de cáncer pulmonar / Positron emission tomography/computed tomography for lung cancer staging

Background: PET/CT (Positron Emission Tomography/Computed Tomography) is widely used in nodal and metastatic staging of lung cancer patients. Aim: To analyze PET/CT detection of metastatic disease in patients with lung cancer. Material and Methods: We reviewed retrospectively F18Fluorodeoxyglucose PET/CT scans performed between December 2008 and December 2013. We selected 143 patients aged 30 to 92 years (63% males) with confirmed lung cancer referred for staging, with no previous treatment. We reviewed whole body PET/CT and brain magnetic resonance images. SUVmax (Standardized Uptake Value maximum) of primary pulmonary lesion, hilar/mediastinal nodes, and distant metastases were calculated. Results: Histological types encountered were adenocarcinoma in 55%, squamous-cell in 15%, small-cell in 8%, large-cell in 6% and adeno-squamous in 2%. In 22 cases (15%) histology was not available. Nodal involvement was observed in 60% of patients (44% hilar and 48% mediastinal). Skip metastases (mediastinal involvement without hilum involvement) were encountered in 17% of cases, and were significantly more common among high uptake lung tumors (p < 0.01). Best SUVmax cut-off for node involvement was 4.4 for hilum and 4.0 for mediastinum (sensibility: 86.4%, specificity: 99.8%). Sixty six patients (46.2%) showed distant metastases on PET/CT. The most common metastases were osseous in 22%, adrenal in 16%, hepatic in14%, pulmonary in 14% and cerebral in 12%. PET/CT detected a second unexpected synchronic cancer in eight patients (6%). Conclusions: PET/CT is accurate for nodal staging using an uptake index as SUVmax. Distant metastases are common, especially in bone, adrenal glands and liver.

Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis

Bronchiectasis continues to be one of the major causes of morbidity and mortality in developing countries, with a probably underestimated higher prevalence than in developed countries. To assess the clinical profile of adult patients with bronchiectasis. We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography. Mean age of participants [45.7% males, 54.3% females] was 56 +/- 25 years and 65.8% of them were lifetime non-smokers. Most common identified causes of bronchiectasis were childhood disease [22.7%], tuberculosis [15.5%], and pneumonia [11.5%]. The predominant symptoms were productive cough [83.6%], dyspnea [72%], and hemoptysis [21.1%]. The most common findings on chest examination were crackles [71.1%] and rhonchi [28.3%]. Types of bronchiectasis were cylindrical in 47%, varicose in 9.9%, cystic in 45.1%, and multiple types in 24.3%. Involvement was multilobar in 75.3% and bilateral in 62.5%. Of 274 patients, 20.8% displayed normal pulmonary function test results, whereas 47.4%, 8% and 23.7% showed obstructive, restrictive, and mixed pattern, respectively. Patients with cystic disease had a higher frequency of hemoptysis [42%] and a greater degree of functional impairment, compared to other types. In patients with bronchiectasis from southern Turkey, generally presenting with recurrent productive cough, hemoptysis, dyspnea, and persistent bibasilar rales, the etiology remains mainly idiopathic. Post-infectious bronchial destruction is one of the major identified underlying pathological processes. The clinical picture and the deterioration of the pulmonary function test might be more severe in patients with cystic type bronchiectasis

Vitamin D status in pregnant Omanis. A disturbingly high proportion of patients with low vitamin D stores

The objective of this study was to determine the vitamin D status of pregnant Omanis by measurement of their circulating 25 hydroxy vitamin D levels. Blood samples were obtained from a cohort of 103 consecutive healthy pregnant Omanis at the Armed Forces Hospital, Muscat, on their first antenatal visit. The study took place in May, June and July 2010. Vitamin D deficiency was present in 34 [33%] of patients [25OHD3 <25 nmol/L], 'at risk' levels were found in 67 [65%] patients [25OHD3 25-50 nmol/L]; two patients [1.9%] had values between 50 and 75 nmol/L, and no patients in the optimal range >75 nmol/L. If confirmed, these findings indicate the need for vitamin D replacement during pregnancy and lactation. Although not evidence based we recommend at least 1000 IU of cholecalciferol, [vitamin D3] daily

Mortalidade materna de mulheres negras no Brasil / Maternal mortality among black women in Brazil

A cada minuto uma mulher morre no mundo em decorrência do trabalho de parto ou complicações da gravidez. A mortalidade materna configura-se no Brasil como um problema de saúde pública, atingindo desigualmente as várias regiões brasileiras. É consenso que a mulheres acometidas pela morte materna são as de menor renda e escolaridade. Juntamente com as questões sócio-econômicas, emerge a questão racial. A análise é difícil de ser realizada em virtude da dificuldade de entendimento da classificação raça/cor que muitas vezes impede o registro dessa informação. Vários Comitês de Morte Materna estão utilizando o quesito cor e revisando seus dados. Este artigo analisa vários relatórios de Comitês de Morte Materna, mostrando que o risco de mortalidade materna é maior entre as mulheres negras, o que inclui as pretas e pardas, configurando-se em importante expressão de desigualdade social. Ao final, apresenta-se uma revisão de recomendações para diminuição da Mortalidade Materna, enfatizando ações políticas e técnicas que possam contribuir para tal.

Every minute a woman dies in the world due to labor or complications of pregnancy. Maternal mortality is a public health problem in Brazil and affects the country's various regions unequally. Researchers agree that maternal death occurs mainly in women with lower income and less schooling. The racial issue emerges in the midst of socioeconomic issues. The analysis is hampered by the difficulty in understanding Brazil's official classification of race/color, which often impedes recording this information. Various Maternal Mortality Committees are applying the color item and reviewing their data. The current article analyzes various Maternal Mortality Committee reports, showing that the risk of maternal mortality is greater among black women (which encompasses two census categories, negra, or black, and parda, or brown), thus representing a major expression of social inequality. The article concludes with a review of political and technical recommendations to decrease maternal mortality.

La morbilidad y mortalidad materna en la altura en el Perú / The morbility and maternal mortality at high altitude in Peru

Dos indicadores importantes de la salud de un país son la morbilidad materna y la mortalidad materna, los que igualmente forman parte del riesgo reproductivo, poco estudiado en el Perú y en especial en aquellas zonas deprimidas socioeconómicamente como las de la sierra (altura) La vigilancia de la morbilidad y mortalidad maternas en la sierra de nuestro país permitirá identificar los factores de riesgo y establecer medidas de prevención y de control que permitan evitar muchas muertes maternas. El propósito de este artículo es evaluar la morbilidad y mortalidad materna en la altura del Perú. La mortalidad por complicaciones del embarazo, parto y puerperio es del 0.70 por ciento en la estructura de mortalidad general del país para los años 1980 a 1985. Los egresos hospitalarios para 1980-82 para aborto fue del 35 por ciento, parto obstruido 15 por ciento, hemorragia del embarazo y parto 6.1 por ciento, toxemia y complicaciones del puerperio 3.1 por ciento y otros 38 por ciento. Las tasas de egresos hospitalarios son mayores en la costa y selva que en la sierra, sin variación anual, siendo las principlaes causas de aborto, parto obstruído y hemorragia del embarazo y parto en las tres regiones. En cambio, las tasas de mortalidad materna son más altas en la sierra que en la selva y la costa, siendo las principales causas hemorragia del embarazo y parto; complicaiones del puerperio y por aborto. En conclusión, es necesario determinar la incidencia de la morbilidad y mortalidad materna para evaluar la magnitud del problema y determinar los factores de riesgo y establecer un sistema de vigilancia de estos indicadores de la salud reproductiva, buscando medidas de asociación y de impacto que permitan delinear políticas de salud en la siera del Perú.