Effects of Selective and Nonselective Beta Blockers on Bone Mineral Density in Mexican Patients with Breast Cancer.

Breast cancer (BCa) is related to chronic stress and can reduce the bone mineral density (BMD) through neurochemicals related to beta-adrenergic receptor (ADRB) 1 and 2. Selective beta blockers (sBBs) and nonselective beta blockers (nsBBs) are used to treat systemic arterial hypertension (SAH) and may have osteoprotective effects, as they inhibit ADRBs. To evaluate the effects of sBBs and nsBBs on the BMD of Mexican patients with BCa. A retrospective study was conducted. We included 191 Mexican women with BCa without SAH and with SAH treated with nsBBs, sBBs, and diuretics. BMD was evaluated using a bone density scan (DEX scan). A greater average BMD (p < 0.05) was observed in patients with prior treatment with both nsBBs and sBBs (0.54 ± 0.94 and -0.44 ± 1.22, respectively) compared to patients treated with diuretics or without SAH (-1.73 ± 0.83 and -1.22 ± 0.98, respectively). Regarding the diagnosis of osteoporosis/osteopenia, no cases were observed in patients treated with nsBBs, whereas 5.6% of the patients treated with sBBs presented osteopenia. A total of 23.1% and 10.6% patients managed with diuretics or without treatment presented with osteoporosis and 61.5% and 48% patients managed with loop diuretics and without treatment presented with osteopenia, respectively (p < 0.05). Treatment with nsBBs is a promising option for the prevention and management of osteoporosis/osteopenia in Mexican patients with BCa; however, further prospective studies are needed.

Sensitivity and Specificity of Computed Tomography in the Evaluation of Bone Mineral Density in Mexican Patients with Breast Cancer.

Introduction Breast cancer (BC) is the most frequently reported cancer among women - reported in 2012 as 25% of all cancers. BC has been related to the increased life and activity of osteoclasts, conferring a higher risk for osteoporosis/osteopenia. This study aimed to determine a cut-off point in Hounsfield units (HU) as well as the sensitivity and specificity of computed axial tomography (CT) in the diagnosis of osteoporosis/osteopenia in Mexican women with BC. Material and methods We included 108 patients with a histopathological diagnosis of BC treated at the ABC Medical Center in Mexico City. All patients were subjected to both dual X-ray densitometry and CT. The receiver operating characteristic (ROC) curve was used to identify the cutoff point and sensitivity and specificity were calculated, as were confidence intervals for the diagnoses of osteoporosis/osteopenia. Results The mean age was 58.49 ± 11.01 years. The cutoff point with the highest sensitivity (82%) and specificity (68%) was <157 HU for osteoporosis/osteopenia in patients with BC. Conclusions Women with BC are exposed to several risk factors for osteoporosis/osteopenia. The CT obtained for the general evaluation of these patients can also be used to evaluate bone mineral density, avoiding additional examinations and exposure to radiation, as well as the cost it confers, offering an earlier diagnosis of osteoporosis/osteopenia for its control.

Medición del grosor diafragmático como parámetro predictivo para retiro de ventilación mecánica invasiva en pacientes de terapia intensiva / Diaphragmatic thickness measurement as a predictive parameter for removal invasive mechanical ventilation in intensive care patients / Medida do espessamento diafragmático como um parâmetro de predição para a remoção da ventilação mecânica invasiva em pacientes em terapia intensiva

Resumen: Introducción: La medición del engrosamiento diafragmático y el cambio de grosor en espiración e inspiración del mismo pueden utilizarse para predecir el éxito o fracaso en la extubación. Se evaluó la fracción de grosor diafragmático (FGD) por ultrasonido en pacientes de terapia intensiva y se comparó con índice de ventilación rápida superficial (VRS). Métodos: Los 65 pacientes con ventilación mecánica invasiva fueron reclutados prospectivamente en el Departamento de Medicina Crítica del Centro Médico ABC en un periodo de nueve meses, de agosto de 2015 a abril de 2016. La FGD se midió en la zona de aposición del diafragma al tórax en ambos hemitórax, utilizando un transductor de ultrasonido 4 MHz y el médico radiólogo realizó el procedimiento en todos los pacientes sin conocimiento de patologías. Los pacientes reclutados fueron sometidos a una prueba de respiración espontánea (PRE) cuando se reunieron los siguientes criterios: FiO2 <50%, la PEEP ≤ 5 cm de H2O, PaO2/FiO2 > 200, frecuencia respiratoria < 30 por minuto, ausencia de fiebre, neurológicamente alerta y sin el apoyo hemodinámico de vasopresores. Se calculó el porcentaje de cambio en FGD, siendo el final de la inspiración y el final de la espiración entre el final de la espiración en pacientes con ventilación mecánica invasiva en modalidad de ventilación presión soporte con progresión ventilatoria con fines de extubación. El éxito en la extubación se definió como respiración espontánea > 48 horas sin soporte ventilatorio después del retiro de tubo endotraqueal. Resultados: De los 65 pacientes reclutados, 23 (35.4%) fueron mujeres y 42 (64.6%) hombres, índice de masa corporal (IMC), de 25.83 (DE ± 4.19) todos fueron extubados en modalidad de ventilación presión soporte. La frecuencia de falla en la extubación fue de 21.5% y la mortalidad de 24.6%. Las variables asociadas a fracaso fueron valores de corte de FGD derecho 25.9%, FGD 23.1% izquierdo. Tiempo de ventilación mecánica en días con mediana de 4 (RIQ 3-6) versus 8.5 (RIQ 7-11), p < 0.001 y VRS con 68.2 ± 9.6 versus 53.9 ± 11.1, p < 0.001. Las variables obtenidas a partir de las mediciones USG fueron las siguientes: grosor diafragmático derecho al final de la espiración (RTEEx) 0.28 ± 0.05 cm, grosor diafragmático derecho al final de la inspiración (RTEI) 0.21 ± 0.05 cm, índice de grosor diafragmático derecho (RDTi) 0.76 ± 0.11 cm, índice de fracción diafragmática derecha (RDFi) 23.1 ± 10.7%. El valor predictivo positivo y el valor predictivo negativo fueron de 92 y 64%, respectivamente. El área bajo la curva ROC fue de 0.79 para FGD. Conclusiones: Las mediciones de grosor diafragmático por ultrasonido tanto VRS como de tiempo de ventilación mecánica son un parámetro útil para predecir el éxito o el fracaso de la extubación. Índice de ventilación rápida superficial (VRS) con una media de 57.0 ± 12.3 puntos. Este estudio demuestra que no hay relación entre falla a la extubación con EPOC, IMC y edad. La extubación es un procedimiento conjunto y entre más parámetros para extubación menor riesgo de presentar falla.

bstract: Introduction: By measuring diaphragmatic thickening and thickness change in expiration and inspiration, it can be used as a measure to predict the success or failure of extubation. The fraction of diaphragmatic thickness (FDT) was assessed by ultrasound in intensive care patients. Methods: 65 patients with invasive mechanical ventilation were recruited prospectively at the Department of Critical Care Medicine ABC Medical Center. The FDT was measured in the area of apposition of the diaphragm to the chest in both hemithorax, using an ultrasound transducer of 4 MHz. Patients underwent a spontaneous breathing trial (SBT) when they met all the following criteria are: FiO2 < 50%, PEEP ≤ 5 cmH2O, PaO2/FiO2 > 200, respiratory rate < 30 per minute, absence of fever, neurologically alert and without hemodynamic vasopressor support. The percentage change in FDT was calculated between the end of expiration and end of inspiration in patients with invasive mechanical ventilation with pressure support ventilation mode, all patients with ventilatory progression purposes extubation. A successful extubation was defined as spontaneous breathing > 48 hours without ventilatory support after removal of the endotracheal tube. Results: We included data obtained from 65 patients, 23 (35.4%) women and 42 (64.6%) men, mean Body Mass Index (BMI) of 25.83 (SD ± 4.19). The frequency of extubation failure was 21.5%, and mortality 24.6%. The variables associated with failure were cut-off values of DTF right 25.9%, DTF 23.1% left. Time of mechanical ventilation in days with a median of 4 (RIQ 3-6) versus 8.5 (RIQ 7-11), p <0.001 and RSBI with 68.2 ± 9.6 versus 53.9 ± 11.1, p < 0.001. The variables obtained from USG measurements were as follows: right thickness at end expiration (RTEEx) 0.28 ± .05 cm, right thickness at end inspiration (RTEIs) 0.21 ± .05 cm, right diaphragmal thickness (RDTi) 0.76 ± 0.11 cm, right diaphragmatic fraction index (RDFi) 23.1 ± 10.7%. The positive predictive value and negative predictive value were 92 and 64%, respectively. The area under the ROC curve was 0.79 for DTF. Conclusions: Diaphragmatic thickness measurements by ultrasound can be a useful parameter to predict the success or failure of extubation during ventilatory progression in patients with invasive mechanical ventilation. Rapid shallow breathing index (RSBI) with a mean of 57.0 ± 12.3 points. This study demonstrates that there is no relation between failure to extubation with COPD, BMI and age. Extubation is a joint procedure and the more parameters for extubation, the lower the risk of failure.

Resumo: Introdução: Ao medir o espessamento do diafragma e a mudança da espessura na exalação e inalação da mesma, pode ser usado como uma medida para prever o sucesso ou a falha da extubação. Avaliou-se a fração de espessamento do diafragma (FED) por meio de ultra-som em doentes na terapia intensiva e se comparou com o índice de respiração superficial e rápida (IRRS). Métodos: Os 65 pacientes com ventilação mecânica invasiva foram recrutados no departamento de medicina crítica do Centro Médico ABC em um período de 9 meses, agosto de 2015 abril de 2016. A FED foi medida na zona de aposição do diafragma ao tórax, em ambos hemitórax, usando um transdutor de ultra-som de 4 MHz e realizou-se por um radiologista em todos os doentes, sem saber as patologias do paciente. Os pacientes recrutados foram submetidos a teste de respiração espontânea (TRE) quando os seguintes critérios foram reunidos: FiO2 < 50%, PEEP ≤ 5 cmH2O, PaO2/FiO2 > 200, frequência respiratória < 30 por minuto, afebril, neurologicamente alerta e sem suporte hemodinâmico de vasopressores. Calculou-se a percentagem de alteração na FED, sendo o final da inspiração e o final da expiração entre o final da expiração, em pacientes com ventilação mecânica invasiva em modo ventilação de pressão suporte com progressão ventilatória com fins de extubação. A extubação bem sucedida foi definida como espontâneos de respiração > 48 horas sem suporte ventilatório após a remoção do tubo endotraqueal. Resultados: Dos 65 pacientes recrutados, 23 (35.4%) mulheres e 42 (64.6%) homens, índice de massa corporal (IMC) de 25.83 (± SD 4.19) todos foram extubados no modo ventilação de pressão suporte. A frequência de falha na extubação foi de 21.5% e mortalidade de 24.6%. As variáveis associadas ao fracasso foram valores de corte da FED direito 25.9%, FED 23.1% esquerdo. Tempo de ventilação mecânica em dias com uma mediana de 4 (IQR 3-6) vs. 8.5 (IQR 7-11), p < 0.001 e VRS com 68.2 ± 9.6 vs 53.9 ± vs 11.1, p < 0.001. Conclusões: As medições da espessura diafragmática por ultra-som tanto de RSV como o tempo de ventilação mecânica é um parâmetro útil para prever o sucesso ou a falha da extubação. Este estudo demonstra que não há relação entre pacientes com EPOC, IMC, idade e falha na extubação. A extubação é um procedimento conjunto e entre mais parâmetros para extubação menor o risco de apresentar falha.