Correction: Evaluation of community based surveillance in the Rohingya refugee camps in Cox's Bazar, Bangladesh, 2019.

[This corrects the article DOI: 10.1371/journal.pone.0244214.].

Innovación en el control gubernamental en la atención de denuncias ciudadanas: Una revisión bibliográfica

R E S U M E N El artículo tiene como objetivo mostrar un análisis conciso de la importancia, dimensiones y relaciones de la innovación en el control gubernamental y la gestión de las denuncias ciudadanas, presente en revistas científicas y publicaciones de entidades como OLACEFS y diversas Contralorías, desde el 2018 al 2022. Para ello, se desarrolló una investigación no experimental, descriptiva y transversal; basada en una revisión bibliográfica en Redalyc, Scielo y Scopus, sobre artículos científicos relacionados a las variables mencionadas, obteniendo 53 publicaciones. Dentro de los principales resultados se encuentra la relación de herramientas de innovación con las variables de control gubernamental y denuncias ciudadanas, obteniendo 22 temáticas, siendo transversal el uso de TIC. Finalmente, se concluyó que la innovación es una variable relacionada con el control gubernamental y la gestión pública, contemplando la gestión de denuncias ciudadanas. Si bien es cierto que, no hay investigaciones puntuales que relacionen estas variables, hay muchas publicaciones que usan términos como TIC, innovación o gobierno abierto para mantener una correlación; contemplando a la participación ciudadana como parte del control social que ayuda al control gubernamental.

A B S T R A C T The article aims to show a concise analysis of innovation's importance, dimensions, and relationships in government control and the management of citizen complaints, present in scientific journals and publications of entities such as OLACEFS and various Comptrollerships, from 2018 to 2022. For this, a non-experimental, descriptive, and cross-sectional investigation was developed; based on a bibliographic review in Redalyc, Scielo, and Scopus, of scientific articles related to the mentioned variables, obtaining 53 publications. Among the main results is the relationship of innovation tools with the variables of government control and citizen complaints, getting 22 themes, the use of ICT being transversal. Finally it was concluded that innovation is a variable related to government control and public management, contemplating the direction of citizen complaints. Although it is true that there is no specific research that relates these variables, there are many publications that use terms such as ICT, innovation, or open government to maintain a correlation; contemplating citizen participation as part of the social control that helps government control.

O artigo tem como objetivo mostrar uma análise concisa da importância, dimensões e relações da inovação no controle governamental e na gestão das reclamações cidadãs, presentes em revistas científicas e publicações de entidades como a OLACEFS e diversas Controladorias, no período de 2018 a 2022. Para isso, desenvolveu-se uma investigação não experimental, descritiva e transversal; baseado em revisão bibliográfica em Redalyc, Scielo e Scopus, em artigos científicos relacionados às variáveis mencionadas, obtendo 53 publicações. Entre os principais resultados está a relação das ferramentas de inovação com as variáveis de controle governamental e reclamações cidadãs, obtendo-se 22 temas, sendo o uso das TIC transversal. Por fim, concluiu-se que a inovação é uma variável relacionada ao controle governamental e à gestão pública, contemplando o gerenciamento das reclamações cidadãs. Embora seja verdade que não há pesquisas específicas que relacionem essas variáveis, existem muitas publicações que usam termos como TIC, inovação ou governo aberto para manter uma correlação; contemplar a participação cidadã como parte do controle social que auxilia o controle governamental.

Atomic layer deposition of vanadium oxide films for crystalline silicon solar cells.

Transition metal oxides (TMOs) are promising materials to develop selective contacts on high-efficiency crystalline silicon solar cells. Nevertheless, the standard deposition technique used for TMOs is thermal evaporation, which could add potential scalability problems to industrial photovoltaic fabrication processes. As an alternative, atomic layer deposition (ALD) is a thin film deposition technique already used for dielectric deposition in the semiconductor device industry that has a straightforward up scalable design. This work reports the results of vanadium oxide (V2O5) films deposited by ALD acting as a hole-selective contact for n-type crystalline silicon (c-Si) solar cell frontal transparent contact without the additional PECVD passivating layer. A reasonable specific contact resistance of 100 mΩ cm2 was measured by the transfer length method. In addition, measurements suggest the presence of an inversion layer at the c-Si/V2O5 interface with a sheet resistance of 15 kΩ sq-1. The strong band bending induced at the c-Si surface was confirmed through capacitance-voltage measurements with a built-in voltage value of 683 mV. Besides low contact resistance, vanadium oxide films provide excellent surface passivation with effective lifetime values of up to 800 µs. Finally, proof-of-concept both-side contacted solar cells exhibit efficiencies beyond 18%, shedding light on the possibilities of TMOs deposited by the atomic layer deposition technique.

Evaluation of community based surveillance in the Rohingya refugee camps in Cox's Bazar, Bangladesh, 2019.

BACKGROUND: Following an influx of an estimated 742,000 Rohingya refugees in Bangladesh, Médecins sans Frontières (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox's Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019). METHODS: Suspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability. RESULTS: Between epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability. DISCUSSION: The CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox's Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.

Microstructural Effects of Sulphate Attack in Sustainable Grouts for Micropiles.

Nowadays, the use of micropiles has undergone a great development. In general, they are made with cement grout, reinforced with steel tubing. In Spain, these grouts are prepared using OPC, although the standards do not forbid the use of other cements, like sustainable ones. Micropiles are in contact with soils and groundwater, in which the presence of sulphates is common. Their deleterious effects firstly affect to the microstructure. Then, the aim of this research is to study the effects of sulphate attack in the microstructure of micropiles grouts, prepared with OPC, fly ash and slag commercial cements, compared to their behaviour when they are exposed to an optimum hardening condition. The microstructure evolution has been studied with the non-destructive impedance spectroscopy technique, which has never been used for detecting the effects of sulphate attack when slag and fly ash cements are used. Its results have been contrasted with mercury intrusion porosimetry and "Wenner" resistivity ones. The 28-day compressive strength of grouts has been also determined. The results of microstructure characterization techniques are in agreement, although impedance spectroscopy is the most sensitive for following the changes in the porous network of grouts. The results showed that micropiles made using fly ash and slag cements could have a good performance in contact with aggressive sodium sulphate media, even better than OPC ones.

Surface passivation and optical characterization of Al2O3/a-SiCx stacks on c-Si substrates.

The aim of this work is to study the surface passivation of aluminum oxide/amorphous silicon carbide (Al2O3/a-SiCx) stacks on both p-type and n-type crystalline silicon (c-Si) substrates as well as the optical characterization of these stacks. Al2O3 films of different thicknesses were deposited by thermal atomic layer deposition (ALD) at 200 °C and were complemented with a layer of a-SiCx deposited by plasma-enhanced chemical vapor deposition (PECVD) to form anti-reflection coating (ARC) stacks with a total thickness of 75 nm. A comparative study has been carried out on polished and randomly textured wafers. We have experimentally determined the optimum thickness of the stack for photovoltaic applications by minimizing the reflection losses over a wide wavelength range (300-1200 nm) without compromising the outstanding passivation properties of the Al2O3 films. The upper limit of the surface recombination velocity (S eff,max) was evaluated at a carrier injection level corresponding to 1-sun illumination, which led to values below 10 cm/s. Reflectance values below 2% were measured on textured samples over the wavelength range of 450-1000 nm.

Endobacter medicaginis gen. nov., sp. nov., isolated from alfalfa nodules in an acidic soil.

A bacterial strain designated M1MS02(T) was isolated from a surface-sterilized nodule of Medicago sativa in Zamora (Spain). The 16S rRNA gene sequence of this strain showed 96.5 and 96.2 % similarity, respectively, with respect to Gluconacetobacter liquefaciens IFO 12388(T) and Granulibacter bethesdensis CGDNIH1(T) from the family Acetobacteraceae. The novel isolate was a Gram-stain-negative, non-sporulating, aerobic coccoid to rod-shaped bacterium that was motile by a subpolar flagellum. The major fatty acid was C18 : 1ω7c and the major ubiquinone was Q-10. The lipid profile consisted of diphosphatidylglycerol, phosphatidylethanolamine, two aminophospholipids, three aminolipids, four glycolipids, two phospholipids and one lipid. Strain M1MS02(T) was catalase-positive and oxidase- and urease-negative. Acetate and lactate were not oxidized. Acetic acid was produced from ethanol in culture media supplemented with 2 % CaCO3. Ammonium sulphate was assimilated in glucose medium. The strain produced dihydroxyacetone from glycerol. Phylogenetic and phenotypic analyses commonly used to differentiate genera within the family Acetobacteraceae showed that strain M1MS02(T) should be classified as representing a novel species of a new genus within this family, for which the name Endobacter medicaginis gen. nov., sp. nov. is proposed. The type strain of the type species is M1MS02(T) ( = LMG 26838(T) = CECT 8088(T)). To our knowledge, this is the first report of a member of the Acetobacteraceae occurring as a legume nodule endophyte.

Toxicidad pulmonar por metenolona: a propósito de un caso / Pulmonary toxicity due to Methenolone: a Case Report

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Ventilación mecánica domiciliaria: dependencia y carga de cuidados en el domicilio / Home Mechanical Ventilation: Dependency and Burden of Care in the Home

IntroducciónLa ventilación mecánica domiciliaria (VMD) aumenta la supervivencia en grupos seleccionados de pacientes, pero se asocia a dependencia progresiva para las actividades básicas y muchos pacientes necesitarán cuidadores informales en su domicilio. Éstos asumen una carga de trabajo que puede tener repercusiones económicas, físicas y/o psíquicas. Nuestro objetivo has sido estudiar a pacientes con VMD y dependencia, y describir el impacto sobre sus cuidadores.Pacientes y métodosEn noviembre de 2007 estudiamos de forma descriptiva y transversal a pacientes con un mínimo de 6 meses en VMD, en situación estable. Se identificó a los dependientes aplicando el índice de Katz (índice C y superiores). En este grupo se estudiaron variables socioeconómicas, de comorbilidad y de necesidad de cuidados. Para establecer la sobrecarga del cuidador se aplicó el índice de Zarit.ResultadosDe los 66 pacientes incluidos, 20 (30%) mostraban dependencia (edad media±desviación estándar: 60±12 años; 46% mujeres), llevaban una media de 45 meses en VMD y el 40% recibía ventilación durante más de 12h al día. Entre los cuidadores, el 58% era cuidador único, la mayoría eran mujeres (77%), la edad media era de 51 años y un 70% trabajaba además fuera del domicilio. El índice de Zarit en 7 casos (35%) era superior a 40.ConclusionesEn nuestra serie, una tercera parte de los pacientes precisan cuidadores informales para poder permanecer en su entorno. El cuidador es mayoritariamente del sexo femenino, y un tercio tiene sobrecarga real o corre el riesgo de presentarla. Para adecuar la asistencia a este colectivo harán falta cambios que impliquen a los médicos y a la Administración sanitaria(AU)

BackgroundWhile home mechanical ventilation (HMV) prolongs survival in selected groups of patients, its use is associated with progressive dependency in basic activities, and many users will require informal care in their homes. The workload assumed by the informal caregivers can have financial, physical, and psychological repercussions. Our objective was to study dependent patients on HMV, and to describe the impact of the situation on their caregivers.Patients and MethodsIn November 2007, we undertook a descriptive cross-sectional study of patients in stable condition who had been receiving HMV for at least 6 months. Using the Katz index, we identified dependent patients (class C and higher). In this group we studied social and economic variables, comorbidity, and need for care. The Zarit interview was used to evaluate the caregiver burden.ResultsOf the 66 patients enrolled, 20 (30%) were dependent. The mean (SD) age in this group was 60 (12) years and 46% were women. These patients had been on HMV for a mean of 45 months, and 40% were using ventilatory support for over 12 hours per day. Care was provided by women in the majority of cases (77%), and 58% were sole caregivers. The mean age of these carers was 51 years, and 70% of them also worked outside the home. In 7 cases (35%), the caregiver scored over 40 on the Zarit index.ConclusionsOne third of the patients required informal care in order to remain in their homes. Most of the caregivers were women, and one third were overburdened or were at risk of becoming so. Changes involving both physicians and the health authorities are needed to provide satisfactory care to this group of patients(AU)

[Home mechanical ventilation: dependency and burden of care in the home]. / Ventilación mecánica domiciliaria: dependencia y carga de cuidados en el domicilio.

BACKGROUND: While home mechanical ventilation (HMV) prolongs survival in selected groups of patients, its use is associated with progressive dependency in basic activities, and many users will require informal care in their homes. The workload assumed by the informal caregivers can have financial, physical, and psychological repercussions. Our objective was to study dependent patients on HMV, and to describe the impact of the situation on their caregivers. PATIENTS AND METHODS: In November 2007, we undertook a descriptive cross-sectional study of patients in stable condition who had been receiving HMV for at least 6 months. Using the Katz index, we identified dependent patients (class C and higher). In this group we studied social and economic variables, comorbidity, and need for care. The Zarit interview was used to evaluate the caregiver burden. RESULTS: Of the 66 patients enrolled, 20 (30%) were dependent. The mean (SD) age in this group was 60 (12) years and 46% were women. These patients had been on HMV for a mean of 45 months, and 40% were using ventilatory support for over 12 hours per day. Care was provided by women in the majority of cases (77%), and 58% were sole caregivers. The mean age of these carers was 51 years, and 70% of them also worked outside the home. In 7 cases (35%), the caregiver scored over 40 on the Zarit index. CONCLUSIONS: One third of the patients required informal care in order to remain in their homes. Most of the caregivers were women, and one third were overburdened or were at risk of becoming so. Changes involving both physicians and the health authorities are needed to provide satisfactory care to this group of patients.

[Tobacco smoking and sputum smear conversion in pulmonary tuberculosis]. / Tabaquismo y negativización bacteriológica del esputo en la tuberculosis pulmonar.

BACKGROUND AND OBJECTIVE: To analyze if cigarette smoking delays the sputum smear conversion in pulmonary tuberculosis. PATIENTS AND METHOD: Ninety eight patients were diagnosed with pulmonary tuberculosis. Patients were all not immunosuppressed, infected by human immunodeficiecy virus (HIV) or drug resistant. Sixty four of them were smokers with a pack-year index (standard deviation) of 33.69 (23.12). Delayed sputum smear conversion (DC) was considered when 2 positive sputum culture results were obtained in the second month of anti-tuberculous treatment and was associated with the following variables in 2 groups: a) total group (in which all the patients were included): age, sex, smoking habits, risk factors (alcohol consumption, diabetes mellitus, immunosuppression, drug addicion, malnutrition), time with symptoms, radiologic presentation and bacterial load, and b) smokers: age, sex, risk factors, time with symptoms, radiologic presentation, bacterial load and pack-year index. For the statistical analysis, chi2 test, Student t test and logistic regression model were used, considering the dependant variable DC. RESULTS: In the total group, 17 patients (17.3%) had DC, 16 of them had a history of smoking and in the univariate analysis it was associated with: alcohol consumption, time with symptoms, radiologic presentation as bilateral cavitary infiltrates and smoking habits. The logistic regression analysis showed an association with smoking habits (odds ratio = 9.8; p = 0.03) and bilateral cavitary infiltrates (odds ratio = 3.61; p = 0.02). In the group of smokers, DC was associated in the univariate analysis with the female sex. CONCLUSIONS: Smoking habits delay sputum conversion in patients with pulmonary tuberculosis not associated with HIV and non-resistant bacilli. According to these results it is necessary to assist smoking cessation in patients who are receiving antituberculous treatment.

Tabaquismo y negativización bacteriológica del esputo en la tuberculosis pulmonar / Tobacco smoking and sputum smear conversion in pulmonary tuberculosis

FUNDAMENTO Y OBJETIVO: Analizar si el consumo de tabaco retrasa la negativización microbiológicaen la tuberculosis pulmonar.PACIENTES Y MÉTODO: Se incluyó a 98 pacientes diagnosticados de tuberculosis pulmonar, sin inmunodepresióncausada por el virus de la inmunodeficiencia humana (VIH) ni resistencia farmacológica.Eran fumadores 64, con un índice medio (desviación estándar) de 33,69 (23,12)paquetes/año. Se consideró conversión bacteriológica retardada (CR) a la persistencia de 2 cultivospositivos al segundo mes del inicio del tratamiento antituberculoso, y se relacionó con lassiguientes variables en 2 grupos: a) general (que englobaba a todos los pacientes): edad, sexo,tabaquismo, factores de riesgo (consumo de alcohol, diabetes mellitus, inmunodepresión, adiccióna drogas, desnutrición), tiempo de evolución de los síntomas, presentación radiológica ycarga bacilar, y b) fumadores: edad, sexo, índice paquetes/año, factores de riesgo, tiempo deevolución de los síntomas, presentación radiológica y carga bacilar. En cuanto al estudio estadístico,se realizaron los siguientes análisis: distribución de la χ2, prueba de la t de Student yregresión logística paso a paso hacia adelante, considerando como variable dependiente la CR.RESULTADOS: En el grupo general presentaron CR 17 pacientes (17,3%), de los que 16 referíanantecedentes de tabaquismo, y en el estudio univariado la CR se relacionó con el consumo dealcohol, el tiempo de evolución de los síntomas, la presentación radiológica cavitaria bilateral yel tabaquismo. En el análisis de regresión logística mantenían la relación el tabaquismo (oddsratio = 9,80; p = 0,03) y la cavitación bilateral (odds ratio = 3,61; p = 0,02). En el grupo defumadores, la CR se asoció en el análisis univariado únicamente con sexo femenino.CONCLUSIONES: El tabaquismo retrasa la CR en pacientes diagnosticados de tuberculosis pulmonarno ligada al VIH y con aislamientos sensibles. Dada la trascendencia de este hallazgo, espreciso reforzar su abandono durante el tratamiento antituberculoso

BACKGROUND AND OBJECTIVE: To analyze if cigarette smoking delays the sputum smear conversionin pulmonary tuberculosis.PATIENTS AND METHOD: Ninety eight patients were diagnosed with pulmonary tuberculosis. Patientswere all not immunosuppressed, infected by human immunodeficiecy virus (HIV) or drugresistant. Sixty four of them were smokers with a pack-year index (standard deviation) of 33.69(23.12). Delayed sputum smear conversion (DC) was considered when 2 positive sputum cultureresults were obtained in the second month of anti-tuberculous treatment and was associatedwith the following variables in 2 groups: a) total group (in which all the patients were included):age, sex, smoking habits, risk factors (alcohol consumption, diabetes mellitus, immunosuppression,drug addicion, malnutrition), time with symptoms, radiologic presentation andbacterial load, and b) smokers: age, sex, risk factors, time with symptoms, radiologic presentation,bacterial load and pack-year index. For the statistical analysis, χ2 test, Student t test andlogistic regression model were used, considering the dependant variable DC.RESULTS: In the total group, 17 patients (17.3%) had DC, 16 of them had a history of smokingand in the univariate analysis it was associated with: alcohol consumption, time with symptoms,radiologic presentation as bilateral cavitary infiltrates and smoking habits. The logistic regressionanalysis showed an association with smoking habits (odds ratio = 9.8; p = 0.03) andbilateral cavitary infiltrates (odds ratio = 3.61; p = 0.02). In the group of smokers, DC was associatedin the univariate analysis with the female sex.CONCLUSIONS: Smoking habits delay sputum conversion in patients with pulmonary tuberculosisnot associated with HIV and non-resistant bacilli. According to these results it is necessary toassist smoking cessation in patients who are receiving antituberculous treatment

[Treatment and course of community-acquired pneumonia caused by atypical pathogens]. / Neumonía adquirida en la comunidad por gérmenes atípicos: tratamiento y evolución.

OBJECTIVE: To study the course of disease and outcomes in a group of patients with community-acquired pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella species ,Coxiella burnetii, and Chlamydophila pneumoniae) according to the empiric treatment received. PATIENTS AND METHODS: Of a total of 390 patients admitted to our hospital with pneumonia between January 1996 and February 2001, the causative microorganism was an atypical pathogen in 89 cases. Patients were divided retrospectively into 2 groups according to the empiric treatment they received: group A, who had received an antibiotic regime (quinolones or macrolides) that provided coverage for atypical pathogens; and group B, who had received treatment that did not provide such coverage. Clinical course was assessed in terms of the differences between the 2 groups in length of hospital stay, radiographic resolution, readmission at 30 days after discharge, and mortality. RESULTS: A total of 89 patients with pneumonia caused by atypical pathogens (39 in group A and 50 in group B) were studied. No significant between-group differences in the variables were found. CONCLUSIONS: In this group of patients hospitalized for community-acquired pneumonia, antibiotic regimens providing coverage for atypical pathogens did not improve either clinical or radiographic evolution.

Neumonía adquirida en la comunidad por gérmenes atípicos: tratamiento y evolución / Treatment and course of community-acquired pneumonia caused by atypical pathogens

Objetivo: Estudiar la evolución de un grupo de neumonías extrahospitalarias causadas por gérmenes atípicos (Mycoplasma pneumoniae, Legionella spp. ,Coxiella burnetii y Chlamydophila pneumoniae) en función del tratamiento empírico recibido. Pacientes y métodos: Entre enero de 1996 y febrero de 2001 ingresaron en nuestra unidad 390 casos de neumonía, de los que 89 estaban causados por gérmenes atípicos. Los pacientes se dividieron retrospectivamente en 2 grupos según el tratamiento empírico pautado: grupo A, al que se había proporcionado cobertura frente a gérmenes atípicos (quinolonas o macrólidos), y grupo B, al que no se había proporcionado dicha cobertura. Se estudió la evolución según las diferencias entre ambos grupos en la estancia hospitalaria, la resolución radiológica, el reingreso en el primer mes tras el alta y la mortalidad. Resultados: El grupo de estudio lo constituyeron 89 pacientes con neumonía causada por gérmenes atípicos (39 en el grupo A y 50 en el B). Las variables estudiadas no mostraron diferencias significativas entre ambos grupos. Conclusiones: En nuestra serie de neumonías extrahospitalarias la cobertura antibiótica frente a gérmenes atípicos no mejoró la evolución clínica y radiológica de los pacientes

Objective: To study the course of disease and outcomes in a group of patients with community-acquired pneumonia caused by atypical pathogens (Mycoplasma pneumoniae, Legionella species ,Coxiella burnetii, and Chlamydophila pneumoniae) according to the empiric treatment received. Patients and methods: Of a total of 390 patients admitted to our hospital with pneumonia between January 1996 and February 2001, the causative microorganism was an atypical pathogen in 89 cases. Patients were divided retrospectively into 2 groups according to the empiric treatment they received: group A, who had received an antibiotic regime (quinolones or macrolides) that provided coverage for atypical pathogens; and group B, who had received treatment that did not provide such coverage. Clinical course was assessed in terms of the differences between the 2 groups in length of hospital stay, radiographic resolution, readmission at 30 days after discharge, and mortality. Results: A total of 89 patients with pneumonia caused by atypical pathogens (39 in group A and 50 in group B) were studied. No significant between-group differences in the variables were found. Conclusions: In this group of patients hospitalized for community-acquired pneumonia, antibiotic regimens providing coverage for atypical pathogens did not improve either clinical or radiographic evolution

[Chemotherapy and survival in advanced non-small cell lung carcinoma: is pneumologists' skepticism justified?]. / Quimioterapia y supervivencia en el carcinoma broncogénico no microcítico en estadios avanzados: 'está justificado el nihilismo de los neumólogos?

OBJECTIVE: Few studies have assessed whether the advantage chemotherapy has been shown to have in treating advanced non-small lung carcinoma in clinical trials is transferrable to normal health care activity. This could explain the skepticism of a large number of pneumologists towards this treatment. The objective of our study was to analyze prognostic factors related to survival and to see whether cytostatic treatment was an independent predictor. PATIENTS AND METHODS: Patients enrolled in the study had been diagnosed with non-small cell carcinoma in stages IV or IIIB with pleural or N2-N3 involvement and with a performance status of 2 or below according to the Eastern Cooperative Oncology Group (ECOG). Survival was analyzed with regard to the following variables: age, sex, comorbidity, weight loss, laboratory test results, histological type, ECOG score, TNM staging, and treatment. The Student t test, the chi(2) test, the Kaplan-Meier method, the log-rank test, and Cox regression analysis were used in the statistical analysis. RESULTS: We enrolled 190 patients (157 men and 33 women) with a mean (SD) age of 61.75 (10.85) years (range, 33-85 years). Of these patients, 144 received cytostatic treatment and 46 palliative treatment. The median survival was 31 weeks and was related to absence of weight loss (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.26-2.39; P=.001), cytostatic treatment (HR, 1.85; 95% CI, 1.25-2.76; P=.002), and ECOG score of 0 to 1 (HR, 2.84; 95% CI, 1.62-5.00; P=.0001). In patients with ECOG scores of 0 to 1, weight loss and treatment were significant prognostic factors. Survival in the ECOG 2 group was 15 weeks for patients undergoing cytostatic treatment and 11 weeks for patients with symptomatic treatment. CONCLUSIONS: In normal clinical practice, chemotherapy significantly prolongs survival in patients with performance status of less than 2, more time being gained if there is no associated weight loss. We conclude that the reluctance shown by many pneumologists toward using this treatment is not entirely justified.

Quimioterapia y supervivencia en el carcinoma broncogénico no microcítico en estadios avanzados: ¿está justificado el nihilismo de los neumólogos? / Chemotherapy and survival in advanced non-small cell lung carcinoma: is pneumologists' skepticism justified?

Objetivo: Pocas series han valorado si el beneficio que en los ensayos clínicos muestra la quimioterapia en el carcinoma broncogénico no microcítico en estadios avanzados es trasladable a la actividad asistencial habitual, lo que podría explicar el escepticismo de gran parte de los neumólogos. En este contexto, el objetivo de nuestro trabajo es analizar factores pronósticos relacionados con la supervivencia y si el tratamiento citostático influye de manera independiente. Pacientes y métodos: Se incluyó a pacientes diagnosticados de carcinoma no microcítico en estadios IV y IIIb con afectación pleural o N2-N3 y grado de actividad, según el Eastern Cooperative Oncology Group (ECOG), menor o igual a 2. Se relacionaron con la supervivencia las siguientes variables: edad, sexo, comorbilidad, pérdida de peso, parámetros analíticos, tipo histológico, ECOG, TNM y tratamiento. Para el análisis estadístico se emplearon las pruebas de la t de Student, de la χ2, el método de Kaplan-Meier, el test de rangos logarítmicos y el modelo de regresión de Cox. Resultados: Se incluyó en el estudio a 190 enfermos (157 varones y 33 mujeres), con una edad media (± desviación estándar) de 61,75 ± 10,85 años (rango: 33-85), de los cuales 144 recibieron tratamiento citostático y 46 paliativo. La mediana de supervivencia fue de 31 semanas y se relacionó con: ausencia de pérdida de peso (razón de probabilidad [HR] = 1,73; intervalo de confianza [IC] del 95%, 1,26-2,39; p = 0,001), tratamiento citostático (HR = 1,85; IC del 95%, 1,25-2,76; p = 0,002) y ECOG 0-1 (HR = 2,84; IC del 95%, 1,62-5,00; p = 0,0001). En el grupo ECOG 0-1 mostraban significado pronóstico la pérdida de peso y el tratamiento. La supervivencia en ECOG 2 fue de 15 semanas en los pacientes con tratamiento citostático y de 11 semanas en aquellos con tratamiento sintomático. Conclusiones: En la práctica clínica habitual la quimioterapia prolonga la supervivencia significativamente en los pacientes con grado de actividad inferior a 2 y esta ganancia es mayor si no existe pérdida de peso asociada. Por tanto, creemos que la opinión poco favorable que muestra gran parte de los neumólogos acerca de este tratamiento no parece plenamente justificada

Objective: Few studies have assessed whether the advantage chemotherapy has been shown to have in treating advanced non-small lung carcinoma in clinical trials is transferrable to normal health care activity. This could explain the skepticism of a large number of pneumologists towards this treatment. The objective of our study was to analyze prognostic factors related to survival and to see whether cytostatic treatment was an independent predictor. Patients and methods: Patients enrolled in the study had been diagnosed with non-small cell carcinoma in stages IV or IIIB with pleural or N2-N3 involvement and with a performance status of 2 or below according to the Eastern Cooperative Oncology Group (ECOG). Survival was analyzed with regard to the following variables: age, sex, comorbidity, weight loss, laboratory test results, histological type, ECOG score, TNM staging, and treatment. The Student t test, the χ2 test, the Kaplan-Meier method, the log-rank test, and Cox regression analysis were used in the statistical analysis. Results: We enrolled 190 patients (157 men and 33 women) with a mean (SD) age of 61.75 (10.85) years (range, 33-85 years). Of these patients, 144 received cytostatic treatment and 46 palliative treatment. The median survival was 31 weeks and was related to absence of weight loss (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.26-2.39; P=.001), cytostatic treatment (HR, 1.85; 95% CI, 1.25-2.76; P=.002), and ECOG score of 0 to 1 (HR, 2.84; 95% CI, 1.62-5.00; P=.0001). In patients with ECOG scores of 0 to 1, weight loss and treatment were significant prognostic factors. Survival in the ECOG 2 group was 15 weeks for patients undergoing cytostatic treatment and 11 weeks for patients with symptomatic treatment. Conclusions: In normal clinical practice, chemotherapy significantly prolongs survival in patients with performance status of less than 2, more time being gained if there is no associated weight loss. We conclude that the reluctance shown by many pneumologists toward using this treatment is not entirely justified