Lung cancer risk associated with occupations in women: a pooling study.

BACKGROUND: Occupation is an important risk factor for lung cancer. This knowledge is mainly based on studies conducted on men, with the results being generalized to women. AIMS: We aimed to identify the relationship between different occupations and lung cancer in women. METHODS: Pooling study in which data were pooled from six case-control studies conducted at 13 Spanish hospitals and 1 hospital in Portugal. Each woman's longest held job was coded as per the ISCO-08. Results were adjusted for age, smoking, and exposure to residential radon. RESULTS: The study population comprised 1262 women: 618 cases and 644 controls. The reference group were white-collar workers. The adjusted multivariate analysis showed a higher risk of developing lung cancer among teaching professionals (odds ratio [OR]: 4.36; 95% confidence interval [CI] 1.73-11.02), cooks (OR: 3.59; 95% CI 1.52-8.48), domestic cleaners and helpers (OR: 2.98; 95% CI 1.54-5.78), homemakers (OR: 2.30; 95% CI 1.26-4.21) and crop farmers, livestock farmers and gardeners (OR: 2.06, 95% CI: 1.11-3.81). For adenocarcinoma, the highest risk was observed in teaching professionals, and for small-cell carcinoma, the highest risk was observed in cooks. Higher risks were observed for small-cell carcinoma compared to other histological types. CONCLUSIONS: Some occupations may be associated with an increased risk of lung cancer in women and this risk could vary by histologic subtype; however, further research is needed to confirm these associations. In any case, protection measures must be implemented in the workplace aimed at reducing the risk of lung cancer among women workers, and more studies exclusively focused on women are warranted.

Self-perceived body weight and weight status: analysis of concordance by age group and sex.

OBJECTIVES: Previous studies suggest that there is discordance between actual weight status and body-weight perception. This fact has implications when it comes to designing public health interventions. The aim of this study was to estimate the prevalence of the different categories of weight status and body-weight perception and to analyse their concordance in a representative Spanish population sample. STUDY DESIGN: Cross-sectional study. METHODS: Data were sourced from the 2018 Galician Risk Behaviour Data System, with the target population being all persons aged 16 years and above. We collected data on self-perceived body weight and assessed weight status on the basis of body mass index (BMI). BMI was estimated using self-reported measures of weight and height. To estimate concordance, Cohen's kappa coefficient, both unweighted and weighted with Cicchetti weights, was calculated. RESULTS: Data were obtained for 7853 individuals aged 16 years and above, whereas the overall unweighted concordance was 0.393 (95%CI: 0.377-0.409), with an agreement percentage of 61.6%, weighted concordance was 0.503 (0.490-0.517), with an agreement percentage of 86.6%. The highest concordance between self-perceived body weight and weight status was observed in women. By age group, the highest concordance was observed in the youngest group (16-24 years) for the BMI categories of underweight and overweight, and in the 45-64 age group for the category of obesity. CONCLUSIONS: The results highlight the existence of differences between self-perceived body weight and weight status, according to sex and age.

Smoking-attributable mortality by sex in the 27 Brazilian federal units: 2019.

OBJECTIVES: The aim of this study was to estimate smoking-attributable mortality (SAM) in the population aged 35 years and over in Brazil's 27 federal units by sex, in 2019. STUDY DESIGN: This is an attributable mortality analysis. METHODS: We applied a method dependent on the prevalence of smoking, based on the population attributable fractions. Data on mortality due to causes causally related to smoking were derived from Brazil's Death Registry, data on prevalence of smoking from a survey conducted in Brazil in 2019, and data on relative risks from five US cohorts. Crude and age-adjusted SAM rates were calculated by sex. Estimates of SAM were calculated by specific causes of death and major mortality groups for each federal unit by sex. RESULTS: In 2019, smoking caused 480 deaths per day in Brazil. Although the SAM varied among the federal units, the pattern is not clear, with the greatest difference being between Rio Grande do Sul (crude rate: 248.8/100,000 inhabitants) and Amazonas (106.0/100,000). When the rates were adjusted by age, the greatest differences were observed between Acre (271.1/100,000) and Distrito Federal (131.1/100,000). SAM was higher in males; however, while the main specific cause of SAM in men was ischemic heart disease, in women it was chronic obstructive pulmonary disease. The major mortality group having the greatest impact on SAM across all federal units was the cardiometabolic diseases. CONCLUSIONS: The variability in the burden of SAM in the different regions of Brazil reaffirms the need for SAM data disaggregated at the geographic level.

Hospitalizaciones por y con enfermedad pulmonar obstructiva crónica en Galicia: 20 años de evolución / Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution

Objetivo Analizar la evolución de las hospitalizaciones relacionadas con enfermedad pulmonar obstructiva crónica (EPOC) en Galicia en el período 1996-2018, tanto como causa principal del ingreso (POR EPOC) como si se codificaba en cualquier posición diagnóstica (CON EPOC), estudiando la influencia de la edad, el sexo, la estacionalidad u otras causas principales del ingreso. Metodología Se realizó un análisis del conjunto mínimo básico de datos (CMBD) de Galicia sobre el primer ingreso por EPOC entre 1996 y 2018. Se calcularon tasas brutas, específicas y estandarizadas tanto globales como por sexo y por grupos de edad. Resultados En el período 1996-2018 se produjeron en Galicia 310.883 primeros ingresos CON EPOC, de los que el 29,6% fueron POR EPOC. Las tasas de ingresos tanto CON EPOC como POR EPOC aumentaron, fundamentalmente en varones. Existe una clara estacionalidad de los ingresos, especialmente relevante POR EPOC. La razón de masculinidad media es aproximadamente 4 en ambos escenarios, si bien es inferior en los grupos etarios extremos, sin cambios a lo largo del tiempo. La edad media al ingreso ha aumentado tres años en este período en los varones; en las mujeres no hubo variaciones. Las causas principales del ingreso cuando no es POR EPOC son insuficiencia cardíaca y neumonía. Conclusión La evaluación combinada de los registros de ingresos hospitalarios CON y POR EPOC aporta información complementaria para un mejor conocimiento de las tendencias de esta enfermedad y establecer hipótesis que expliquen los resultados descritos, aportando información para una mejor planificación sanitaria (AU)

Objective This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. Methods An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. Results In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. Conclusion The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning (AU)

Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution.

OBJECTIVE: This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. METHODS: An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. RESULTS: In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. CONCLUSION: The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning.

Recent epidemiological trends in extrapulmonary TB in Galicia, Spain.

OBJECTIVE: To describe the epidemiological trends and characteristics of extrapulmonary tuberculosis (EPTB) in Galicia, Spain, from 2000 to 2019.METHODS: This was a retrospective cohort study based on data from the Galician TB information system.RESULTS: Of the total number of TB cases (n = 15,871), 5,428 (34.2%) had EPTB. The absolute number of cases and incidence of EPTB decreased dramatically (from 480 cases and 17.8 cases/100,000 in 2000, to 172 and 6.4 cases/100,000 in 2019, respectively), with a mean annual decrease of respectively 64% and 4.7% for absolute cases and incidence rates. The risk for EPTB was higher in men than in women (RR 3.86, 95% CI 3.66-4.07). The most frequent age group was 15-44 years (2,234 patients, 41.2%); overall reductions per age group were 82% (0-14 years), 75% (15-44 years), 44% (45-64 years) and 63% (≥65 years), with statistically significant differences. The most frequently locations were the pleura (1,916 cases; 35.3%) and the lymph nodes (1,504; 27.7%).CONCLUSION: The incidence of EPTB in Galicia has decreased significantly in the last 20 years. The epidemiological characteristics have not changed, except for the number of patients with risk factors. This improvement of EPTB epidemiological trends coincides with the implementation of the programme for the prevention and control of TB, which suggests that it has been very effective in the control of the EPTB.

Small-cell lung cancer in never-smokers.

BACKGROUND: Lung cancer is a public health problem worldwide. Small-cell lung cancer (SCLC) is the most aggressive histologic type, with a 5-year survival <10%. SCLC is closely associated with tobacco consumption and infrequent in never-smokers. We aim to describe SCLC characteristics in never-smokers recruited in a radon-prone area. PATIENTS AND METHODS: We designed a multicentric case series where SCLC cases were recruited consecutively following histologic confirmation. Detailed information was obtained for indoor radon exposure, occupation and environmental tobacco smoke. We also collected different clinical characteristics such as extended or limited disease at diagnosis. RESULTS: We recruited 32 never-smoking SCLC cases. Median age was 75 years and 87.5% were women; 47% had extended disease. Median radon concentration was 182 Bq/m3. There were no statistically significant differences in residential radon concentration neither regarding age at diagnosis nor regarding sex. The most frequent symptoms were constitutional syndrome (23.1%) and coughing (23.1%). As much as 63% of cases had an Eastern Cooperative Oncology Group Study (ECOG) status of 0-2. The 1- and 2-year survival rates were 34.4% and 21.9%, respectively. The 2-year survival rate with a localized tumor was 26.7%, compared with 18.8% for extended disease. CONCLUSIONS: These results show, for the first time, that indoor radon might not be associated with SCLC characteristics at diagnosis in never-smokers, and also confirms the low survival of this aggressive type of lung cancer also for never-smokers.

Predictores sociales y clínicos asociados con estancia hospitalaria prolongada en pacientes con agudización grave de EPOC / Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease

Objetivo: Analizar si existen factores sociales que influyan en la estancia hospitalaria prolongada (EHP) de pacientes con agudización grave de EPOC (AEPOC), además de factores clínico-demográficos. Metodología: Estudio de cohortes prospectivo. Se incluyeron pacientes consecutivos que ingresaron por AEPOC en un servicio de Neumología. Se registraron variables demográficas, clínicas (tabaquismo, exacerbaciones e infecciones, disnea, impacto según cuestionario CAT, función pulmonar, comorbilidades, oxigenoterapia y ventilación no invasiva) y sociales (situación económica, disponibilidad y sobrecarga de cuidador, dependencia en actividades básicas e instrumentales, riesgo social y uso de servicios sociales), utilizando cuestionarios e índices como Barthel, Lawton-Brody, Zarit, Barber y Gijón. Se realizó un análisis univariante y multivariante mediante un modelo de regresión logística. Resultados: Se incluyeron 253 pacientes, y la edad media fue de 68,9+/-9,8años. El 77,1% fueron varones. En el modelo de regresión logística se incluyeron tabaquismo activo, valor del FEV1, puntuación en CAT >10, disnea 3-4 de la mMRC, presencia de gérmenes en cultivos de esputo, comorbilidad cardiovascular, anemia, oxigenoterapia domiciliaria, vivir solo, residencia en zona rural, sobrecarga del cuidador y la detección de riesgo/problema sociofamiliar. Las variables que se asociaron de forma independiente con la posibilidad de una EHP fueron la puntuación en cuestionario CAT >10 (OR=8,9; p=0,04) y la detección de riesgo/problema sociofamiliar (OR=2,6; p=0,04). Fumar activamente fue predictor de estancia más breve (OR=0,15; p=0,002). Conclusiones: Variables relacionadas con la esfera social juegan un papel relevante en la estancia hospitalaria, además del impacto de la enfermedad y la persistencia del tabaquismo en pacientes con AEPOC graves

Objective: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. Methodology: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. Results: The study included 253 patients, with a mean age of 68.9+/-9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). Conclusions: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation

Social and clinical predictors associated with prolonged hospital stays for patients with severe exacerbation of chronic obstructive pulmonary disease. / Predictores sociales y clínicos asociados con estancia hospitalaria prolongada en pacientes con agudización grave de EPOC.

OBJECTIVE: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. METHODOLOGY: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. RESULTS: The study included 253 patients, with a mean age of 68.9±9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). CONCLUSIONS: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation.

COPD prevalence and hospital admissions in Galicia (Spain). An analysis using the potential of new health information systems.

INTRODUCTION AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a major public health problem. The aim of this study was to ascertain the prevalence of COPD and whether such prevalence was positively or negatively associated with COPD admissions, using all the data of a regional health care system. MATERIALS AND METHODS: We designed a descriptive cross-sectional study which included all subjects aged over 45 years, diagnosed with COPD in primary care in 2013. We also calculated the number of such patients who had a record of hospital admissions due to this disease. COPD prevalence and incidence of admissions were calculated. Poisson regression models were then used to analyse the association between cases with diagnosis of COPD and admissions due to COPD, by sex, adjusting for socio-demographic variables and distance to hospital. Sensitivity subanalyses were performed by reference to the respective municipal rurality indices. RESULTS: Median municipal prevalence of COPD was 5.29% in men and 2.19% in women. Among patients with COPD, 28.22% of men and 16.00% of women had at least one hospital admission. The relative risk of admission per unit of the standardised prevalence ratio was 0.37 (95% CI 0.34-0.41) for men and 0.39 (95% CI 0.34-0.45) for women. CONCLUSIONS: There is a significant negative association between COPD prevalence and hospital admissions due to this disease. The proportion of admissions is lower in municipalities lying furthest from hospitals. There is considerable municipal variability in terms of COPD prevalence and proportion of admissions. In-depth attention should be given to disease-management training programmes.

Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings.

INTRODUCTION: Environmental tobacco smoke (ETS) is currently the main indoor pollutant and causes a high morbility and mortality. A partial restriction came into force in Portugal, in 2008, law 37/2007, trying to control, define and regulate smoke-free environments. OBJECTIVE: To assess exposure and perceived impact of the law 37/2007 on exposure to ETS among adults attending to the two health care facilities of Chaves (Portugal). METHOD: A cross-sectional survey on tobacco consumption and exposure to ETS was undertaken in Chaves (Northern Portugal) between November 2009 and February 2010. All the patients, over 17, attending to any of the Chaves Primary Care Facilities were interviewed. Patient enrolment was done on a rolling basis covering all days of the week. A face to face interview was carried out and a carbon monoxide was measured. Prevalence and means are shown with 95% confidence intervals. RESULTS: 287 patients participated in the survey, 56% were males and the mean age was 54 years. Smoking prevalence was 23,6%, significantly higher in males (31% vs 17%). 46,2% reported exposure tobacco smoke elsewhere (53% in males vs. 40% in females). Smokers declared to be more exposed to ETS than non-smokers. 16.2% of the population declared to be exposed at home, 14% at work and 33% at leisure places. The highest decrease in perception of passive exposure was found for restaurants (95%). In nightclubs 68% of the participants stated that exposure has remained unchanged. CONCLUSION: The tobacco control law offered protection against tobacco smoke in several closed public spaces. However, a significant proportion of the population remains exposed. This study highlights the ineffectiveness of a partial ban. A comprehensive law is, therefore, required in Portugal.

Efficacy and safety of intraoperative radiotherapy in breast cancer: a systematic review.

The objective of this study is to assess the efficacy and safety of intraoperative radiotherapy (IORT) for early breast cancer through a systematic review. Fifteen studies met the inclusion criteria. Most studies assessed the combined treatment with IORT (10-24Gy) and external beam radiotherapy (EBRT) (45-50Gy) on early stage breast cancer (T(0-2)). Local control was over 95% for 1 and 4years of follow-up and the 5-year overall survival was 99%. The TARGIT-A study found a similar survival comparing IORT with standard treatment. The incidence of acute and chronic complications was scarce. IORT is well tolerated by patients and acute and late toxicities are low. There are no differences in survival for IORT treated patients versus standard treatment.

Efficacy and safety of intraoperative radiotherapy in colorectal cancer: a systematic review.

Intraoperative radiotherapy (IORT) has been proposed as an encouraging treatment for colorectal cancer. The aim of this study is to assess the efficacy and safety of IORT for this cancer through a systematic review. Studies located in electronic databases were selected according to established criteria, read and analysed and the results extracted by two independent reviewers. Fifteen studies met the selection criteria. Five-to-six-year local control (LC) was over 80% and 5-year overall survival (OS) was close to 65%. For recurrences, the 5-year overall survival was 30%. The main acute complications were gastrointestinal. Adding IORT to conventional treatment reduces the incidence of local recurrences within the radiation area over 10%. IORT is a safe technique as it does not increase toxicity associated with conventional treatment.

A meta-analysis on wood dust exposure and risk of asthma.

Work-related asthma is the most common occupational respiratory disorder in the industrialized countries. It has been postulated that wood dust exposure may increase the risk of work-related asthma. The objective of this study was to assess, through a meta-analysis, the risk of developing work-related asthma associated with wood dust exposure. A systematic search of the literature was performed. Inclusion and exclusion criteria were applied and a quality scale used to measure the quality of the included studies was developed. Using standard meta-analysis techniques, studies were pooled using both random and fixed effects models. Nineteen studies were included which consisted of three cohort studies, twelve case-control studies and four mortality studies. The pooled relative risk (RR) of asthma among workers exposed to wood dust was 1.53 (95% CI 1.25-1.87). When the analysis was restricted to studies carried out on Caucasian populations, the pooled RR was 1.59 (95% CI 1.26-2.00) while the pooled RR of studies on Asian populations was 1.15 (95% CI 0.92-1.44). Wood workers present a higher risk of asthma. Future research should include careful evaluation of ethnicity and nativity as risk modifiers.

Tobacco consumption and oral and pharyngeal cancer in a Spanish male population.

The incidence of oral and pharyngeal cancer in Spain is among the highest in Europe. A hospital-based case-control study was carried out in NW Spain to investigate the role of tobacco. The study included 92 incident male cases and 230 male controls. Tobacco smoking was strongly associated with oral and pharyngeal cancer (OR(ever smokers)=27.7). The risk for black tobacco (OR=33.1) was approximately double that of blond tobacco (OR=15.4). Alcohol drinking increased the risk posed by tobacco consumption. Risks were significantly lower for subjects that started smoking later and was significantly reduced after 10 years of leaving the habit.

Short daily versus conventional hemodialysis quality of life: a cross-sectional multicentric study in Spain.

BACKGROUND: End-stage renal disease is a major health problem worldwide nowadays. Although conventional hemodialysis is the most widely used modality, short daily hemodialysis has been proposed as a more physiologic treatment. The objective of this article is to compare the quality of life of patients on each hemodialysis modality. METHODS: A multicentric cross-sectional study was performed in 9 Spanish hospitals. Patients treated for at least 3 months with conventional or short daily hemodialysis were included and quality of life measured using the Euroqol-5D quality of life questionnaire. Bayesian models were used for analyzing quality of life results. RESULTS: Ninety-three patients were included, 27 were on daily hemodialysis and 66 on conventional hemodialysis. All models demonstrated a better quality of life for daily hemodialysis versus conventional hemodialysis. Only 14% of the patients on conventional hemodialysis were willing to change to a daily schedule. CONCLUSIONS: Short daily hemodialysis shows a better quality of life than conventional hemodialysis with all Bayesian approaches considered.

[Clinical utility of (18)F-DOPA-PET in movement disorders. A systematic review]. / Utilidad clínica de la (18)FDOPA-PET en trastornos del movimiento. Una revisión sistemática.

INTRODUCTION: (18)F-fluorodopa ((18)F-DOPA) is a functional tracer of presynaptic dopaminergic neuron terminations in the nigrostriatal system. This review is aimed to assess the efficacy of (18)F-DOPA-PET in the diagnosis and evaluation of the progression of Parkinson's Disease (PD) and in the differential diagnosis with other Parkinsonism Syndromes. METHODS: A review was made of the literature by searching six databases and selecting the most relevant articles according to strict inclusion and exclusion criteria. The study data were systematically extracted and included in evidence tables. RESULTS: Of the 1478 registries recovered through the search of the literature, 48 studies were extracted. Of these, only 13 were included in the systematic review. It was observed in all of them that PD is manifested by a lower striatal uptake of (18)F-DOPA, especially in the putamen with posterior predominance. Prospective studies have shown that there is loss of uptake with disease progression. One article described regional differences in (18)F-DOPA striatal pattern between PD, multisystem atrophy (MSA) and progressive supranuclear palsy (PSP). Cognitive impairment in PD seems to be related with (18)F-DOPA abnormal uptake in some regions of frontal cortex and caudate nucleus. CONCLUSION: (18)F-DOPA-PET seems to be useful for the diagnosis and evaluation of PD progression. However, the evidence is not conclusive regarding its utility in the differential diagnosis with other Parkinsonism Syndromes and in the differentiation between ex novo and advanced PD.

Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review.

The aim of the present systematic review was to assess the effectiveness and safety of real time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with suspected or known bronchopulmonary carcinoma, as well as in other clinical indications presented by lymphatic adenopathies. A systematic review was carried out in November 2007 and updated in April 2008 using the main databases. Inclusion and exclusion criteria were applied to the papers retrieved. A total of 20 publications were included. Of these, 14 were original studies that investigated the clinical usefulness of the technique in visualising and staging lymph nodes in patients with suspected or established lung cancer. Sensitivity ranged 85-100% and negative predictive value ranged 11-97.4%. Three studies assessed the clinical usefulness of the technique in the diagnosis of sarcoidosis. EBUS-TBNA was diagnostic in 88-93% of patients. One retrospective study evaluated the use of EBUS-TBNA in the diagnosis of lymphoma. None of the studies included in the present review reported important complications. Endobronchial ultrasound-guided transbronchial needle aspiration is a safe and highly accurate procedure for the examination and staging of mediastinal and hilar lymph nodes in patients with known or suspected lung malignancy. The evidence is promising for sarcoidosis but is not sufficient for lymphoma.