Important prognostic factors for survival in patients with malignant pleural effusion.

BACKGROUND: The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. Our study aimed to develop a model to identify prognostic factors or survival time in patients diagnosed with MPE. METHODS: This is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed cancer diagnosis. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death. RESULTS: One hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years, and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.0-96.0 months). Kaplan-Meier univariate analysis showed that survival was significantly related to the following prognostic factors: ECOG PS (hazard ratio [HR] 10.0, 95% confidence interval [95% CI] 5.96 to 18.50, p < 0.0001), primary cancer site (HR 1.99, 95% CI 1.23 to 3.22, p < 0.01), positive pleural cytology (HR 1.25, 95% CI 0.88 to 1.78, p = 0.04), and positive histology (HR 1.33, 95% CI 0.97 to 1.81, p = 0.04). Other potential independent diagnostic factors that were examined did not affect survival. Cox regression analysis showed that only the ECOG PS was highly predictive of survival (HR 73.58, 95% CI 23.44 to 230.95, p < 0.0001). CONCLUSIONS: ECOG PS is an independent predictor of survival in patients with MPE at initial diagnosis. This prognostic factor can help physicians select patients for appropriate palliative treatment of this syndrome.

Evaluation of adenosine deaminase activity for the diagnosis of pleural TB in lymphocytic pleural effusions.

AIM: To evaluate the diagnostic value of pleural adenosine deaminase (P-ADA) as a pleural TB-specific biomarker in lymphocytic pleural effusions. MATERIALS & METHODS: Pleural effusions were classified on the basis of definitive diagnosis. RESULTS: A total of 218 patients (122 tuberculous and 96 nontuberculous) were included in the study. The optimal cut-off value of P-ADA (receiver operating characteristic curve) for the diagnosis of pleural TB was 40.0 U/l (Giusti method). In lymphocytic pleural effusions P-ADA had a sensitivity of 80.3%, a specificity of 96.0% and an accuracy of 86.2%. The positive predictive value was 97.0% and the negative predictive value was 75.0%. The positive likelihood ratio and negative likelihood ratio were 19.8 and 0.2, respectively (p < 0.0001). CONCLUSION: P-ADA activity is recommended for the diagnosis of TB in lymphocytic pleural effusions.

Comparison of maximal inspiratory pressure, tracheal airway occlusion pressure, and its ratio in the prediction of weaning outcome: impact of the use of a digital vacuometer and the unidirectional valve.

OBJECTIVE: To investigate the predictive value of the maximal inspiratory pressure obtained by a digital vacuometer using a unidirectional valve (P(ImaxUV)) as to weaning outcome, and to compare its performance with the respiratory drive using airway occlusion pressure at 0.1 second (P(0.1)), and P(0.1)/P(ImaxUV). METHODS: Patients on mechanical ventilation for > 24 hours who fulfilled the weaning criteria were prospectively enrolled. Measurements of P(ImaxUV) and P(0.1) were accomplished with a digital vacuometer with a unidirectional valve that allows only exhalation. Measured values were electronically recorded and stored on the digital vacuometer measurement device. Cutoff points for the used parameters were: absolute values of P(ImaxUV) > 30 cm H(2)O, P(0.1) < 2.3 cm H(2)O, and P(0.1)/P(ImaxUV) < 0.10. Receiver operating characteristic curves were calculated to compare the predictive values of the indexes. RESULTS: One hundred three subjects completed the test. The areas under the receiver operating characteristic curve were 0.79 ± 0.04, 0.65 ± 0.05, and 0.74 ± 0.04 for P(ImaxUV), P(0.1), and P(0.1)/P(ImaxUV), respectively. The area under the receiver operating characteristic curve for P(ImaxUV) was higher than for P(0.1) and P(0.1)/P(ImaxUV), but statistical significance was only found against P(0.1) (P = .007). CONCLUSIONS: Every studied index had only a modest performance regarding prediction of weaning outcome. Of note, P(ImaxUV) values obtained by digital technology using a unidirectional valve performed better than historically reported using a conventional techniques, surpassing P(0.1) and P(0.1)/P(ImaxUV) in this regard.

Evaluation of the inspiratory pressure using a digital vacuometer in mechanically ventilated patients: analysis of the time to achieve the inspiratory peak.

BACKGROUND: The measurement of the maximal inspiratory pressure (P(Imax)) is of great importance in choosing the time for the start of weaning. OBJECTIVE: To measure the inspiratory pressure in mechanically ventilated patients suitable for weaning to determine the point at which the P(Imax) is achieved within 60 seconds of observation, and analyze factors associated with P(Imax) values. METHODS: Measurement of P(Imax) was accomplished with a digital vacuometer with a unidirectional valve, which allows only exhalation (P(ImaxUV)). With this technique, values are registered and stored, remaining accessible whenever necessary. All patients were on mechanical ventilation, and met the criteria recommended by the American Thoracic Society/European Respiratory Society in 2007 to undergo weaning trial. RESULTS: Eighty-four from the 87 enrolled patients completed the test. No patients reached the P(ImaxUV) in the first 20 seconds of observation. P(ImaxUV) was achieved between 20.1 and 40 seconds in 12 patients (14.0%), and between 40.1 and 60 seconds in 72 cases (86.0%). In a multivariate analysis model in which age, sex, days of mechanical ventilation, APACHE score, and respiratory drive (measured as airway-occlusion pressure 0.1 s after the start of inspiratory flow [P(0.1)]) were included, only age (P = .006) and P(0.1) (P = .003) were significantly associated with the values of P(ImaxUV). CONCLUSIONS: Within an observation period of 60 seconds, the majority of patients reached the maximal inspiratory peak between 40.1 and 60 seconds. Older patients were found to have lower P(ImaxUV) values, whereas higher values for P(0.1) strongly correlated with higher P(ImaxUV) values. These findings are potentially useful to improve successful weaning prediction in the future, but further studies are needed to better clarify this issue.

The influence of an undergraduate scientific initiation programme on the professional profile of new physicians.

INTRODUCTION: This paper studies the influence of a Scientific Initiation Programme (SIP) on the professional profile of new doctors from a Brazilian university. AIM AND METHODS: Evaluate fifty-two new doctors divided into two groups matched by sex, age and academic performance and differing only in participation in the SIP. Professional and socioeconomic data were collected, including schooling of parents; average income before, during and after the medical course; current professional situation; results of exams for civil servant recruitment; and titles and degrees obtained after graduation. RESULTS: Significant differences were found only in civil servant recruitment exam results (p = 0.0098) and in income after graduation (p = 0.02), which were both higher in the non-SIP group. Only one doctor got a M.Sc. degree after graduation, but many of them in both groups obtained technical titles, and had papers presented at congresses or published. CONCLUSIONS: Apparently, taking part in a SIP led to lower income and worse civil servant recruitment exam results. However, this may only reflect a transient phase in a long-term process. New research currently under way will answer this remaining question, now that more time has elapsed since graduation.

[Risk predictive factors for the appearing of a second primary lung neoplasms in 104 patients]. / Fatores preditivos de risco para surgimento de segundo tumor maligno primário no pulmão em 104 casos.

OBJECTIVES: The objective of our study was to identify the risks factors for the de development of a second pulmonary primary cancer. METHODS: It was a primary, observational, multicentric and retrospective study with 104 patients from the Cancer National Institute and the Antonio Pedro Universitary Hospital, in Rio de Janeiro, Brazil. RESULTS: The sites of primary tumors were: head and neck (56.7%); with laryngeal carcinoma (42.4%); lungs (15.5%); bladder (8.6%); uterine cervix (7.6%); stomach (4.8%); others (6.8%). Male patients represented 84.6%. Average age 56.7 +/- 10.7 years, with a coefficient of variation 18.8%. Among the patients 91.4% were smokers and 92.0% were alcohol consumers. Multiple logistic regression model: site of primary tumor (OR:8.22; CI 95% - 2.21 to 30.56; p = 0,0017); specific histologic of primary cancer (OR:0.21; IC 95% : 0.04 to 0.99; p = 0.0498); sex (OR: 0.25; CI 95% : 0.03 to 1.81; p = 0.1711); age (OR: 0.98; CI 95%: 0.92 to 1.04; p = 0.6318); smoking (OR: 2.80; CI 95%: 0.44 to 17.55; p = 0.2711) and alcohol consumption (OR:0.76; CIIC 95%: 0.19 to 2.95; p = 0.6964). Adjusted model: odds ratio of the site of the primary tumor was 4.14, ; CI 95%; from 1.36 and 12.78 and p = 0.0123 (p < 0.05). Accuracy or the model: 82. 69%. CONCLUSION: In this study teh site of the primary tumor was the only predictor of risk for the second pulmonary primary cancer.

[Endocrine and metabolic manifestations in tuberculosis]. / Manifestações endócrino-metabólicas na tuberculose.

In the present paper, the authors reviews the endocrine and metabolic manifestations in tuberculosis. Disorders as adrenal insufficiency, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), hypercalcemia, endocrine effects of antituberculous drugs, hypopituitarism, tuberculous involvement of the thyroid gland and pancreas and chest radiograph presentation in diabetes mellitus are discussed. In the literature, several reports support the presence of abnormal calcium metabolism in tuberculosis.