Asociación del inmunofenotipo linfocitario de sangre periférica con la presencia de linfomas no Hodgkin / Association of peripheral blood lymphoid immunophenotype with presence of non-Hodgkin lymphomas

Introducción: Los cambios en el inmunofenotipo de los linfocitos en los pacientes con linfoma no Hodgkin están asociados con el pronóstico y las respuestas terapéuticas. Sin embargo, no se ha establecido sistemáticamente la asociación con la enfermedad y por tanto su contribución al diagnóstico. Objetivo: Evaluar la asociación del inmunofenotipo linfocitario en sangre periférica con la presencia del linfoma no Hodgkin. Métodos: Se analizaron 31 muestras de sangre periférica de pacientes con diagnóstico confirmado de linfoma no Hodgkin y de 68 individuos sanos como controles, durante el período de 2018 a 2020. Se empleó la citometría de flujo multiparamétrica para el inmunofenotipado. Se calculó el área bajo la curva y el índice de Youden para establecer puntos de corte en los porcentajes linfocitarios. La asociación de los cambios inmunofenotípicos con el linfoma no Hodgkin, se realizó mediante cálculos de Odd ratio. Resultados: El aumento de linfocitos TCD8+ y NKCD56opaco se asoció significativamente con la presencia de linfoma no Hodgkin (OR= 3,4 y 2,9; respectivamente). Por el contrario, la disminución de linfocitos TCD4+, T doble positivo, T doble negativo y NKCD56brillante también se asoció con la existencia de linfoma no Hodgkin (OR= 23,0; 10,7; 6,9 y 15,8; respectivamente). Además, la disminución del índice CD4/CD8 también fue asociada con la enfermedad. Conclusiones: Los cambios encontrados en los inmunofenotipos linfocitarios se asociaron de forma significativa con la presencia del linfoma no Hodgkin, lo cual representa una expresión sistémica de la enfermedad y sugiere su valor diagnóstico(AU)

Introduction: Lymphocyte immunophenotype changes in non-Hodgkin lymphoma patients are associated with prognosis and therapeutic responses. However, its association with the disease has not been systematically established. Therefor its contribution to the diagnosis process. Objective: To assess the association of lymphocyte immunophenotype in peripheral blood with the presence of non-Hodgkin lymphoma. Methods: 31 peripheral blood samples were analyzed from patients with a confirmed diagnosis of non-Hodgkin lymphoma and from 68 healthy individuals as controls, during the period 2018 to 2020. Multiparametric flow cytometry was used for immunophenotyping. The area under the curve and the Youden index were calculated to establish cut-off points in lymphocyte percentages. The association of immunophenotypic changes with non-Hodgkin's lymphoma was made using Odd ratio calculations. Results: The increase in TCD8+ and NKCD56dim lymphocytes from peripheral blood was significantly associated with the presence of non-Hodgkin lymphoma (OR= 3.4 and 2.9, respectively). Oppositely, the decrease in TCD4+, double positive T, double negative T and NKCD56bright lymphocytes was associated with the existence of non-Hodgkin lymphoma (OR= 23.0, 10.7, 6.9 and 15.8, respectively). Therefore, the decrease in the CD4/CD8 rate was also associated with the disease. Conclusion: The changes found in these lymphocytic immunophenotypes were significantly associated with the presence of non-Hodgkin lymphoma, which represents a systemic expression of the disease and suggests its diagnostic value(AU)

Diagnostic utility of LDH, CA125 and CYFRA21-1 in tuberculosis pleural effusion.

OBJECTIVE: The aim of this study was to assess the diagnostic value of several markers for tuberculosis pleural effusion (TPE) using the combined analysis of Lactate dehydrogenase (LDH), Carbohydrate antigen 125 (CA125), Cytokeratin-19 fragment (CYFRA21-1). METHODS: From January to December in 2018, a total of 37 patients with pleural effusion (22 cases of transudative pleural effusion, 15 cases of tuberculosis pleural effusion and 22 cases of Transudative pleural effusion who were hospitalized in our hospital were reviewed. Receiver operating characteristic (ROC) curves and logistic regression equations was used to evaluate the diagnostic efficiency of each marker. RESULTS: The levels of LDH and CYFRA21-1 of tuberculosis pleural effusions were obviously higher than those of transudative pleural effusion with statistically significant difference (<0.05). The areas under the ROC curve of LDH, CA125 and CYFRA21-1 were 0.92, 0.344 and 0.656, respectively. The diagnostic sensitivity of LDH, CA125 and CYFRA21-1 were 100%, 13.3%, 73.3%, respectively. The combined detection of LDH, CA125 and CYFRA21-1 were higher than those of any other combinations of the indexes. CONCLUSIONS: The study showed a high diagnostic sensitivity and specificity of combined speculation of LDH, ADA and CYFRA21-1 in Tuberculosis pleural effusion.

Expression and significance of CK5/6, P63, P40, CK7, TTF-1, NapsinA, CD56, Syn and CgA in biopsy specimen of squamous cell carcinoma, adenocarcinoma and small cell lung carcinoma / Expresión y significado de CK5/6, P63, P40, CK7, TTF-1, NapsinA, CD56 Syn y CgA en muestras de biopsia de carcinoma de células escamosas, adenocarcinoma y carcinoma de células pequeñas de pulmón

Nine tumor and various potential biomarkers were measured and combined the information to diagnose disease, all patients accepted fiber bronchoscopy brush liquid based cytologyand histopathology examination in order to reliably detect lung cancer. The samples from 314 Chinese lung cancer patients were obtained and CK5/6, P63, P40, CK7, TTF-1, NapsinA CD56, Syn and CgA were measured with the immunohistochemical SP method and analyzed correlation of the expression of these markers with pathological and clinical features of squamous cell carcinoma, adenocarcinoma, and small cell lung carcinoma. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma were 61 cases, 114 cases and 139 cases,CK5/6 and P63 expression were more frequent in squamous cell carcinoma, with sensitivity and specificity of 77.05 % and 96.44 %, 83.61 % and 88.93 %,and compared with adenocarcinoma and small cell carcinoma difference was statistically significant (P<0.05), The incidences of a positive P40 expression were 100 % in squamous cell carcinoma, with specificity of 98.81 %.CK7, TTF-1 and NapsinA expression were more frequent in adenocarcinoma, with sensitivity and specificity of 85.09 % and 78.69 %, 79.82 % and 93.44 %, 56.14 % and 95.08 %, and compared with squamous cell carcinoma and small cell carcinoma difference was statistically significant (P<0.05). TTF-1, Syn, CgA and CD56 expression were more frequent in adenocarcinoma, with sensitivity and specificity of 86.33 % and 93.44 %, 89.21 % and 98.36 %, 74.10 % and 100 %, 96.40 % and 96.72 %. The combined detection of CK5/6, P63 and P40 were more useful and specific in differentiating squamous cell carcinoma. CK7, TTF-1 and NapsinA were more useful and specific in differentiating lung adenocarcinoma. The impaired CD56, TTF-1, Syn and CgA reflects the progression of small cell lung cancer.

Se midieron tumores y utilizaron nueve biomarcadores potenciales y se analizó la información para diagnosticar la enfermedad. A todos los pacientes se les realizó citología en líquido con broncoscopía de fibra y examen histopatológico para detectar de manera confiable el cáncer pulmonar. Se obtuvieron muestras de 314 pacientes chinos con cáncer de pulmón y CK5 / 6, P63, P40, CK7, TTF-1, Napsina A, CD56, Syn y CgA se midieron a través de histoquímica SP y analizaron la correlación de la expresión de estos marcadores con características patológicas y clínicas de carcinoma de células escamosas, adenocarcinoma y carcinoma de células pequeñas en el cáncer de pulmón. El carcinoma de células escamosas, el adenocarcinoma y el carcinoma de células pequeñas fueron 61 casos, 114 casos y 139 casos, respectivamente, la expresión de CK5 / 6 y P63 fueron más frecuentes en el carcinoma de células escamosas, con una sensibilidad y especificidad del 77,05 % y 96,44 %, 83,61 % y 88,93 %, y en comparación con el adenocarcinoma y el carcinoma de células pequeñas, la diferencia fue estadísticamente significativa (P <0,05). La incidencia de ap la expresión positiva P40 fue del 100 % en el carcinoma de células escamosas, con una especificidad del 98,81 %. La expresión de CK7, TTF-1 y NapsinA fueron más frecuentes en el adenocarcinoma, con una sensibilidad y especificidad del 85,09 % y 78,69 %, 79,82 % y 93,44 %, 56,14 % y 95,08 %, y en comparación con el carcinoma de células escamosas y la diferencia de carcinoma de células pequeñas fue estadísticamente significativa (P <0,05) .TTF-1, Syn, CgA y la expresión de CD56 fueron más frecuentes en adenocarcinoma, con sensibilidad y especificidad de 86.33 % y 93.44 %, 89.21 % y 98.36 %, 74.10 % y 100 %, 96.40 % y 96.72 %. La detección combinada de CK5 / 6, P63 y P40 fue más útil y específica en la diferenciación del carcinoma de células escamosas. CK7, TTF-1 y NapsinA fueron más útiles y específicos para diferenciar el adenocarcinoma de pulmón. El deterioro de CD56, TTF-1, Syn y CgA refleja la progresión del cáncer de pulmón de células pequeñas.

Diagnostic Value of Anti-Fibrinogen Citrullinated Peptide in Rheumatoid Arthritis. / Valor diagnóstico de anticuerpos antipéptido citrulinado del fibrinógeno en la artritis reumatoide.

OBJECTIVE: To determinate the diagnostic value of an antibody against a citrullinated fibrinogen peptide in Cuban patients with rheumatoid arthritis, using an enzyme immunasay. MATERIALS AND METHODS: A citrullinated peptide of fibrinogen designed by informatics prediction was synthesized and used in an enzyme immunoassay. The participants were 81 patients with early disease, 81 patients with established disease, 58 patients with other rheumatic and inflammatory diseases, and 43 healthy individuals. Anti- citrullinated fibrinogen peptide, anti-mutated citrullinated vimentin, anti second generation citrullinated peptides and rheumatoid factor antibodies were determined by enzyme-linked immunosorbent assay. RESULTS: Determination of anti-citrullinated peptide of fibrinogen antibodies by the designed enzyme immunoassay showed the best diagnostic value in early rheumatoid arthritis patients, with the highest value sensitivity (84%), negative predictive value (85%), Youden index (0.73%) and area under the receiver operating curve (0.9192). Specificity (89%) and positive predictive value (88%) were higher than rheumatoid factor, similar to anti- mutated citrullinated vimentin, but lower than second generation anti-citrullinated peptides assay. The positivity of C-reactive protein was associated with the presence of anti- citrullinated fibrinogen peptide antibodies and the titres of these antibodies correlated with clinical activity in early disease. CONCLUSIONS: The immunoassay designed with a citrullinated fibrinogen peptide has a high diagnostic value and can identify patients with greater clinical activity in early rheumatoid arthritis.

Valor diagnóstico de un modelo de predicción clínico-radiográfico para rupturas completas del manguito de los rotadores por pinzamiento subacromial / Diagnostic value of a predictive model for complete ruptures of the rotator cuff associated to subacromial impingement

Resumen: La patología relacionada al manguito de los rotadores permanece entre las enfermedades musculoesqueléticas más prevalentes. Hay una creciente necesidad de estudios de imagen (RMN, US, artroscopía) para probar el rendimiento diagnóstico de la historia clínica y el examen físico. Objetivo: Demostrar el valor diagnóstico de un modelo predictor clínico-radiográfico para rupturas completas del manguito de los rotadores. Material y métodos: Estudio descriptivo, observacional, prospectivo, transversal, analítico. Se evaluaron 55 pacientes con dolor de hombro en forma preoperatoria con 13 variables de predicción: edad > 50 años, dolor nocturno, debilidad muscular, signos clínicos de Neer, Hawkins, Jobe, caída de la rotación externa, Napoleón, abrazo del oso, Gerber; medición radiológica del espacio subacromial, índice acromial y ángulo crítico del hombro. En cada variable se midió sensibilidad-especificidad, valor predictivo positivo y negativo. Se compararon los resultados de cada variable para diagnosticar rupturas del manguito de los rotadores contra los hallazgos postoperatorios. Resultados: De los 55 pacientes evaluados, 42 presentaron ruptura completa del mango rotador en el postoperatorio. Se seleccionaron las ocho variables con mayor valor diagnóstico y se realizó una curva ROC, proporcionando un área bajo la curva de 0.88. Conclusiones: Este modelo de predicción emplea ocho variables (edad > 50 años, dolor nocturno, debilidad muscular, caída de la rotación externa, Jobe, Hawkins, espacio subacromial ≤ 6 mm y ángulo crítico del hombro > 35o) que en conjunto suman el valor predictivo de 0.88 (AUC) para diagnosticar rupturas completas del tendón supraespinoso.

Abstract: Pathology related to the rotator cuff remains among the most prevalent musculoskeletal diseases. There is an increasing need for imaging studies (MRI, US, arthroscopy) to test the diagnostic performance of the medical history and physical examination. Objective: To prove the diagnostic value of a clinical-radiographic predictive model to find complete ruptures of the rotator cuff. Material and methods: Descriptive, observational, prospective, transversal and analytical study. Fifty-five patients with preoperative shoulder pain were evaluated with 13 predictive variables: age > 50 years, nocturnal pain, muscle weakness, clinical signs of Neer, Hawkins, Jobe, external rotation lag (ERLS), belly-press, bear hug, and lift-off, radiographic measurement of subacromial space, acromial index and critical shoulder angle. Sensitivity, specificity, and positive and negative predictive values were measured in each variable, comparing the results of each one against the postoperative findings. Results: Of the 55 patients evaluated, 42 had a complete rupture of the rotator cuff in the postoperative period. The eight variables with a higher diagnostic value were selected and a ROC curve was performed, providing an area under the curve of 0.88. Conclusions: This predictive model uses eight variables (age > 50 years, nocturnal pain, muscle weakness, Jobe, Hawkins, ERLS, subacromial space ≤ 6 mm, and critical shoulder angle ˃ 35o), which together add the predictive value of 0.88 (AUC) to diagnose complete ruptures of the supraspinatus tendon.

Vida y obra de Abel Cetrángolo (1916 - 1977) / Life and work of Abel Cetrángolo (1916-1977)

Desde 1947 se inició el tratamiento específico de la tuberculosis que adquirió un valor inusitado, dado que el mismo modificó en el mundo entero el curso de la enfermedad tuberculosa. Roentgen desde 1895 nos mostró su ubicación en el pulmón, pero fue el laboratorio que permitió su diagnóstico y tratamiento, sucesivamente modificado con el transcurrir de los años. Abel Cetrángolo, como quien fuera su maestro y padrino de tesis, Andrés Arena entre nosotros, logró caracterizar al bacilo de Koch y en esa misma tesis nos enseñó el valor diagnóstico del contenido gástrico. Se distinguió por la seriedad de sus trabajos científicos tanto en Córdoba en la escuela de Gumersindo Sayago como en la Cátedra de Patología y Clínica de la Tuberculosis con la conducción de Raúl F Vaccarezza; fue un verdadero maestro para sus discípulos sentando bases valederas en sus conclusiones. Todo jefe de servicio debe trascender por lo que dejacientíficamente, pero también en la formación de médicos que puedan continuar en la profesión desde el punto de vista asistencial y docente con el ejemplo que él les legó.

Since 1947 the specific treatment of tuberculosis acquired an unused value, since it changed over the world the course of tuberculosis. Roentgen from 1895 showed us its location in the lung, but it was the laboratory that allowed its diagnosis and treatment, successively modified with the passing of the years. Abel Cetrángolo, and his former teacher and thesis godfather Andrés Arena among us, characterized the Koch bacillus and in that same thesis reinforced the value of gastric content. It was distinguished by the seriousness of his scientific works, both in Córdoba in Gumersido Sayago school and in the Department of Pathology and Clinical Tuberculosis headed by Raul F Vaccarezza, was a true master for his disciples sitting valid bases of conclusions. All service manager must transcend so scientifically leaves, but also in the training of doctors that can continue in the profession from the point of view clinical and teaching by example that he bequeathed them.

Antineutrophil cytoplasm antibody: positivity and clinical correlation.

OBJECTIVE: To determine positivity and clinical correlation of anti-neutrophil cytoplasmic antibodies (ANCA), taking into account the interference of antinuclear antibodies (ANA). MATERIAL AND METHODS: A prospective study was conducted in the Laboratory of Immunology of the National Cuban Center of Medical Genetic during one year. Two hounded sixty-seven patients with indication for ANCA determination were included. ANCA and ANA determinations with different cut off points and assays were determined by indirect immunofluorescense. Anti proteinase 3 and antimyeloperoxidase antibodies were determined by ELISA. RESULTS: Most positivity for ANCA was seen in patients with ANCA associated, primary small-vessel vasculitides, rheumatoid arthritis and systemic lupus erythematosus. Presence of ANCA without positivity for proteinase 3 and myeloperoxidase was higher in patients with ANA and little relation was observed between the perinuclear pattern confirmed in formalin and specificity by myeloperoxidase. Highest sensibility and specificity values for vasculitides diagnostic were achieved by ANCA determination using indirect immunofluorescense with a cut off 1/80 and confirming antigenic specificities with ELISA. CONCLUSION: ANCA can be present in a great number of chronic inflammatory or autoimmune disorders in the population studied. This determination using indirect immunofluorescence and following by ELISA had a great value for vasculitis diagnosis. Anti mieloperoxidasa assay has a higher utility than the formalin assay when ANA is present.

Predictors of bone metastasis in pre-treatment staging of asymptomatic treatment-naïve patients with prostate cancer.

BACKGROUND: There is no general consensus on the optimal criteria for the application of bone scintigraphy in screening of bone metastasis in patients with prostate cancer. Our study was conducted to assess the value of bone scan for pre-treatment staging of asymptomatic treatment-naïve patients with prostate cancer. METHODS: A total of 203 consecutive asymptomatic and treatment-naïve patients with prostate cancer (age: 67.6±6.4 years) who were referred to our department for whole body bone scintigraphy were enrolled in the study. Three hours after intravenous injection of 20mCi (99m)Tc-MDP, all patients underwent whole body bone scanning using a single head gamma camera. The planar images were supplemented with SPECT as needed for questionable abnormalities or those having uncertain location on planar images. RESULTS: The mean serum PSA levels, serum alkaline phosphatase (ALP) and Gleason score (GS) were 42.41±37.1ng/ml, 223.9±129.9IU/L and 6.7±1.1, respectively. A total of 55 cases (27.1%) out of 203 patients had bone metastases. The univariate analysis showed that serum PSA levels, GS and ALP were all significant predictors of bone metastases. However, only serum PSA and ALP levels were found to be independent predictors of bone metastasis in the multivariate logistic regression analysis. The combination of PSA and ALP (in which patients with either elevated PSA [>20ng/ml] or elevated ALP were considered as positive) had the best screening value, with 98.2% sensitivity and 48.6% specificity. CONCLUSION: Serum ALP screening can be employed as a tool to detect the subgroup of patients who are at high risk of bone metastases, while having a PSA of <20ng/ml. The combination of PSA and ALP can be used to improve predictability of bone metastasis in newly diagnosed patients with prostate cancer, without affecting staging accuracy.

Valor diagnóstico de punción aspirativa con aguja fina en nódulo tiroideo: hospital Doctor Gustavo Fricke / Diagnostic value of puncture aspiration with fine needle in thyroide nodule: hospital Doctor Gustavo Fricke

Introducción: la punción aspirativa con aguja fina (PAAF) ha ido introduciéndose paulatinamente en la práctica clínica y constituye actualmente el método de elección en la aproximación diagnóstica del cáncer tiroideo. La PAAF ha contribuido a reducir el porcentaje de pacientes tiroidectomizados, 67 aumentando la cirugía por cáncer tiroideo del l5 porciento al 39 porciento. Objetivo: determinar el Valor diagnóstico de la PAAF en pacientes sometidos a tiroidectomía en el Hospital Doctor Gustavo Fricke (HGF), entre los71 años 2006-2007. Material y Método: estudio observacional descriptivo retrospectivo. Se utilizó el registro de pacientes sometidos a procedimiento quirúrgico por nódulo tiroideo, que hayan sido previamente estudiados con PAAF en policlínico de Endocrinología del HGF. Resultados: el valor diagnóstico de la PAAF, en el estudio pre-operatorio del nódulo tiroideo y su relación con la biopsia definitiva postoperatoria, alcanzó una sensibilidad de 7l porciento y una especificidad del 54,S porciento. Discusión: el rendimiento que alcanzó la PAAF de los nódulos tiroideos para excluir o confirmar carcinoma tiroideo fueron bajos en relación a estudios internacionales que poseen una sensibilidad del 83 porciento y una especificidad del 92 porciento.

Introduction: the flne-needle aspiration (FNA) has been gradually incorporated into the clinical practice and nowadays represents the method of choice in the diagnosis of the thyroid cancer. The FNA has helped to reduce the percentage of patients that undergo thyroidectomy, and it has increased the operation for thyroid cancer from 15 percent to 39 percent. Objetive: establish the diagnostic value ofthe FNA in patients submitted to thyroidectomy in Hospital Doctor Gustavo Fricke (HGF), between 2006 and 2007. Materials and Methods: this is a descriptive observational retrospective study. We used a register of patients submitted to surgical procedure for thyroid nodule that also have been studied with FNA in the clinic of Endocrinology of the HGF. Results: the diagnostic value of FNA in the preoperative study of the thyroid nodule and its relationship with the definitive surgical biopsy reaches a sensibility of 71 percent and a specificity of S4,8 percent. Discussion: the thyroid nodules FNA had a low performance for exclude or confirm thyroid carcinoma in thyroid nodules compared to international studies (sensibility 83 percent and specificity 92 percent).