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Valdes-Elizondo GD, Álvarez-Maldonado P, Ocampo-Ocampo MA, Hernández-Ríos G, Réding-Bernal A, Hernández-Solís A. Burnout symptoms among physicians and nurses before, during and after COVID-19 care. Rev Lat Am Enfermagem 2023; 31:e4046. [PMID: 37937599 PMCID: PMC10631294 DOI: 10.1590/1518-8345.6820.4046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/13/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care. METHOD a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used. RESULTS 280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff. CONCLUSION the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.
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Affiliation(s)
| | - Pablo Álvarez-Maldonado
- Hospital General de México, Servicio de Neumología, Ciudad de México, México
- Becario del Sistema Nacional de Investigadores, CONACYT, México
| | | | | | - Arturo Réding-Bernal
- Hospital General de México, Servicio de Neumología, Ciudad de México, México
- Becario del Sistema Nacional de Investigadores, CONACYT, México
| | - Alejandro Hernández-Solís
- Hospital General de México, Servicio de Neumología, Ciudad de México, México
- Becario del Sistema Nacional de Investigadores, CONACYT, México
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Hernández-Solís A, Reding-Bernal A, Álvarez-Maldonado P, Mojica Jaimes E, Serna Valle FJ, Quintana Martínez A, Velazquez Gachuz M. The Prevalence of Depression and Anxiety Symptoms and Their Association With Respiratory Diseases. Cureus 2023; 15:e49488. [PMID: 38152800 PMCID: PMC10752249 DOI: 10.7759/cureus.49488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Patients with respiratory diseases face adverse situations such as symptom management, general condition deterioration, and a hostile perception of the hospital environment, favoring the appearance of anxiety and depression. METHODS A total of 317 patients hospitalized for a disease of pulmonary origin were analyzed and divided into the following subgroups: infectious, oncological, acute, and chronic diseases. Patients over 18 years of age with preserved cognitive capacity were included in the study. The Hospital Anxiety and Depression Scale (HADS) was applied to them on the second or fourth day of their hospital stay and five days after the first evaluation. Multiple linear regression models were carried out to analyze the association between anxiety and depression measured over two different periods. The models present the statistically significant variables with a 95% confidence level. RESULTS The patients presented with anxiety in 74.4% of cases, mainly those with acute respiratory diseases (42.4%) and neoplastic diseases (27.5%). A total of 69.5% presented with depression, with symptoms more significant in those with chronic and oncological pulmonary diseases and those with no job. Patients with at least one comorbidity presented with anxiety in 53.9% of cases and depression in 52.1% of cases. Linear regression models were carried out and showed that anxiety was 1.75 and 1.84 times more frequent in patients with chronic diseases compared to those with infectious pathologies in the first and second reviews, respectively. The linear regression model also showed a higher frequency of depressive symptoms in patients with chronic conditions (1.62 times) compared to the group with infectious and contagious pathologies, and prolonged hospital stays were associated with depressive symptoms 1.37 times more than short stays. CONCLUSIONS Anxiety and depression are frequent disorders in patients with respiratory diseases, negatively affecting the prognosis. Routine mental health screening and multidisciplinary management are essential in this population.
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Affiliation(s)
- Alejandro Hernández-Solís
- Pulmonology and Thorax Surgery Service, "Dr. Eduardo Liceaga" General Hospital of Mexico, Mexico, MEX
| | | | - Pablo Álvarez-Maldonado
- Pulmonology and Thorax Surgery Service, "Dr. Eduardo Liceaga" General Hospital of Mexico, Mexico, MEX
| | - Eliasib Mojica Jaimes
- Pulmonology and Thorax Surgery Service, "Dr. Eduardo Liceaga" General Hospital of Mexico, Mexico, MEX
| | - Fryda Jareth Serna Valle
- Pulmonology and Thorax Surgery Service, "Dr. Eduardo Liceaga" General Hospital of Mexico, Mexico, MEX
- Surgery, Anahuac University Mexico North Campus, Mexico, MEX
| | - Andrea Quintana Martínez
- Pulmonology and Thorax Surgery Service, "Dr. Eduardo Liceaga" General Hospital of Mexico, Mexico, MEX
| | - Merari Velazquez Gachuz
- Pulmonology and Thorax Surgery Service, "Dr. Eduardo Liceaga" General Hospital of Mexico, Mexico, MEX
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Hernández-Solís A, Reding-Bernal A, Cantú-Torres VP. Clinical behaviour of SARS-CoV-2 infection (COVID-19) in patients with type-2 diabetes mellitus in a respiratory care unit. Med Clin (Engl Ed) 2023:S2387-0206(23)00242-5. [PMID: 37361369 PMCID: PMC10266498 DOI: 10.1016/j.medcle.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Alejandro Hernández-Solís
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Arturo Reding-Bernal
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
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Hernández-Solís A, Álvarez-Maldonado P, Araiza-Santibáñez J, Cruz-Muñoz K, Cícero-Sabido R, Quintana Martínez A. Pulmonary aspergilloma in immunocompromised patients in a Respiratory Care Unit. J Infect Dev Ctries 2022; 16:564-569. [DOI: 10.3855/jidc.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/01/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients.
Methodology: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient.
Results: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%).
Conclusions: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection.
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Hernández-Solís A, Quintanar-Ramírez MI, Quintana-Martínez A, Casillas-Suárez C, Álvarez-Maldonado P, Reding-Bernal A. Behavior of COVID-19 in people under 60 years of age in a tertiary hospital in Mexico City. CIR CIR 2022; 90:137-139. [PMID: 35120109 DOI: 10.24875/ciru.21000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - Arturo Reding-Bernal
- Dirección de Investigación. Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
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Hernández-Solís A, Vargas-Abrego B, Vidal-Andrade E, Sanjurjo-Martínez JL, Reding-Bernal A, Álvarez-Maldonado P. Induced Apnea During Delayed Tracheostomy in Mechanically Ventilated Patients With COVID-19: A 2-center Early Experience. J Bronchology Interv Pulmonol 2022; 29:83-85. [PMID: 34935669 PMCID: PMC8691167 DOI: 10.1097/lbr.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
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Rojas-Espinosa O, Rivero-Silva MA, Hernández-Solís A, Arce-Paredes P, Arce-Mendoza AY, Islas-Trujillo S. Sera from patients with tuberculosis increase the phagocytic-microbicidal activity of human neutrophils, and ESAT-6 is implicated in the phenomenon. Int J Mycobacteriol 2021; 10:271-278. [PMID: 34494566 DOI: 10.4103/ijmy.ijmy_134_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background It has been reported that sera from patients with active pulmonary tuberculosis (APT) induced nuclear changes in normal neutrophils that included pyknosis, swelling, apoptosis, and production of extracellular traps (NETs). Similar changes were observed with some sera from their household contacts but not with sera from healthy, unrelated individuals. It was suggested that those sera from household contacts that induced neutrophil nuclear changes might correspond to people with subclinical tuberculosis. Thus, our experimental approach might serve to identify individuals with early, ongoing disease. Methods Nuclear changes in neutrophils were fully evident by 3 h of contact and beyond. Circulating mycobacterial antigens were the most likely candidates for this effect. We wanted to know whether the nuclear changes induced on neutrophils by the sera of APT patients would negatively affect the phagocytic/microbicidal ability of neutrophils exposed to APT sera for short periods. Results We now provide evidence that short-term contact (30 min) with sera from patients with pulmonary tuberculosis increases several phagocytic parameters of normal neutrophils, including endocytosis, myeloperoxidase levels, production of free reactive oxygen species, phagolysosome fusion, and microbicidal activity on Staphylococcus aureus, with these effects not being observed with sera from healthy donors. We also give evidence that suggests that ESAT-6 and CFP-10 are involved in the phenomenon. Conclusion We conclude that activation is a stage that precedes lethal nuclear changes in neutrophils and suggests that autologous neutrophils must circulate in an altered state in the APT patients, thus contributing to the pathology of the disease.
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Affiliation(s)
- Oscar Rojas-Espinosa
- Department of Immunology, National School of Biological Sciences, National Polytechnic Institute, Mexico City, Mexico
| | - Miguel Angel Rivero-Silva
- Department of Immunology, National School of Biological Sciences, National Polytechnic Institute, Mexico City, Mexico
| | | | - Patricia Arce-Paredes
- Department of Immunology, National School of Biological Sciences, National Polytechnic Institute, Mexico City, Mexico
| | - Alma Yolanda Arce-Mendoza
- Department of Immunology, Faculty of Medicine, Autonomous University of Nuevo Leon, Monterrey, Mexico
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Hernández-Solís A, Torres-Rojas B, Reding-Bernal A. Comorbilidad asociada con infección por SARS-CoV-2 (Covid-19), en el Hospital General de México Dr. Eduardo Liceaga. Salud Publica Mex 2021; 63:159-160. [PMID: 33989473 DOI: 10.21149/12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alejandro Hernández-Solís
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México.
| | - Berenice Torres-Rojas
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México.
| | - Arturo Reding-Bernal
- Dirección de Investigación, Hospital General de México Dr. Eduardo Liceaga. Ciudad de México, México..
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Hernández-Solís A, Velázquez-Sámano G, Cicero-Sabido R. [A brief review of respiratory diseases in pre-Hispanic times in Mexico]. ACTA ACUST UNITED AC 2021; 67:305-308. [PMID: 33636073 DOI: 10.29262/ram.v67i3.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It is known that, in ancient Mexico, diseases of the respiratory system were a major cause of death in the population. Severe epidemics in the XVI Century ravaged and killed nine out of ten indigenous persons. Pre-Hispanic physicians served as medical sorcerers and dealt with the physical and spiritual diseases that afflicted the population. Important medical knowledge pertaining to each culture has been identified; this knowledge explained the diseases depending on the religious beliefs of each culture, and it tried to solve the health problems that afflicted the population at that time.
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Affiliation(s)
- Alejandro Hernández-Solís
- Secretaría de Salud, Hospital General de México Dr. Eduardo Liceaga, Servicio de Neumología, Ciudad de México, México.
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Rodríguez IM, Hernández-Solís A, Messaoudi N, Van den Eynde G. The nuclear fuel cycle code ANICCA: Verification and a case study for the phase out of Belgian nuclear power with minor actinide transmutation. Nuclear Engineering and Technology 2020. [DOI: 10.1016/j.net.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hernández-Solís A, Navarro-Reynoso F, Cruz-Muñoz K. Cambios epidemiológicos del cáncer pulmonar en el Hospital General de México Dr. Eduardo Liceaga, en relación con una serie histórica. Salud Publica Mex 2020; 62:466-467. [DOI: 10.21149/11409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
No disponible
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Hernández-Solís A, Camerino Guerrero A, Colín Muñoz Y, Bazán Cuervo S, Cícero Sabido R, Reding-Bernal A. [Pulmonary mycosis in patients with diabetes mellitus. Clinical characteristics and risk factors]. Rev Iberoam Micol 2020; 37:53-57. [PMID: 32616359 DOI: 10.1016/j.riam.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/11/2020] [Accepted: 04/17/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications. AIMS To describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity. METHODS Case-control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient. RESULTS From the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001). CONCLUSIONS Our results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality.
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Affiliation(s)
- Alejandro Hernández-Solís
- Unidad de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México.
| | - Alejandra Camerino Guerrero
- Unidad de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Yesenia Colín Muñoz
- Unidad de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Saret Bazán Cuervo
- Unidad de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Raúl Cícero Sabido
- Unidad de Neumología y Cirugía de Tórax, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
| | - Arturo Reding-Bernal
- Dirección de Investigación, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de México, México
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Hernández-Solís A, Navarro-Reynoso F, Reding-Bernal A. Factores de riesgo en pacientes con tuberculosis pulmonar y extrapulmonar en un hospital de concentración de la Ciudad de México. Salud Publica Mex 2020; 62:452-453. [DOI: 10.21149/11163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
No disponible
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Hernández-Solís A, González-Villa M, Cicero-Sabido R, González-González H, Colín-Muñoz Y, Camerino-Guerrero A, Ramírez-González E. Identification of Mycobacterium bovis in patients diagnosed with pulmonary and extrapulmonary tuberculosis. GAC MED MEX 2020. [DOI: 10.24875/gmm.m20000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Skarbeli A, Merino Rodríguez I, Álvarez-Velarde F, Hernández-Solís A, Van den Eynde G. Quantification of the differences introduced by nuclear fuel cycle simulators in advanced scenario studies. ANN NUCL ENERGY 2020. [DOI: 10.1016/j.anucene.2019.107160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hernández-Solís A, González-Villa M, Cícero-Sabido R, González-González H, Colin-Muñoz Y, Camerino-Guerrero A, Ramírez-González E. Identificación de Mycobacterium bovis en pacientes con diagnóstico de tuberculosis pulmonar y extrapulmonar. GAC MED MEX 2019; 155:608-612. [PMID: 31787773 DOI: 10.24875/gmm.19005407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction In Mexico, there is an alarming increase in the number of cases of Mycobacterium bovis infection on pulmonary and extrapulmonary presentations. The lack of timely identification triggers complications and increases mortality. Objective To know the frequency of M. bovis infections in clinical samples of patients with tuberculosis in the mycobacteria laboratory of a reference hospital in Mexico City. Method Prospective, descriptive study. Strains isolated from biological material were studied in Löwestein-Jensen and MGITI960 cultures. M. bovis was identified by amplifying the RD9 fragment with end-point polymerase chain reaction (PCR). Results Eight-hundred and fifty tuberculosis-diagnosed patients were included; in 441 cases, Mycobacterium tuberculosis was confirmed by positive culture (250 pulmonary, 65 ganglionic, 39 renal, 34 meningeal, 25 miliary, 14 pleural, 8 peritoneal, 4 bone and 2 pericardial cases). Forty-eight strains (10.8%) were typified as M. bovis by amplification of the RD9 fragment with end-point PCR. Conclusions M. bovis is not currently thought of a causative agent of tuberculosis, which could be the cause of pharmacological treatment failure. In this study, the main extrapulmonary form was observed to be cervical lymphadenopathy.
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Affiliation(s)
- Alejandro Hernández-Solís
- Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Unidad de Neumología. Ciudad de México, México
| | - Maribel González-Villa
- Secretaría de Salud, Instituto de Diagnóstico y Referencia Epidemiológicos. Ciudad de México, México
| | - Raúl Cícero-Sabido
- Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Unidad de Neumología. Ciudad de México, México
| | - Heleodora González-González
- Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Unidad de Neumología. Ciudad de México, México
| | - Yesenia Colin-Muñoz
- Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Unidad de Neumología. Ciudad de México, México
| | - Alejandra Camerino-Guerrero
- Secretaría de Salud, Hospital General de México "Dr. Eduardo Liceaga", Unidad de Neumología. Ciudad de México, México
| | - Ernesto Ramírez-González
- Secretaría de Salud, Instituto de Diagnóstico y Referencia Epidemiológicos. Ciudad de México, México
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Álvarez-Maldonado P, Reding-Bernal A, Hernández-Solís A, Cicero-Sabido R. Impact of strategic planning, organizational culture imprint and care bundles to reduce adverse events in the ICU. Int J Qual Health Care 2019; 31:480-484. [PMID: 30256944 DOI: 10.1093/intqhc/mzy198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/26/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the occurrence of adverse events during a multifaceted program implementation. DESIGN Cross-sectional secondary analysis. SETTING The respiratory-ICU of a large tertiary care center. PARTICIPANTS Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used. INTERVENTIONS The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented. MAIN OUTCOME MEASURES Rates of adverse events (episodes per 1000 patient/days). RESULTS Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97). CONCLUSIONS A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU.
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Affiliation(s)
- Pablo Álvarez-Maldonado
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Arturo Reding-Bernal
- Research Division, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Alejandro Hernández-Solís
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico
| | - Raúl Cicero-Sabido
- Division of Pulmonology and Thoracic Surgery, General Hospital of Mexico, c/Dr. Balmis 148, Colonia Doctores, Delegación Cuauhtémoc, CP, Mexico City, Mexico.,Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Copilco, Cd. Universitaria, CP 04510 Coyoacán, Mexico City, Mexico
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Cázares-Sosa FR, Hernández-Solís A, Andrés-Dionicio AE, González-González H, Ibáñez-Hernández M, Cicero-Sabido R, Huerta H, Tapia-Romero R, De-la-Rosa-Arana JL. Comparative analysis of antibodies and lymphocytes in pulmonary tuberculosis patients with negative and positive cultures. J Infect Dev Ctries 2019; 13:28-34. [PMID: 32032020 DOI: 10.3855/jidc.10583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/29/2018] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The sputum smear or the culture are the definitive diagnosis of pulmonary tuberculosis. Only a fraction of clinical patients are culture-confirmed. METHODOLOGY A total of 24 clinical cases (40 ± 14 years old) with positive smear and negative co-morbidity were studied. Cases were selected from 600 patients who attended the pneumology service over two years. A sputum sample was cultured in Löwenstein-Jensen medium with consequent amplification of the rrnA V2 promoter, the differentiation region 4, and the IS6110 insertion sequence of Mycobacterium tuberculosis. After the culture result, the patients were divided into negative (n = 14) or positive (n = 10) culture groups. In addition, 30 samples from healthy donors (45 ± 10 years) were studied. The numbers of CD4, CD8 and CD19 lymphocytes were determined by flow cytometry. Levels of IgA and IgG to M. tuberculosis were measured by ELISA. RESULTS IgG and IgA levels were detected in patients with positive culture, while only IgA was found in patients with negative cultures. The lymphocyte populations in the two groups were similar. The presence of a pleural apical cap was found more frequently in patients with negative- (57%) than with positive cultures (10%). CONCLUSIONS The isotype profile in patients with positive cultures was both IgA and IgG positive, while in patients with negative culture, only IgA was found. The results will contribute to improve the diagnostic algorithm and appropriate treatment of patients with clinical tuberculosis. Further studies are needed to determine if this profile is predictive of the outcome of isolation.
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Affiliation(s)
| | | | | | | | - Miguel Ibáñez-Hernández
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México.
| | - Raúl Cicero-Sabido
- Servicio de Neumología, Hospital General de México, Ciudad de México, México.
| | - Herón Huerta
- Instituto de Diagnóstico y Referencia Epidemiológicos, Secretaria de Salud, Ciudad de México, México.
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Hernández-Solís A, González-Villa M, Ramírez-González E, González-González H, de la Torriente-Mata R, Reding-Bernal A, Cícero-Sabido R. [Nontuberculous mycobacteria in cervical lymphadenopathies of HIV positive and HIV-negative adults]. Rev Med Inst Mex Seguro Soc 2019; 56:456-461. [PMID: 30777413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Tuberculosis is a global public health problem, especially in emerging countries. Mycobacterium tuberculosis is the main cause of cervical lymphadenopathy; nontuberculous mycobacteria are relatively common in children and rare in adults. OBJECTIVE To identify and establish the frequency of infectious etiology by nontuberculous mycobacteria in Mexican adult patients with cervical lymphadenopathy. METHODS The study included 85 patients over 18 years with cervical lymphadenopathy; 45 were HIV-positive, 40 were HIV-negative; they had no history of tuberculosis treatment and were selected from a third-level hospital. It was carried out a biopsy of the lymph node for the histopathological study, a search for acid-fast bacilli, a tube culture to indicate growth of Mycobacterium BACTEC (MGIT-960) and identification of mycobacterial strain by PCR-RFLP (restriction fragment length polymorfism) of hsp65. RESULTS In 42 HIV-positive patients (93%), strains corresponded to Mycobacterium tuberculosis complex, two (4.4%) to M. intracellulare and one (2.2%) to M. gordonae. Among HIV-negative patients, 39 of strains (97.5%) corresponded to patients with M. tuberculosis complex and one strain (2.5%) to M. fortuitum. CONCLUSION The presence of nontuberculous mycobacteria was found in 4.7% of all cases. Despite this low frequency, it must be taken into account as a possible cause of lymphadenopathy, since its prompt identification enables introducing specific treatment.
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Affiliation(s)
- Alejandro Hernández-Solís
- Secretaría de Salud, Hospital General de México “Dr. Eduardo Liceaga”, Unidad de Neumología y Cirugía de Tórax. Ciudad de México, México
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Juárez-Ortega M, Rojas-Espinosa O, Muñiz-Salazar R, Becerril-Villanueva E, Hernández-Solís A, Arce-Paredes P, Islas-Trujillo S, Cicero-Sabido R. Sera from patients with active pulmonary tuberculosis and their household contacts induce nuclear changes in neutrophils. Infect Drug Resist 2018; 11:1685-1702. [PMID: 30349326 PMCID: PMC6188193 DOI: 10.2147/idr.s171289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Resident alveolar macrophages, dendritic cells, and immigrating neutrophils (NEU) are the first cells to contact Mycobacterium tuberculosis in the lung. These cells, and additional lymphoid cells in the developing granuloma, release a series of components that may concentrate in the serum and affect disease progression. Purpose The aim of this study was to investigate the effect of the serum from tuberculosis (TB) patients and their household contacts (HHC) on the nuclear morphology of NEU. Materials and methods NEU from healthy (HLT) people were incubated with sera from patients with active pulmonary TB, their HHC, and unrelated people. Changes in the nuclear morphology of NEU were analyzed by light and electron microscopy. Results Sera from patients with TB induced changes in the nuclear morphology of NEU that included pyknosis, swelling, apoptosis, and netosis in some cases. Sera from some HHC induced similar changes, while sera from HLT people had no significant effects. Bacteria did not appear to participate in this phenomenon because bacteremia is not a recognized feature of nonmiliary TB, and because sera from patients that induced nuclear changes maintained their effect after filtration through 0.22 µm membranes. Neither anti-mycobacterial antibodies, TNFα, IL-6, IFNγ, or IL-8 participated in the phenomenon. In contrast, soluble mycobacterial antigens were likely candidates, as small quantities of soluble M. tuberculosis antigens added to the sera of HLT people led to the induction of nuclear changes in NEU in a dose-dependent manner. Conclusion These results might help to detect subclinical TB within HHC, thus leading to a recommendation of prophylactic treatment.
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Affiliation(s)
- Mario Juárez-Ortega
- Department of Immunology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico,
| | - Oscar Rojas-Espinosa
- Department of Immunology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico,
| | - Raquel Muñiz-Salazar
- School of Health Sciences, Unidad Ensenada, Universidad Autónoma de Baja California, Ensenada, BC, Mexico
| | - Enrique Becerril-Villanueva
- Laboratory of Psychoimmunology, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | | | - Patricia Arce-Paredes
- Department of Immunology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico,
| | - Sergio Islas-Trujillo
- Department of Immunology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico,
| | - Raúl Cicero-Sabido
- Pneumology Unit, Hospital General de México "Eduardo Liceaga", UNAM, Mexico City, Mexico
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Hernández-Solís A, Cruz-Ortiz H, Gutiérrez-Díaz Ceballos ME, Cicero-Sabido R. [Bronchogenic cysts. Importance of infection in adults. Study of 12 cases]. CIR CIR 2015; 83:112-6. [PMID: 25986980 DOI: 10.1016/j.circir.2015.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bronchogenic cyst is a rare congenital malformation and commonly located in the mediastinum and lung parenchyma. OBJECTIVE To determine the clinical characteristics of the patients with diagnosis of bronchogenic cysts, their location and the infectious bacteria when the cysts are infected. The cases were collected from 1 January 2005 to 1 January 2013, in a third level hospital. MATERIAL AND METHODS The cases with bronchogenic cysts resected by thoracotomy were confirmed by histological study. Age, sex, admission diagnosis, location, size, imagenologic studies, and bacteriological cultures were evaluated. RESULTS Of the 12 cases with diagnosis of bronchogenic cysts surgically resected by thoracotomy, six were male and six female, with 50% located in lung parenchyma and 50% in mediastinum, one of the latter was para-oesophageal. Bacteriological study of the cystic content demonstrated bacterial infection in seven (58%) cases. CONCLUSIONS Bronchogenic cysts are rare congenital benign lesions. They must be resected because their content might be infected. The histopathology study is necessary to confirm the diagnosis, together with bacteriological examination. Thoracotomy is a safe procedure to resect bronchogenic cysts.
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Affiliation(s)
| | - Humberto Cruz-Ortiz
- Facultad de Medicina. Universidad Nacional Autónoma de México, México, D.F., México
| | | | - Raúl Cicero-Sabido
- Facultad de Medicina. Universidad Nacional Autónoma de México, México, D.F., México.
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Escobar-Escamilla N, Ramírez-González JE, González-Villa M, Torres-Mazadiego P, Mandujano-Martínez A, Barrón-Rivera C, Bäcker CE, Fragoso-Fonseca DE, Olivera-Díaz H, Alcántara-Pérez P, Hernández-Solís A, Cícero-Sabido R, Cortés-Ortíz IA. Hsp65 phylogenetic assay for molecular diagnosis of nontuberculous mycobacteria isolated in Mexico. Arch Med Res 2013; 45:90-7. [PMID: 24333253 DOI: 10.1016/j.arcmed.2013.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/22/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS Nontuberculous mycobacteria (NTM) are mainly distributed as important emerging pathogens in patients with chronic or immunosuppressive diseases. Accurate identification of causative species is crucial for proper treatment and patient follow-up. However, several difficulties are associated with phenotypic and molecular diagnostic methods for precise identification at the species level due to shared metabolic and genetic characteristics. We undertook this study to evaluate the application of the phylogenetic method based on hsp65 gene into Telenti's PCR-restriction enzyme analysis (PRA) for molecular identification of NTM. METHODS The study population was comprised of 1646 Mycobacterium clinical isolates (AFB positive) collected from 2008-2011, of which 537 (32.6%) were MNT identified by PRA analysis. DNA sequencing of hsp65 in 53 isolates (10%) was performed. Sequence identification through NCBI-Basic Local Alignment Search Tool (BLAST) achieved correct identification in 23 isolates. Phylogenetic trees including hsp65 available GenBank sequences for all described genres of NTM and hsp65 obtained sequences were constructed using Mega 5.05 software. We compared sequence identification based on phylogenetic clustering and BLAST similarity search. RESULTS Phylogenetic clustering allowed more specific differentiation of closely related species and clearer identification in comparison with BLAST; 30 Mycobacterium species (this is the first report of isolation of some of these from clinical samples in Mexico) were identified in this way. CONCLUSIONS The proposed 440 bp hsp65 phylogenetic method allows a better identification tool to differentiate Mycobacterium species and is useful to complement diagnosis and epidemiological surveillance of NTM.
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Affiliation(s)
- Noé Escobar-Escamilla
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - José Ernesto Ramírez-González
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - Maribel González-Villa
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - Pilar Torres-Mazadiego
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - América Mandujano-Martínez
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | | | | | - David Esaú Fragoso-Fonseca
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - Hiram Olivera-Díaz
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - Patricia Alcántara-Pérez
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico
| | - Alejandro Hernández-Solís
- Servicio de Neumología, Hospital General de México "Eduardo Liceaga", Secretaría de Salud, México, D.F., Mexico
| | - Raúl Cícero-Sabido
- Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F., Mexico
| | - Iliana Alejandra Cortés-Ortíz
- Departamento de Biología Molecular y Validación de Técnicas, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Secretaría de Salud, México, D.F., Mexico.
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Hernández-Solís A, Garcia-Hernández C, Reding-Bernal A, Cruz-Ortiz H, Cicero-Sabido R. [Malignant mesothelioma risk factors: experience in the General Hospital of Mexico]. CIR CIR 2013; 81:312-6. [PMID: 25063896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Malignant mesothelioma is a neoplasm of bad prognosis, it is linked with asbestos contact, but there are cases without this antecedent. OBJECTIVE To investigate the relationship of asbestos exposition and other factors with malignant mesothelioma. METHODS Retrospective analysis of histologic confirmed cases of malignant mesothelioma, neoplasic familiar history, tobacco smoking, exposure to wood smoke and to asbestos, were annotated in a paired case/control study 1: 1-3 with logistic regression model to identify risk factors for OR. RESULTS 61 cases of malignant mesothelioma were confirmed by histopathologic study, 41 male and 20 female. Mean age was 56 years ± 13 years; 56 cases (91.8%) correspond to epithelial malignant mesothelioma, three sarcomatous (4.9%) one desmoplastic and one biphasic. One in eight (13.1%) had exposure to asbestos. Model of logistic regression with four variables: history of familiar cancer, tobacco smoking, wood smoke and asbestos exposition, the the last one with an OR= 3.083 and p > 0.05. No other variables found to be a risk factor for malignant mesothelioma. CONCLUSIONS Exposure to asbestos is a risk factor for malignant mesothelioma, which is confirmed in this study, however it is important to extend the investigation of other possible causal factors of this disease.
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Affiliation(s)
- Alejandro Hernández-Solís
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México O.D. Secretaría de Salud, Mexico.
| | - Cyntia Garcia-Hernández
- Servicio de Neumología y Cirugía de Tórax. Hospital General de México O.D. Secretaría de Salud, Mexico.
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Gutiérrez-Díaz Ceballos ME, Hernández-Solís A, Cruz-Ortiz H, González-Atencio Y, Cicero-Sabido R. Solitary fibrous tumor. Clinic and pathological study of 16 cases. CIR CIR 2011; 79:417-423. [PMID: 22385761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a localized fibrous mesothelioma and was originally described as a benign pleural lesion. It is a mesenchymatous lesion that has been found in different structures and tissues of the human organism. It originates from a stromal fibroblastic cell positive to CD4. We undertook this study to determine the clinical and histopathological characteristics of SFT found from January 1, 2002--January 31, 2010 in a concentrated third-level general hospital in Mexico City. METHODS We present 16 resected cases of different localizations: three pleural, three mediastinal, three lung, two oral cavity, one nasopharyngeal, one in the lateral aspect of the neck, one kidney, one paratesticular and another in the crural region. All were studied with hematoxylin and immunoperoxidase. RESULTS There was similar affection in both genders. Mean age was 51 years (range: 43-81 years). Two pleural cases presented recurrence and one had hypoglycemia but none demonstrated metastases. No deaths were registered during a mean follow-up of 18 months. Histological pattern corresponded to a fusocellular growth that coincided with hemangiopericytoid zones in five cases and sarcomatoid in four. These cases were considered as mixed. All were positive to vimentin. CONCLUSIONS Definitive diagnosis must be made by immunoperoxidase. Immediate treatment is surgical resection; relapses.
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Hernández-Solís A, Cicero-Sabido R, Olivera H, Rivero V, Ramírez E, Escobar-Gutiérrez A. Tuberculosis is still a major cause of cervical lymphadenopathies in adults from developing countries. Epidemiol Infect 2004; 131:1071-6. [PMID: 14959772 PMCID: PMC2870054 DOI: 10.1017/s0950268803001304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To establish the frequency of infectious aetiology in Mexican adult patients with cervical lymphadenopathies (CLAs), 87 consecutive patients with enlarged cervical lymphatic nodes, HIV negative and without anti-tuberculous treatment, were selected from a tertiary-level speciality concentration hospital. Histopathological studies, investigation of acid-fast bacilli, cultures in Löwenstein Jensen and Mycobacterium growth indicator tube (MGIT) media, and in-house polymerase chain reaction (PCR) with IS6110-based primers for Mycobacterium tuberculosis complex were performed in resected lymphatic nodes. Non-infectious aetiology corresponded to 45 cases (52 %). Tuberculosis was suspected in 42 cases (48%) by histology and confirmed positive results were obtained by staining in 8 (19%), by culture in 23 (55%), and by PCR in 34 (81 %) patients. All were confirmed after therapeutic success. In addition to the epidemiological transition process occurring in Mexico, tuberculosis remains an important cause of CLA. Histopathology with confirmatory studies including PCR can detect tuberculous aetiology.
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Affiliation(s)
- A Hernández-Solís
- Unidad de Neumología, Hospital General de México and Facultad se Medicina, UNAM, México
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