Mexico City, The Federal District, Mexico

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    ABSTRACT: Objective: The World Health Organization endorsed the Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis, but there is limited information about the utility of this assay for the diagnosis of tuberculous lymphadenitis. Therefore, the objective of this study was to assess the diagnostic accuracy of Xpert MTB/RIF assay in HIV-infected patients with palpable cervical lymph nodes. Study Design: Prospective, diagnostic test study. Methods: Consecutive patients with cervical lymphadenopathy were prospectively enrolled between January 2011 and March 2013. Lymph node specimens were obtained through fine-needle aspiration or excisional biopsy. Mycobacterial culture was considered as the gold standard. Results: Mycobacterium tuberculosis was cultured from 15 of 68 specimens (22.05%), and 53 specimens had negative cultures (77.94%). The sensitivity of Xpert MTB/RIF was 100% (95% CI, 74.65-100%); and the specificity was 100% (95% CI, 91.58-100%). Smear microscopy had a lower diagnostic performance. Conclusion: Although based on a limited sample size, our study indicates that Xpert MTB/RIF is a useful method for the diagnosis of cervical tuberculous lymphadenitis in HIV-infected patients, regardless of the bacillary load in smear positive samples or the CD4 T cell count. The sensitivity, specificity, positive predictive value and negative predictive value were similar to gold-standard culture.
    The Laryngoscope 06/2014; 124(6). DOI:10.1002/lary.24478
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    ABSTRACT: Results supporting the use and the effectiveness of positive expiratory, pressure devices in chronic obstructive pulmonary disease (COPD) patients are still controversial, We have tested the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over, pharmacological therapy only in patients with severe COPD. Fourty-five patients were randomized in three groups: a group was treated; with IPPB,a group was treated with TPEP and a group with pharmacological; therapy alone (control group). Primary outcome measures included the measurement of scale or, questionnaire concerning dyspnea (MRC scale),dyspnea,cough, and, sputum (BCSS) and quality of life (COPD assessment test) (CAT). Secondary, outcome measures were respiratory function testing,arterial blood gas,analysis,and hematological examinations. Both patients in the IPPB group and in the TPEP group showed a significant, improvement in two of three tests (MRC,CAT) compared to the control, group.However,in the group comparison analysis for, the same variables between IPPB group and TPEP group we observed a, significant improvement in the IPPB group (P≤.05 for MRC and P≤.01 for, CAT). The difference of action of the two techniques are evident in the results of, pulmonary function testing: IPPB increases FVC, FEV1, and MIP; this reflects, its capacity to increase lung volume. Also TPEP increases FVC and FEV1 (less, than IPPB), but increases MEP, while decreasing total lung capacity and, residual volume. The two techniques (IPPB and TPEP) improves significantly dyspnea; quality of; life tools and lung function in patients with severe COPD. IPPB demonstrated a greater effectiveness to improve dyspnea and quality of life tools (MRC, CAT) than TPEP.
    Archivos de Bronconeumología 12/2013; 50(1). DOI:10.1016/j.arbr.2013.12.008
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    ABSTRACT: IntroductionAlthough spirometry quality standards for children were proposed by American Thoracic Society/European Respiratory Society (ATS/ERS) in 2007, there is limited information on the percentage of children that fulfill these criteria during routine clinical testing, especially among 5-to-8-year-olds. Aims of the Studyto report the percentage of children that met the current 2007 ATS/ERS quality criteria; explore factors potentially associated with poor quality spirometry; and ascertain the repeatability of forced expiratory volume at 0.5sec (FEV0.5), and at 1sec (FEV1), as well as forced vital capacity (FVC). Methods We evaluated the quality of spirometries without bronchodilator use performed at our laboratory in 2008 by 5-to-8-year-old children. FEV1, FEV0.5, FVC, back-extrapolated volume (BEV), forced expiratory time (FET), number of acceptable maneuvers, and repeatability, were computed and the percentage of tests that met the quality criteria standards was calculated. Based on our results, we propose a quality scoring system for spirometry for children that grades on a scale from A-to-F. ResultsThree hundred seventy-six spirometries were reviewed. Mean age was 6.7 years; (53% males); 68% fulfilled the 2005 and 2007 ATS/ERS quality standards; >90% reached a repeatability 150 and 100ml, or 10%, in FVC or FEV1; 87.2% reached FET 3sec; 88% had a BEV 80ml. The 90 percentile repeatability was 120ml for FVC and FEV1. Quality improved with age. Conclusions Our results support the proposal that a FET 3sec, a BEV 80ml, and repeatability in FEV1 and FVC 100ml, or 10%, be taken into account as elements in quality control for spirometry in children. Pediatr Pulmonol. 2013; 48:1231-1236. (c) 2013 Wiley Periodicals, Inc.
    Pediatric Pulmonology 12/2013; 48(12). DOI:10.1002/ppul.22765


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    Calzada de Tlalpan 4502, 14080, Mexico City, The Federal District, Mexico
  • Head of Institution
    Dr. Jorge Salas Hernández
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    +52 55 54871700
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Salud publica de Mexico 37(4):344-53.
100 Reads
New England Journal of Medicine 07/2009; 361(7):680-9. DOI:10.1056/NEJMoa0904252
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