Since the middle of the last century, North America and occidental countries have reported variations in the frequency of gastrointestinal neoplasms. Several environmental factors, mainly nutritional ...and dietary exposure, as well as habits have contributed to these changes. We have documented these changes in Mexico during the last 35 years.
To define the epidemiologic changes of gastrointestinal neoplasms during the last three decades in our population.
We summarized the evidence of an observational study, registering the frequency of different gastrointestinal malignancies from four institutions of socioeconomically different populations in Mexico City during 35 years. The Mexican National Academy of Medicine supported this effort. During this period, two nutritional surveys took place, letting us define the relationship between dietary changes and cancer occurrence.
Replacement of gastric cancer by colorectal cancer as the leading gastrointestinal malignancy. Relationship between cancer and diet changes. Increase of esophageal adenocarcinoma in relation to epidermoid carcinoma secondary to gastroesophageal reflux and Barrett's esophagus rising incidence. Gall bladder cancer had a high frequency in one institution, probably related to genetic and racial factors.
This epidemiologic data should lead us to implement sanitary measures for the prevention, early diagnosis, and appropriate treatment of gastrointestinal neoplasms.
The objective of the study was to evaluate the effects of a multidisciplinary intervention on the outcomes of polypathological patients (PP).
A multicenter quasi-experimental pre-post study with a ...12-month follow up was performed. In-hospital, at discharge and outpatient clinics patients who met criteria of PP between March 2012 and October 2013 were included. The multidisciplinary approach was defined by 11 interventions performed by general practitioners, internal medicine physicians, team care nurses and hospital pharmacists. The primary outcome was reduction in the number of hospital admissions and days of hospitalization. Secondary outcomes included mortality and the effects of 11 interventions on mortality.
420 patients were included. Mean patient age was 77.3 (SD: 8.90) and average number of PP defining categories was 2.99 (SD: 1.00). Number of hospital admissions and days of hospitalization decreased significantly after intervention: 1.52 (SD: 1.35) versus 0.82 (SD: 1.29), p<0.001, and 13.77 (SD: 15.20) versus 7.21 (SD: 12.90), p<0.001 respectively. 12-month mortality was 37.7%. PP who failed to receive a structured medical visit from the internal medicine physician and educational workshops from the team care nurses had a higher risk of exitus in the next 12 months, HR: 1.68; 95% CI: 1.15–2.46, p=0.007 and HR: 2.86; 95% CI: 1.92–4.27, p<0.001, respectively.
This multidisciplinary intervention reduced the risk of PP hospital admission and days of hospitalization. Educational workshop programs for PP and their caregivers and structured IM medical visits were associated with improvements of survival.
El objetivo del estudio fue evaluar los resultados en salud tras la implantación de una intervención multidisciplinar a pacientes pluripatológicos (PP).
Se realizó un estudio multicéntrico antes-después cuasi-experimental, con seguimiento a 12 meses. Se incluyeron pacientes que cumplían los criterios de PP entre marzo de 2012 y octubre de 2013, tanto en el ámbito hospitalario como en atención primaria. El enfoque multidisciplinar fue definido por 11 intervenciones realizadas por médicos de familia, médicos internistas, enfermeras y farmacéuticos hospitalarios. El resultado fundamental fue la reducción en el número de ingresos hospitalarios y días de hospitalización al año de seguimiento. Los resultados secundarios incluyeron la mortalidad y los efectos de las intervenciones sobre la misma.
Se incluyeron 420 pacientes. La edad media de los pacientes fue de 77,3 (DE: 8,90) y la media de categorías definitorias de PP fue de 2,99 (DE: 1,00). El número de ingresos hospitalarios y los días de hospitalización disminuyeron significativamente después de la intervención: 1,52 (DE: 1,35) versus 0,82 (DE: 1,29), p<0,001 y 13,77 (DE: 15,20) versus 7,21 (DE: 12,90), p<0,001, respectivamente. La mortalidad a los 12 meses fue del 37,7%. Los PP que no recibieron la visita médica estructurada del médico internista tras la inclusión y los talleres educativos de las enfermeras tuvieron un mayor riesgo de exitus en los 12 meses de seguimiento, HR: 1,68; IC del 95%: 1,15-2,46, p=0,007 y HR: 2,86; IC del 95%: 1,92-4,27, p<0,001, respectivamente.
Esta intervención multidisciplinaria reduce el riesgo de ingreso y los días de ingreso hospitalario en PP. Los programas de talleres educativos para PP y sus cuidadores, y las visitas médicas estructuradas por parte de medicina interna se asociaron con una mayor supervivencia.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, ...prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.
Mixoma gigante de la aurícula derecha Valdés Martín, Alexander; Ortega Torres, Yanela Yordanka; Hevia Sánchez, Luis ...
Revista Cubana de Investigaciones Biomédicas,
06/2012, Volume:
31, Issue:
2
Journal Article
Peer reviewed
Open access
Los tumores primarios del corazón son raros, con una incidencia estimada de 0,0017-0,19 %.Los mixomas cardíacos son los más frecuentes (50 %). La localización en la aurícula derecha es inusual y ...ocurre solo en el 15-20 % de los casos. Su presentación clínica puede ser asintomática, con presencia de síntomas constitucionales o dependientes de una obstrucción cardíaca o un embolismo pulmonar. Presentamos el caso de un paciente masculino de 36 años de edad con historia de astenia, palpitaciones y disminución de la capacidad funcional. La ecocardiografía transtorácica mostró una gran masa en la aurícula derecha, prolapsando al interior del ventrículo derecho y obstruyendo la válvula tricúspide. El paciente fue sometido a cirugía de bypass cardiopulmonar y la masa (9 × 9 cm) fue extirpada sin complicaciones. El examen histológico confirmó el diagnóstico de mixoma.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Las enfermedades crónicas no transmisibles son una prioridad de salud pública, representan las principales causas de enfermedad y muerte en el mundo y en Tunja; se estima que el consumo diario de ...cinco porciones de fruta y/o verdura es un factor protector que puede contribuir a la disminución de este tipo de enfermedades, no obstante, en Tunja, en la población de 15 a 44 años de edad, este consumo es insuficiente. Objetivo: diseñar, implementar y evaluar una estrategia de intervención para incrementar la disponibilidad de verduras en una comunidad de Tunja. Metodología: estudio cualitativo en el que se aplicaron cinco principios de la investigación basada en comunidad. Tuvo dos componentes: educativo y agricultura urbana, que se desarrollaron en cuatro fases: inserción en la comunidad, diseño, implementación y evaluación. Resultados: se realizaron siete sesiones educativas de carácter participativo y se implementaron ocho huertas caseras y una huerta comunitaria, aspectos que permitieron reflejar la importancia del consumo de verduras en la alimentación diaria. Se logró empoderamiento comunitario, construcción de redes sociales y visualización del rol del profesional de enfermería en el campo comunitario. Discusión: este proyecto es un referente piloto a nivel local que contribuye a la efectividad de procesos educativos en la ciudad y en contextos similares en torno al tema de alimentación saludable. Conclusión: la estrategia de intervención permitió incrementar la disponibilidad de verduras, empoderar a la comunidad, crear redes sociales y visualizar al profesional de enfermería en el direccionamiento y liderazgo de acciones comunitarias tendientes a promocionar estilos de vida saludables.
Bite mark analysis assumes the uniqueness of the dentition can be accurately recorded on skin or an object. However, biting is a dynamic procedure involving three moving systems, the maxilla, the ...mandible, and the victim's reaction. Moreover, bite marks can be distorted by the anatomic location of the injury or the elasticity of the skin tissue. Therefore, the same dentition can produce bite marks that exhibit variations in appearance. The complexity of this source of evidence emphasizes the need for new 3D imaging technologies in bite mark analysis. This article presents a new software package, DentalPrint (2004, University of Granada, Department of Forensic Medicine and Forensic Odontology, Granada, Spain) that generates different comparison overlays from 3D dental cast images depending on the pressure of the bite or the distortion caused by victim-biter interaction. The procedure for generating comparison overlays is entirely automatic, thus avoiding observer bias. Moreover, the software presented here makes it impossible for third parties to manipulate or alter the 3D images, making DentalPrint suitable for bite mark analyses to be used in court proceedings.
Changes in the levels of homovanillic acid in blood plasma (pHVA) may reflect changes which occur in the brain. In healthy individuals, this concentration of pHVA is stable over time.
Over the course ...of one month, we studied 98 acute schizophrenic patients who had not been taking any medication but were administered neuroleptics upon hospital admission, together with 23 chronic schizophrenic patients on long-term treatment from whom medication was withdrawn. Blood samples were taken at regular intervals from each individual and the concentration of plasma homovanillic acid was measured.
We found relative stable values of pHVA with an intraclass correlation coefficient of 0.363 in acute patients and 0.638 (
p
<
0.0001) in chronic patients, although no differences were found in mean values (13.79 and 14.18 μg/L, respectively) or in the variation range (7.20 to 26.7 μg/L and 6.96 to 29.96 μg/L respectively). The index of individuality was calculated to be 1.36 in acute patients and 0.74 in chronic patients.
Despite the wide range of values in the concentration of pHVA and the presence of pharmacological stimuli, we found a certain reproducibility in the levels of this dopamine metabolite. These findings are consistent with the idea that the dopaminergic activity is characterized by a constitutive value which would be under genetic control. The higher stability observed in chronic patients may reflect a weaker, age-related dopaminergic plasticity; conversely, it may indicate that a lack of plasticity in response to a pharmacological stimulus may be an indicator of poorer prognosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
El objetivo de esta revisión fue conjuntar conceptos relacionados con estudios dirigidos a elucidar los mecanismos de defensa contra agentes causantes de enfermedades, principalmente en poscosecha. ...Al igual que las plantas, los frutos se encuentran expuestos al ataque por patógenos que producen podredumbres durante su almacenamiento en poscosecha, causando considerables pérdidas. Para el control de dichos patógenos, se emplean productos químicos de síntesis que son tóxicos, y la resistencia genética se considera una alternativa viable. Los frutos pueden tolerar a los patógenos mediante barreras físicas (presencia de capas gruesas de cutícula o de tricomas) y químicas, o bien, a través de defensas inducidas que se activan una vez que el huésped detecta la presencia del patógeno, desencadenando la explosión oxidativa durante las primeras horas de la interacción. Esta explosión conlleva la generación de especies reactivas de oxígeno (ROS) como el superóxido (O2ˉ), el radical hidroxilo (OHˉ) o el peróxido de hidrógeno (H2O2), y la activación de genes involucrados en diversas rutas metabólicas. El estudio de tales mecanismos puede permitir detectar materiales genéticos resistentes a enfermedades, reduciendo así el uso de productos tóxicos.
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