ABSTRACT
Screening programs for colorectal cancer (CRC) are standard in most developed countries because they reduce mortality and are cost-effective. Within them, colonoscopy allows to directly visualize the colon and remove neoplastic lesions. However, it is an expensive exam with low adherence in asymptomatic individuals. The fecal occult blood test (FOBT) is a low-cost and risk-free method for the user, which results in a high rate of adherence, explaining its use in most screening programs. This article analyzes the effectiveness of different fecal occult blood tests in screening programs. The main conclusions are that the sensitivity of the guaiac-based chemical test for the detection of colorectal cancer is lower than that observed with qualitative and quantitative immunological tests. Automated quantitative methods allow objective readings independent of the operator and the reaction reading time, necessary for the analysis of large numbers of samples. The participation rate with immunological FOBTs is higher than with chemical ones, which is why they are preferred by the different countries that have screening programs. The use of quantitative tests allows stratification of symptomatic and asymptomatic patients at higher risk, in the screening programs.
Subject(s)
Humans , Colorectal Neoplasms/diagnosis , Occult Blood , Mass Screening , Colonoscopy , Early Detection of Cancer , GuaiacABSTRACT
El objetivo de este estudio fue establecer una asociación entre diversas variables demográficas y epidemiológicas con la agresividad del cáncer de próstata (CaP). Métodos: pacientes diagnosticados con CaP respondieron una encuesta que incluye el nivel de educación, los factores de riesgo cardiovascular (FRCV), los antecedentes familiares (HF) de CaP, consumo de alcohol, tabaquismo y otros. Se utilizó análisis univariado y multivariado (AMV) para establecer si los factores mencionados anteriormente afectan las variables asociadas con la agresividad del CaP, como la edad al momento del diagnóstico, el índice de Gleason, los márgenes positivos (MP) y las metástasis óseas (MO), entre otras. Resultados: se incluyeron ciento setenta y dos hombres en el análisis. Los pacientes con HF fueron diagnosticados a edades más tempranas que los pacientes sin HF (55,73 vs 66,45 años, p = 0,0001). Los pacientes que beben tienen un mayor número de MP que los pacientes que no (15 vs 4 pacientes, p = 0,04). El AMV mostró que los pacientes que consumen alcohol y los que fuman (activos o suspendidos) tuvieron un mayor riesgo de MP (OR = 4,45 y 4,1, IC 95 por ciento 1,16-17,07 y 1,14-14,72, respectivamente, ambos p <0,05). Los pacientes con mayor nivel de educación presentaron un mayor riesgo de CaP confinado (OR = 3,42, IC 95 por ciento 1,392-8,434, p = 0,007). Conclusiones: los pacientes que consumen alcohol, fuman y tienen un menor nivel de educación presentaron un mayor riesgo de desarrollar CaP agresivo. (AU)
The aim of this study was to establish an association between various demographic and epidemiological variables with aggressiveness of prostate cancer (PCa). Methods: Patients diagnosed with PCa, answered a survey that include level of education, cardiovascular risk factors (CVRF), family history (FH) of PCa, alcohol intake, smoke and others. Univariate and multivariate analysis (MVA) were used to establish whether the factors mentioned above affect variables associated with aggressiveness of PCa such as: age at diagnosis, Gleason score, positive margins (PM), and bone metastasis (BM). Results: One hundred and seventy two men were included in the analysis. Patients with FH had cancer diagnosed at younger ages (55.73 years to FH vs 66.45 years to no FH, p = 0.0001). Patients who drink had higher number of PM than patients who did not (15 vs 4 patients, p= 0.04). MVA showed that patients who consumed alcohol and patients who smoked (active or suspended) had an increased risk of PM (OR= 4.45 and 4.1, 95 percent CI 1.16-17.07 and 1.14-14.72, respectively, both p<0.05). Patients with higher level of education presented an increased risk of confined PCa (OR= 3.42, 95 percent CI 1.392-8.434, p= 0.007). Conclusions: Patients who consume alcohol, smoke and have lower level of education presented a higher risk of developing aggressive PCa. (AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Prostatic Neoplasms , Surveys and Questionnaires , Nicotiana , Alcoholic BeveragesABSTRACT
Although radioiodine (131-I) can be used as treatment of hyperthyroidism for patients in hemodialysis, its use is limited and the experience is mainly related to differentiated thyroid carcinoma. We report a 58 years old female on hemodialysis with recurrent hyperthyroidism after propylthiouracil treatment. She was successfully treated with 131-I and four months after the intervention her euthyroid state was confirmed. We measured 131-I activity in blood, dialysate liquid and other waste products, as well as patient radiation exposure rates. We found that 131-I elimination was prolonged through time with no major dependence on hemodialysis, as opposed to the elimination of 131-I in patients with thyroid carcinoma. This was probably due to high radiotracer uptake in hyper functioning thyroid tissue. Conversely, radiation content in dialysate wastes or equipment was minimal. Furthermore, the rate of both environmental exposure and exposure of nursing staff in charge of hemodialysis sessions, was minimal and met international security standards. In conclusion, I-131 therapy showed both appropriate effectiveness and safety in this case and may be considered as a suitable treatment alternative to thyroidectomy when antithyroid drugs are unsuccessful.
Subject(s)
Humans , Female , Middle Aged , Renal Insufficiency, Chronic/therapy , Hyperthyroidism/radiotherapy , Iodine Radioisotopes/therapeutic use , Renal Dialysis , Iodine Radioisotopes/pharmacokineticsABSTRACT
Background: Colorectal cancer (CRC) is an heterogeneous disease. Three carcinogenic pathways determine its molecular profile: microsatellite instability (MSI), chromosomal instability (CIN) and CpG island methylator phenotype (CIMP). Based on the new molecular classification, four consensus CRC molecular subtypes (CMS) are established, which are related to clinical, pathological and biological characteristics of the tumor. Aim: To classify Chilean patients with sporadic CRC according to the new consensus molecular subtypes of carcinogenic pathways. Material and Methods: Prospective analytical study of 53 patients with a mean age of 70 years (55% males) with CRC, operated at a private clinic, without neoadjuvant treatment. From normal and tumor tissue DNA of each patient, CIN, MSI and CIMP were analyzed. Combining these variables, tumors were classified as CMS1/MSI-immune, CMS2/canonical, CMS3/metabolic and CMS4/mesenchymal. Results: CMS1 tumors (19%) were located in the right colon, were in early stages, had MMR complex deficiencies and 67% had an activating mutation of the BRAF oncogene. CMS2 tumors (31%) were located in the left colon, had moderate differentiation, absence of vascular invasion, lymphatic and mucin. CMS3 tumors (29%) were also left-sided, with absence of vascular and lymphatic invasion, and 29% had an activating mutation of the KRAS oncogene. CMS4 tumors (21%) showed advanced stages and presence of metastases. Conclusions: This new molecular classification contributes to understanding the heterogeneity of tumors. It is possible to differentiate molecular subgroups of a single pathological diagnosis of adenocarcinoma, opening the door to personalized medicine.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , DNA, Neoplasm/genetics , Colorectal Neoplasms/genetics , Adenocarcinoma/genetics , Biomarkers, Tumor/genetics , DNA Methylation/genetics , Microsatellite Instability , Phenotype , Colorectal Neoplasms/pathology , Adenocarcinoma/pathology , Chile , Prospective Studies , Consensus , MutationABSTRACT
Background: In Chile, colorectal cancer (CRC) is often diagnosed in late stages. Thus, surgical treatment must be complemented with chemotherapy. KRAS mutations and microsatellite instability have been detected in these tumors. However, the response to treatment in patients without KRAS mutations varies and requires a better understanding. Aim: To determine the frequency and distribution of somatic point mutations in KRAS, BRAF and PIK3CA genes and microsatellite instability status (MSI) in patients with colon cancer (CC). Material and Methods: A prospective observational study of patients undergoing surgery for colon cancer. Tumor-derived DNA was analyzed by polymerase chain reaction (PCR) for the most frequent mutations of KRAS, BRAF and PIK3CA. PCR was also used to analyze MSI. Results: Fifty-eight patients with sporadic CC were analyzed, 16 showed KRAS mutations (G12R, G12D, G12V, G13D) and out of the 42 patients that did not show any mutation, 10 had mutations in BRAF (V600E) and PIK3CA (E542K, E545D, E545K, Q546E, H1047R). BRAF mutations alone or in combination with PIK3CA mutations were observed in 27% of high MSI tumors and in 2% of tumors without instability (p < 0.049). A higher percentage of high MSI tumors were located in the right colon (p < 0.001), and showed BRAF mutation (p < 0.020). Conclusions: The highest percentage of high MSI and BRAF mutations was observed in the right colon. Therefore, this study suggests the presence of different molecular features between right and left colon tumors that should be considered when defining the therapeutic management.
Subject(s)
Animals , Mice , Interferon Type I/immunology , Interferon-gamma/immunology , /immunology , /immunology , Interleukins/immunology , Macrophages/immunology , Mycobacterium tuberculosis/immunology , Tuberculosis/immunology , Interferon Type I/genetics , Interferon-gamma/genetics , /genetics , /genetics , Interleukin-1beta/immunology , Interleukins/genetics , Macrophage Activation/immunology , Macrophages/microbiology , Macrophages/pathology , Mice, Knockout , Tuberculosis/genetics , Tuberculosis/pathology , Tumor Necrosis Factor-alpha/genetics , Tumor Necrosis Factor-alpha/immunologyABSTRACT
Background: The molecular testing of KRAS mutation status in metastatic colorectal cancer patients is mandatory to identify patients eligible for anti-epidermal growth factor receptor monoclonal antibody therapy. Aim: To report the frequency of KRAS gene mutations in Chilean patients with colorectal cancer (CRC). Material and Methods: A cohort of 262 Chilean patients with CRC aged 26 to 90 years (53% males), was studied. KRAS mutation status was analyzed by real-time polymerase chain reaction and correlated with clinicopathological data. Results: Ninety-eight patients (37%) were positive for KRAS mutations. G12D was the most common mutation with a frequency of 36.7%, followed by G12V (25.5%), G13D (17.3%), G12A (7.1%), G12C (6.1%), G12S (5.1%) and G12R (2%). The frequency of the mutation in left, right colon and rectal tumors was 37.8, 32.6 and 44.9%, respectively. Among tumors with mutations, 86.7% were well or moderately differentiated tumors and the rest were poorly differentiated. No significant associations between KRAS gene mutations and other clinicopathological features of the tumor were observed. Conclusions: The frequencies of KRAS mutations reported in this study are similar to frequencies reported for European and North-American populations, lower than in a Spanish study and higher than in a Peruvian study.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Colorectal Neoplasms/genetics , Mutation , Proto-Oncogene Proteins/genetics , ras Proteins/genetics , Age Factors , Chile/ethnology , Colorectal Neoplasms/ethnology , Colorectal Neoplasms/pathology , DNA Mutational Analysis , DNA, Neoplasm/genetics , Epidermal Growth Factor/genetics , Neoplasm Invasiveness/genetics , Prospective Studies , Real-Time Polymerase Chain Reaction , Sex FactorsABSTRACT
La superación continua de los cuadros que dirigen los procesos universitarios constituye una prioridad desde perspectivas científicas que propicien la integración de lo gerencial con lo técnico, lo metodológico y lo investigativo; en correspondencia con las particularidades de cada contexto. La Dirección de Cuadros de la Universidad de Ciencias Médicas de Villa Clara, ha identificado brechas en las competencias gerenciales de los jefes de departamentos docentes para el trabajo metodológico e investigativo, que fueron caracterizadas científicamente mediante un estudio descriptivo transversal con enfoque cualitativo realizado en 12 jefes de departamentos docentes de la sede central seleccionados mediante un muestreo no probabilístico; la aplicación combinada de métodos teóricos y empíricos permitió constatar necesidades de aprendizaje, expresadas y encubiertas, referidas al trabajo metodológico y la aplicación de la política científica departamental que sugieren la proyección de acciones de capacitación pertinentes e inmediatas.
The on & on upgrading of the leaders who lead the university processes is a priority from the scientific perspective which propitiates the integration of the scientific and managerial aspects, and the methodological and researching ones; according to the peculiarities of each contest. The board of managers of Villa Clara University of Medical sciences has identified problems in the managerial competences of the head of the teaching departments in the methodological and researching work, which were scientifically characterized in a descriptive cross-sectional study with a qualitative approach, on a non probabilistic sampling the head of 12 teaching departments of the central site were selected. There were applied theoretical and empirical methods which made possible to state implicit and explicit learning necessities in reference to the methodological work and the application of the scientific policy in the departments that suggest the design of immediate and pertinent qualifying actions.
Subject(s)
Organization and Administration , Education, Medical , Methodology as a Subject , Faculty, MedicalABSTRACT
Background: Selection of patients with Lynch Syndrome (LS) for a genetic study involves the application of clinical criteria. To increase the rate of identification of mutations, the use of molecular studies as Microsatellite Instability (MSI) and Im-munohistochemistry (IHC) in the tumor has been proposed. Aim: To demonstrate the usefulness of MSI and IHC in the detection of mutations in patients with LS. Material and Methods: From our Familial Colorectal Cancer Registry, families suspected of LS were selected according to Amsterdam or Bethesda clinical criteria. Screening of germline mutations of MLH1, MSH2 and MSH6 genes was performed. In addition, analysis of MSI and IHC were performed in colorectal tumors. Results: A total of 35 families were studied (19 met Amsterdam and 16 met Bethesda criteria). Twenty one families harbored a germline alteration in MLH1, MSH2 or MSH6 (18 Amsterdam and 3 Bethesda). In these families, eighteen different alterations were found, 15 of which were mutations and 3 corresponded to variants of uncertain pathogenicity. On the other hand, 80% of the tumors showed positive microsatellite instability (27 MSI-high and 1 MSI-low), and immunohistochemical testing showed that 77% of tumors had the loss of a protein. Correlation between results of tumor molecular studies and the finding of germline nucleotide change showed that IHC and MSI predicted mutations in 81 and 100% of patients, respectively. Conclusions: MSI and IHC can efficiently select patients with a high probability of carrying a mutation in DNA repair genes.
Subject(s)
Humans , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Germ-Line Mutation , Microsatellite Instability , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , DNA Repair/genetics , Genetic Testing , ImmunohistochemistryABSTRACT
Se denomina pólipo intestinal a una lesión visible elevada o tumor que se proyecta desde la superficie epitelial al lumen visceral. En relación al número, presencia de antecedentes familiares, manifestaciones extraintestinales y estudios genéticos es que se constituyen diversas poliposis intestinales. Si bien, las poliposis intestinales se manifiestan en general en la edad adulta, existen manifestaciones que pueden hacer sospechar la presencia de un síndrome poliposico hereditario en la infancia. Además en una proporción considerable estas poliposis presentan manifestaciones extraintestinales, tanto benignas como tumores en otros órganos. Es por esto, que una alta tasa de sospecha, en particular frente a pacientes con antecedentes familiares, puede conducir a un diagnóstico y tratamiento oportuno, además de considerar a la familia como potenciales pacientes e ingresar al grupo familiar a un registro de tumores hereditarios. Diversas técnicas de biología molecular han permitido la identificación de las mutaciones que son heredadas en estas enfermedades, permitiendo realizar conductas preventivas al saber el riesgo de cada persona en una familia afectada. El objetivo de esta revisión, es caracterizar las distintas poliposis intestinales, en cuanto a sus manifestaciones clínicas, clasificaciones, estudio genético y enfrentamiento multidisciplinario.
Polyps are solid or tumoral elevated lesions that arise from the intestinal epithelium so that they become visible in the intestinal epithelium so that they become visible in the intestinal lumen. Information regarding familial history, number, extraintestinal manifestations and genetic studies of polyps, assemble different types of intestinal polyposis. Generally, clinical manifestations occur in adult patients, although in children there are several signs that should make the physician suspect a hereditary polyposis syndrome. In addition it is important to know extraintestinal manifestations which are mostly benign but tumors may be present in other organs too. Bearing in mind that high clínical suspicion of hereditary polyposis syndrome especially if familial history is present, provides early diagnosis and appropriate treatment for the patient and eventually for the family members that could be affected, entering that family in a registry of hereditary tumors. Molecular biology has created different techniques to identify the presence of hereditary mutations that are specific for intestinal polyposis. Acknowledgment of these mutations establishes risks groups allowing adequate prevention strategies. The objective of this revision is to characterize and different types of intestinal polyposis, according to clinical manifestations, classification, genetic study and multidisciplinary approach.
Subject(s)
Humans , Adenomatous Polyposis Coli/genetics , Intestinal Polyposis/classification , Intestinal Polyposis/diagnosis , Intestinal Polyposis/genetics , Colonoscopy , Diagnostic Imaging , Neoplastic Syndromes, HereditaryABSTRACT
El propósito de este estudio fue evaluar el grabado del esmalte con ácido fosfórico al 37 por ciento en diferentes tiempos de aplicación en piezas con ápices inmaduro y maduro por medio de microscopía electrónica de barrido (MEB). Se incluyeron 40 premolares humanos de recientes extracción, 20 con ápice inmaduro y 20 con ápice maduro. Los especímenes fueron seccionados, grabados durante 15, 30, 45 y 60 segundos y analizados por medio de MEB. Los datos fueron evaluados con la prueba de J2 (chi cuadrado). Los resultados no revelaron diferencias significativas entre los dientes con ápice inmaduro y maduro al utilizar tiempos de 15, 30 y 45 seugndos, excepto en las piezas con ápice maduro tratados por 60 segundos donde encontramos los peores resultados (p<0.05). Bajo las condiciones de este estudio, concluimos que el grabado del esmalte en piezas con ápice maduro no debe de ser realizado clínicamente por períodos de 60 segundos