Decreased levels of cathepsin Z mRNA expressed by immune blood cells: diagnostic and prognostic implications in prostate cancer

Cathepsin Z (CTSZ) is a cysteine protease responsible for the adhesion and migration of both immune and tumor cells. Due to its dual role, we hypothesized that the site of CTSZ expression could be determinant of the pro- or anti-tumorigenic effects of this enzyme. To test this hypothesis, we analyzed CTSZ expression data in healthy and tumor tissues by bioinformatics and evaluated the expression levels of CTSZ mRNA in the blood cells of prostate cancer (PCa) patients by qRT-PCR compared with healthy subjects, evaluating its diagnostic and prognostic implications for this type of cancer. Immune cells present in the blood of healthy patients overexpress CTSZ. In PCa, we found decreased CTSZ mRNA levels in blood cells, 75% lower than in healthy subjects, that diminished even more during biochemical relapse. CTSZ mRNA in the blood cells had an area under the curve for PCa diagnosis of 0.832, with a 93.3% specificity, and a positive likelihood ratio of 9.4. The site of CTSZ mRNA expression is fundamental to determine its final role as a protective determinant in PCa, such as CTSZ mRNA in the blood cells, or a malignant determinant, such as found for CTSZ expressed in high levels by different types of primary and metastatic tumors. Low CTSZ mRNA expression in the total blood is a possible PCa marker complementary to prostate-specific antigen (PSA) for biopsy decisions, with the potential to eliminate unnecessary biopsies.

Resultados preliminares en la implementación de una técnica de detección de ganglio centinela en cáncer de cuello uterino y endometrio en un hospital público y centro formador en chile / Preliminary results in the implementation of a sentinel node detection technique in cervical and endometrial cancer in a public hospital and training center in Chile

Resumen Objetivo Evaluar el rendimiento diagnóstico de la técnica de azul patente (disponible en todo el territorio nacional) en el ganglio centinela para la estadificación del cáncer cérvico uterino y en-dometrial. Método Estudio prospectivo realizado entre enero de 2014 y diciembre de 2018. Se evaluó la técnica de azul patente para la detección de ganglio centinela en la estadificación del cáncer cérvico uterino y endometrial, antes de la linfadenectomía pélvica estándar. La inyección del azul patente se aplicó en el cuello uterino (1 cc 1 cm de profundidad y 1 cc superficial) a las 3 y 9 horas, 20 minutos antes del inicio de la cirugía (laparotomía o laparoscópica). La identifica-ción y extracción del ganglio centinela fue realizado por un ginecólogo oncólogo certificado y evaluado mediante histología tradicional con hematoxilina y eosina (H&E). Resultado Se realiza-ron un total de 80 cirugías. El ganglio centinela se identificó en 75 (94%) pacientes, 60 (75%) bilateralmente; Con una detección media de 1,9 nodos por paciente. El sitio de identificación más frecuente fue la fosa obturatriz (43,9%), seguida de los vasos ilíacos externos. Otro 2,6% de los nodos fueron encontrados en sitios poco comunes. Entre los ganglios linfáticos seleccio-nados, 10 casos fueron positivos para el cáncer. No hubo ganglio centinela falso negativo. La tasa de detección fue del 83%, con una especificidad del 95%. Conclusiones Los datos aquí expuestos nos permiten estandarizar e implementar el uso de gan-glio centinela con azul patente. El uso de GC adecua la cirugía a la necesidad de la paciente, con una clara disminución en la incidencia de complicaciones asociadas a la linfadenectomía. Este trabajo forma parte de un estudio inicial el cual se debe complementar con el uso de la tin-ción de verde de indocianina y el estudio anatomo patológico con ultraestadiaje para obtener una validación e implementación adecuada del GC en la etapificación en cáncer de cérvix y endo-metrio.

SUMMARY Objective To assess the diagnostic performance of patent blue dye technique (available in the whole country) in sentinel lymph node for cervical and endometrial cancer staging. Methods A prospective cohort study was conducted between January 2014 to December 2018. Patent blue dye technique was assessed for the detection of sentinel lymph node in cervical and endometrial cancer staging, before standard pelvic lymphadenectomy. Blue dye injection was applied in the cervix (1cc 1cm deep and 1cc superficial) at 3 and 9 hour, 20 minutes prior start-ing a surgery (laparotomy or laparoscopic). The sentinel lymph node was collected by a certified surgeon and assessed by traditional histologic hematoxylin and eosin stain. Results A total of 80 surgeries were performed. The sentinel lymph node was identified in 75 (94%) patients, 60 (75%) bilaterally; with an average detection of 1,9 nodes per patient. The most common site of identifi-cation was the obturator fossa, followed by the external iliac vessels (43,9%). 2,6% of the nodes were found in uncommon sites. 10 lymph nodes were cancer-positive. There were no false neg-ative sentinel node.Overall in our cohort the detection rate was 83% for specificity 95%. Conclusions Our data presented in this publication allow us to safely standardize and implement a sentinel lymph node technique with patent blue. This technique will allow us to adapt the sur-gery for the patient's needs, diminishing the incidence of complications associated with lym-phadenectomy. This is the first stage of our work which we must complement with indocyanine green and pathological study with ultrastaging to obtain an adequate validation and implementa-tion of sentinel node in cervical and endometrial cancer staging.

Las coordenadas pedagógicas del cuidado a los enfermos en las Órdenes Religiosas con Voto de Hospitalidad / Pedagogic coordinates in the care of sick under the Religious Orders with Hospitality Vow

Objetivo: Explicar las coordenadas ideológico-formativas del cuidado a los enfermos en el seno de las órdenes religiosas con voto de Hospitalidad. Método: Histórico documental y gadameriano. Resultados: Las fuentes sometidas a estudio nos informan que el cuidado a los pobres y enfermos queda bajo control eclesiástico, a diferencia del mundo de la reforma en donde las órdenes religiosas son abolidas. El dogma, que emana del Concilio de Trento, acerca de la Salvación de las Almas a través de las Obras, es el postulado pedagógico donde se construyen las coordenadas ideológicas-formativas del cuidado a los enfermos y en donde no se advierte una intención propedéutica, más allá del cenobio, para las personas encargadas del cuidado a los enfermos, dado que se trata de personas consagradas a Dios, mediante Votos Solemnes. Conclusiones: Hemos podido constatar, a través del estudio de las Reglas y Constituciones de las principales órdenes religiosas con voto de Hospitalidad, que las coordenadas pedagógicas en las que se inscribe la formación de las personas encargadas del cuidado a los enfermos son de cuño eclesiástico, basadas en el dogma tridentino por el cual: las Obras, y no sólo la Fe, son necesarias para la Salvación del Alma. Es por ello, que el desarrollo de esta actividad humana, inscrita en la Caridad, no asume la intención de conformarse como "oficio-profesión" y, por ende, se configura como un obstáculo epistémico.

Objective: To explain the ideological and formation coordinates in the care of sick under the religious Orders with Hospitality Vow. Method: Historical documentary and gadamerian. Results: The sources we studied inform us that care provided to the poor and sick is under ecclesiastic control, contrasting with the reform world in which religious Orders are abolished. The dogma, which emanates from the Trent Council, and which refers to the Salvation of the Soul through the actions, is the pedagogic postulate for the ideological and formative coordinates of care, wherein a propaedeutic intention, not beyond the monastery, characterizes the care providers consecrated to God by means of their Solemn Vows. Conclusions: We have been able to verify that, through the study of the rules and Constitutions of the main religious Orders with Vow. of Hospitality, the pedagogic coordinates related to people in charge of care are ecclesiastic and based on the Tridentine dogma, which states that actions, and not only faith, are necessary for Salvation of the human Soul. This is why the development of this Charity-inserted activity does not assume an intention to settle as an "office-profession". This results in an epistemic obstacle.

A tutorial in genetic epidemiology and some considerations in statistical modeling

A new door has been opened to health professionals since the completion of the map of the human genome was announced in 2003, coinciding with the 50th anniversary of the discovery of the DNA helical structure by Watson and Crick in 1953. The continuous updating of the technology has enabled scientists to simultaneously analyze thousands of variables for genome analysis. These advances have created new opportunities to locate genes, to assess the gene-gene relationship, to measure the gene-environment interaction, to describe gene products, and to evaluate the gene-disease relationship. In epidemiology, new strategies have been developed to determine cause-effect relationship in case-control studies and cohort studies. With the information provided by the Human Genome Project, new epidemiological designs and new statistical methodology have been developed. The addition of molecular biology to traditional epidemiological approaches has given birth to a new discipline known as genetic epidemiology. The objective of this paper is to provide an introduction to concepts needed for assessing the association between genes and specific diseases in population based studies. Firstly, a description of the genetic concepts is presented as a framework for the epidemiological designs and the statistical procedures that have been utilized in genetic epidemiology. Then, a description of the different designs in genetic epidemiology is presented with the most recent publications. Finally, some considerations in the statistical analysis for genetic epidemiology are discussed.

Hepatitis C in Puerto Rico: a time for public health action

Studies investigating the seroprevalence of HCV infection have been carried out in diverse populations, showing an estimated worldwide prevalence of 3%. A seroprevalence survey conducted among randomly selected non-institutionalized adults aged 21-64 years in San Juan, Puerto Rico in 2001-2002 revealed that 6.3% were positive for HCV antibodies. These data suggest that Puerto Ricans are burdened with a significantly greater prevalence of HCV infection compared to the general United States population aged 20-69 years (0.9%-4.3%). This article illustrates data from different sources that taken together establish the need to start addressing HCV infection in Puerto Rico with prompt and decisive public health actions. Some of these include (1) establish hepatitis C prevention as a priority for state and municipal public health authorities, (2) raise awareness and educate target populations about HCV transmission and prevention, (3) increase clinician awareness of the HCV reporting system and the epidemiology and management of hepatitis C, (4) increase availability of diagnosis and treatment facilities, (5) increase access to effective drug treatment services, and (6) develop appropriate control measures to help reduce continued transmission in correctional settings.

Las lesiones placentarias en la infección humana por Trypanosoma cruzi / Placental lesions in human Trypanosoma cruzi infection

This histopathological study analyzes placentas of babies congenitally infected with T. cruzi (M+B+), or babies not infected but born from infected- (M+B-), or non infected-mothers (M-B-). Placentas M+B+ showed lesions of chorionitis, chorioamnionitis and cord edema with lymphocyte infiltration, whereas such lesions were infiltrated only with polymorphonuclear cells in M+B- and M-B- placentas. Parasites were found in M+B+ placentas, in fibroblasts and macrophages of chorion, membranes, chorionic plate, mainly in the area of membrane insertion, as well as in cells of Wharton jelly and myocytes of umbilical cord vessels. These results suggest that the materno-fetal transmission of parasites occurs mainly through the marginal sinus, spreading into the chorionic plate infecting fibroblasts and macrophages so far as to found a fetal vessel, inducing a fetal infection by hematogenous route.

Dosificación de anticuerpos IgM e IgA anti-trypanosoma cruzi en sangre de recién nacidos de madres con serología positiva para Chagas / Serum levels for IgM and IgA antibodies to anti-trypanosoma cruzi in samples of blood from newborns from mothers with positive serology for Chagas disease

This study compares the levels of specific antibodies IgM and IgA for Chagas in samples of blood from newborns. Three groups of cord blood samples have been analysed: a group of 42 samples from newborns, displaying positive parasitemia, of seropositive mothers (M+B+), 68 samples from newborns with negative parasitemia whose mothers were seropositive (M+B-) and a group of 45 control newborns coming from mothers with negative serology for Chagas. From the 42 M+B+ samples with congenital Chagas disease, 81 and 82.9% displayed detectable levels of IgM and IgA antibodies, respectively In the M+B- group, 70.6 and 33.8% presented antibodies of IgM and IgA classes, respectively, whereas in the control group M-B-, we detected 6% and 11.1% of IgM and IgA antibodies, respectively. The calculated sensitivity of detection of congenital cases using IgM or IgA antibodies was of 82.9% and 80.9% respectively, whereas the specificity of detection was of 29.4% for IgM antibodies and of 66.1% for IgA antibodies.

Estimación de la parasitemia en la infección humana por Trypanosoma cruzi: las altas parasitemias están asociadas con la severa y fatal enfermedad de Chagas congenita / Estimation of the parasitemia in Trypanosoma cruzi human infection: high parasitemias are associated with severe and fatal congenital Chagas disease

The aim of this study was to validate the method of microhematocrit tube, as a rapid method to estimate the parasitemia in blood and to associate the parasites concentration with the morbidity and mortality of new born children with congenital Chagas diseases. Our results were determined experimentally and shown that the detection limit of the microhematocrit tube method is 40 parasites/ml when at least one of the four observed tubes is positive. Besides, it was also established that when the four examined tubes are positive the parasitemia in blood reaches more than 100 parasites/ml. It is important to highlight the modification made by our laboratory in the microscopic observation of the microhematocrit tubes with respect to the methodology used by previous investigators. A positive association exists between a high number of parasites in blood and the morbi-mortality of the newly born children with congenital chagas. The results of positive association between the parasitic load and the morbility and mortality could constitute an argument to understand the possible role of the parasite in the pathology of the disease.

Tratamiento integral de la enfermedad de Chagas congenita: la experiencia boliviana / Integral treatment of congenital Chagas disease: the Bolivian experience

We have analyzed the response to the treatment with benznidazol in newborns and nurslings in the Hospital Materno Infantil Germán Urquidi of Cochabamba, Bolivia, between 1999 and 2002. It is important an integral treatment of the nursling with a subsequent information directed to the family. The response was close to 100% when the treatment was correctly administrated. They were not adverse effects and the detected biochemical alterations did not present clinical significance.

Nivel de endemia de la infección por Trypanosoma cruzi en el lugar de residencia de la madre y desarrollo de la enfermedad de Chagas congénita en Bolivia / Endemic level of congenital Trypanosoma cruzi infection in the areas of maternal residence and the development of congenital Chagas disease in Bolivia

In Bolivia, the prevalence of infection by T. cruzi in women in fertile age can vary between 20 and 60%. The present study made in the Maternity Germin Urquidi of Cochabamba - Bolivia, it has demonstrated, that 19.9% of the mothers who go to this hospitable center to be taken care of in the childbirth, they are carrying of the infection and that 4,6% of them, they are going to transmit, by transplacentaria route, the infection to its babies. Of the 71 children born with congenital Chagas, only 47,8 % present/display some type of alteration or of development(Apgar to 1 minute low, BPN, prematuridad, pathological dismadurez) or signs (SDR, hepatomegalia, esplenomegalia, neurological signs, cardiomegalia, anasarca, petequias). When investigating the effect of the differences in the vectorial density (low, medium and high) of the zone of maternal residence, on the transmission of the infection of the mother infected to the fetus, we concluded that the rate of transmission of the congenital infection of T. cruzi is not modified by the level of endemicidad of the zone of maternal residence. By another infected new born sides whose mothers reside in zones of high endemicidad present/display, most frequently and of significant way, Apgar to 1 minute < to 7, low weight when being born and prematuridad or an association of these alterations with respiratory syndrome of distress or anasarca, when one compares them with new born of resident mothers in the zones of loss or medium endemicidad, mortality in this group is greater. These results suggest calls to account it of the mothers, in areas of high endemicidad, she is associate with a serious increase in the risk of Disease of newborn severe and mortal congenital Chagas in.

Epidemiology of hepatitis C infection and its public health implications in Puerto Rico

Hepatitis C infection is the most common chronic blood-borne pathogen in the United States associated with liver cirrhosis and hepatocellular carcinoma and is the leading reason for liver transplantation. It has been estimated that hepatitis C infection may lead to a substantial health and economic burden over the next 10 to 20 years. The prevalence of hepatitis C virus (HCV) infection varies worldwide, with an estimated overall prevalence of 3%. However, the only available data of hepatitis C in the general population of Puerto Rico suggest an elevated prevalence of hepatitis C infection in the municipality of San Juan (6.3%) in comparison with estimates for the adult population residing in the United States (0.9%-3.9%). Much of the inter-region variability in the prevalence of hepatitis C can be attributable to the frequency and extent to which different risk factors have contributed to the transmission of the virus. Established risk factors for infection include injection drug use, transfusion of blood and solid organ transplantation from infected donors prior to July 1992 and blood clotting products before 1987, occupational injury, vertical transmission, sex with an HCV infected partner, and multiple sexual partners. Other potential exposures for infection that have been investigated in epidemiologic studies include history of intranasal cocaine use, sharing of contaminated equipment and personal care items, tattooing, body piercing, imprisonment, acupuncture, and use of contaminated healthcare instruments. The high incidence of AIDS in Puerto Rico and the large prevalence observed in Puerto Rican inmates and in adults residing in the municipality of San Juan indicate that HCV infection is an emerging public health concern. From a public health perspective, potential targets for intervention to decrease the spread of HCV infection, ongoing surveillance, increased clinician awareness of disease reporting systems and the epidemiology and management...

Headache profile at a medical institution with a specialized center for headache management

OBJECTIVE: To describe the clinical characteristics of headache to determine the distribution of antimigraine medication use by specialty of treating physician and the cost of the treatment of headache, among suffers by type of employee (health professionals vs. others). BACKGROUND: The services of a Headache Center are usually offered to the employees of the hospital in which the Center is localized; however, the number and related outcomes of employees who use the Center services versus those who use primary care facilities remain unknown in Puerto Rico. METHODS: A self-administered questionnaire was completed by 350 out of 415 (84.3) employees of one of the private hospital in San Juan, Puerto Rico regarding their management of headache. The data collected included age, gender, occupation, headache intensity and frequency, type of treating physician and medication use. Contingency tables were used to describe statistical associations among categorical variables. Pearson's chi square test or Fisher's exact test was used to assess significance. RESULTS: Nearly 75 of employees suffers headaches on a regular basis. Among these, 25 classified the headache as severe, 20.3 had 5 or more attacks per month, 62.1 reported that productivity was affected and 85 lost 1-2 days of work per month due to headache attacks. Approximately 20 visit a physician when they suffer a headache, and more than one-third visits a specialist. Only 2.34 of the employees used antimigraine medications (triptans). The use of triptans was more common among those employees attending a specialist for headache treatment than those attending primary care physicians (p < 0.05). A similar finding was observed for employees attending a neurologist versus other physicians (p < 0.05). CONCLUSIONS: These results indicate that headache attacks are prevalent and affect productivity and the cost for this institution was near dollars 4,400.00 per month. Despite the frequency and intensity of headache, less than one-fourth seek medical evaluation. Prescription ofspecific antimigraine medication was more common among specialists suggesting a more aggressive management for headache

Prevalence of obesity and its association with blood pressure, serum lipids and selected lifestyles in a Puerto Rican population of adolescents 12-16 years of age

OBJECTIVES: To describe the prevalence of obesity and determine its association with blood pressure, serum lipids and lifestyles in adolescents attending a public junior-high school in San Juan, Puerto Rico. METHODS: During the 1999-2000 academic school year, 352 students, ranging in age from 12 years to 16 years, were screened for weight, height, and blood pressure. A sub-sample of voluntary adolescents (n = 26) was screened for serum lipids and lifestyles were assessed using a standardized questionnaire. RESULTS: The prevalence of level I obesity and level II obesity among 12 to 16 years old adolescents were 33.2 per cent and 2 per cent, respectively. The mean systolic and diastolic blood pressures were significantly higher in obese than in non-obese adolescents (p < .001). There were no significant differences in serum lipids between the study groups (p > .05). However, the obese group showed higher median levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. The study group reported engaging in hazardous lifestyles (alcohol intake, smoking, and unhealthy eating patterns), but no real differences in lifestyles were found between obese and non-obese groups (p > .05). CONCLUSIONS: A high prevalence of level I and level II obesity was found in this population. In addition, significant positive correlations between blood pressure and body mass index were observed. This study underscores the need to assess the burden of obesity in Puerto Rico in order to develop community intervention strategies encouraging early detection and conduct modification towards healthier lifestyles.

Estudio comparativo de indinavir versus ritonavir para evaluar el desarrollo de enfermedades oportunistas en pacientes adultos de SIDA / A comparative study of indinavir versus ritonavir for assessing the development of opportunistic diseases in adult AIDS patients

This observational study compared the probability of developing the first opportunistic infection among AIDS adult patients attending the [quot ]Programa SIDA de San Juan[quot ] who received either indinavir plus zidovudine and lamivudine (n = 45) or ritonavir plus zidovudine and lamivudine (n = 16) between August 1, 1996 and July 31, 1997. No significant differences were observed with respect to appearance of an opportunistic infection, increase in CD4 levels and decrease in viral load between both groups during the study period. However, an increased probability of being free of opportunistic infection after 10 months was observed for the indinavir group (p > 0.05). In addition, the probability of changing or interrupting prescribed therapy was 2 times higher for patients under ritonavir (p < 0.05). These results suggest the need to confirm these findings in a larger group of patients in a controlled clinical trial and to assess the short-term and long-term effects of both therapies among Puerto Rican AIDS patients

Efecto de un gel blanqueador de peroxido de Carbamida al 10 por ciento en la adhesion de discos de porcelana a esmalte humano / The effect of a bleaching gel of carbamide peroxide at 10 per cent in the adhesion of ceramic disks in human enamel

El proposito de este estudio fue investigar si la adhesion de las resinas compuestas al esmalte, se altera en dientes que han sido previamente tratados con un gel de peroxido de carbamida al 10 por ciento (peroxido de hidrogeno al 3 por ciento). Con este fin se seleccionaron veinte premolares recientemente extraidos, sin caries y sin restauraciones. Diez de ellos fueron sometidos a la accion del agente blanqueador ocho horas diarias, durante diez dias. Los otros diez se usaron como grupo control. Todos fueron mantenidos posteriormente durante 10 dias en una solucion de saliva artificial. A ellos se adhirieron por medio de cemento de resina discos de porcelana por carillas tratados segun procedimientos estandarizados. Posteriormente se los sometio a una fuerza de corte en una maquina de testeo universal para determinar la fuerza de adhesion obtenida y su variacion despues del tratamiento. No se observo diferencia estadisticamente significativa en cuanto a valores de adhesion observados entre ambos grupos. En todos los casos se observo fractura de tipo cohesiva a nivel del cemento de resina

Tumores de la estroma endometrial. / Endometrial stromal tumors

1. Se presentan 5 casos de tumores de la estroma endometrial revisando su historia clinica, diagnostico histopatologico, tratamiento, seguimiento y pronostico.2.Estos casos son aprovechados para revisar los conceptos actuales en cuanto a su clasificacion, caracteristicas clinicas, tratamiento y factores conocidos que determinan su pronostico

La rigidez ventricular en la estenosis mitral determinada por un metodo ecocardiografico-hemodinamico. / Ventricular rigidity in mitral stenosis determined by an ecocardiographic-hemodynamic method

Diez pacientes con estenosis mitral fueron estudiados mediante cateterismo cardiaco derecho e izquierdo. A fin de determinar las propiedades diastolicas del ventriculo izquierdo se utilizo una tecnica hemodinamica-ecocardiografica, con la que se registraron simultaneamente la presion intraventricular y un ecocardiograma a nivel del cuerpo del ventriculo izquierdo. El volumen ventricular fue medido determinando el diametro menor directamente del eco ventricular y asumiendo el diametro mayor (L) de la relacion L/T obtenida de la cineventriculografia izquierda. Con una microcomputadora se obtuvo una curva suavizada de volumen-tiempo, su derivada y un asa de presion-volumen. La porcion diastolica exponencial del asa fue utilizada para obtener un indice de rigidez ventricular a volumen cero. El volumen diastolico y la fraccion de expulsion fueron normales. El llenado ventricular se encontro disminuido y la rigidez ventricular normal. Se concluye que el metodo propuesto permite facilmente la obtencion de datos simultaneos de presion-volumen, que el procesamiento de datos complejos puede hacerse con una microcomputadora de bolsillo y que no hay un defecto de las propiedades elasticas del ventriculo