Meta-analysis of the efficacy of invisible orthodontic appliances for maxillary molar distalization in adult patients / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of invisible orthodontic appliances without brackets for the distal movement of maxillary molars to improve the ability of orthodontists to predict treatment outcomes.@*Methods@#Web of Science, Cochrane Library, Embase, PubMed, Wanfang Database, CNKI Database, and VIP Database were searched for studies investigating the efficacy of invisible orthodontic appliances for distal movement of maxillary molars in adult patients and published from database inception to August 1, 2023. A total of three researchers screened the studies and evaluated their quality and conducted a meta-analysis of those that met quality standards.@*Results@#This study included 13 pre- and postcontrol trials with a total sample size of 281 patients. The meta-analysis revealed no significant differences in the sagittal or vertical parameters of the jawbone after treatment when compared with those before treatment (P>0.05). The displacement of the first molar was MD=-2.34, 95% CI (-2.83, -1.85); the displacement was MD=-0.95, 95% CI (-1.34, -0.56); and the inclination was MD=-2.51, 95% CI (-3.56, -1.46). There was a statistically significant difference in the change in sagittal, vertical, and axial tilt of the first molar before and after treatment. After treatment, the average adduction distance of the incisors was MD=-0.82, 95% CI (-1.54, -0.09), and the decrease in lip inclination was MD=-1.61, 95% CI (-2.86, -0.36); these values were significantly different from those before treatment (P<0.05).@*Conclusion@#Invisible orthodontic appliances can effectively move the upper molars in a distal direction and control the vertical position of the molars. When the molars move further away, there is some degree of compression and distal tilt movement, which is beneficial for patients with high angles. The sagittal movement of incisors is beneficial for improving the patient's profile.

Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

Abscesos renales bilaterales multifocales por Candida albicans / Bilateral multifocal kidney abscess due to Candida al bicans

Resumen Los abscesos renales son una complicación poco frecuente de las infecciones del tracto urinario y suelen asociarse con un aumento de la morbi-mortalidad. La mayoría de los casos ocurre en pacientes con factores predisponentes como la inmunosupresión. El diagnóstico requiere de una elevada sospecha clínica y el trata miento consiste en el uso de antibióticos y antifúngicos parenterales asociados o no a intervenciones quirúrgicas como nefrostomía y nefrectomía. Son pocos los casos publicados en la literatura médi ca de abscesos renales bilaterales multifocales y menos aún por Candida albicans. Se presenta el caso de una mujer de 20 años de edad con diabetes mellitus tipo 1 diagnosticada a los 8 años, múltiples internaciones por cetoacidosis diabética y reciente internación por can didemia (Candida albicans) completando tratamiento con fluconazol por 23 días. A los 18 días de su externación, consulta por dolor en flancos de tipo sordo y síntomas ge nerales; se realizó tomografía de abdomen con contraste que mostró abscesos multifocales bilaterales. Aislándose Candida albicans en una de las muestras obtenidas de las lesiones; recibió tratamiento con fluconazol 400 mg por 6 semanas endovenoso y 2 semanas vía enteral, evolu cionando favorablemente con mejoría clínica e image nológica continuando seguimiento clínico ambulatorio. Este reporte resalta la importancia del diagnóstico y tratamiento de esta complicación infrecuente en enfer medades complejas como la diabetes.

Abstract Renal abscesses are a rare complication of urinary tract infections and may be associated with increased morbidity and mortality. Most cases occur in patients with predisposing factors such as immunosuppression. Diagnosis requires high clinical suspicion and its treat ment consists in the use of parenteral antibiotics and antifungals associated or not with surgical interventions such as nephrostomy and nephrectomy. Few cases have been published in the medical literature of multifocal bilateral renal abscesses and even fewer due to Candida albicans. We present the case of a 20-year-old woman with type 1 diabetes mellitus, diagnosed at age 8, multiple hospitalizations for diabetic ketoacidosis, and recent hospitalization for candidemia (Candida albicans) treated with fluconazole for 23 days. Eighteen days after her discharge, she consulted for dull flank pain and gen eral symptoms. Contrast enhanced abdominal tomography showed bilateral multifocal abscesses and Candida albicans was isolated in one of the samples obtained from lesions. She received fluconazole 400 mg, 6 weeks i.v. and 2 weeks via enteral route, evolving favorably with clinical and imag ing improvement, continuing outpatient clinical monitoring. This report highlights the importance of diagnosis and treatment of this rare complication in complex diseases such as diabetes mellitus.

A correlation study of arterial stiffness, cardiac autonomic neuropathy and lipid profile in type 2 diabetes mellitus patients

Objectives: Micro and macrovasculopathy are common complications of undertreated or undiagnosed type 2 diabetes mellitus (T2DM) patients. One of the underlying factors of macrovasculopathy is arterial stiffness, which may lead to cardiovascular and cerebrovascular diseases. Understandably, diabetic micro and macrovasculopathy affect vital functions, which may affect the well-being of the individual. However, few studies have attempted to determine arterial stiffness, cardiac autonomic neuropathy (CAN) and lipid profile separately in South Asian population and examined its associations with T2DM. Moreover, there is a need to understand the mechanistic links among cardiovascular risk factors. This forms the basis of the present study. Materials and Methods: T2DM patients of 53–62 years and age- and gender-matched healthy control subjects were recruited in the cross-sectional and observational study (n = 30 each, eight women). Anthropometric measurements, physiological parameters such as resting heart rate, peripheral blood pressure (PBP), central blood pressure (CBP), augmentation index% (AIx%), brachial-ankle pulse wave velocity and lead II ECG for analysis of heart rate variability parameters were recorded after obtaining the consent of the study participants. The lipid profile and fasting blood glucose were also analysed. Results: Peripheral systolic blood pressure was significantly higher (P = 0.05) in T2DM patients. Dyslipidaemia was evident in T2DM patients. Atherogenic index of plasma (AIP) was also significantly higher in T2DM patients. Correlation analysis revealed a positive association between AIx% with PBP and CBP as well as between AIP index and central systolic blood pressure, serum triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) levels. AIP index was found to be negatively associated with HF (nu). Serum TG, high-density lipoprotein cholesterol (HDL-C) levels and AIP index have emerged as significant independent predictors of T2DM vasculopathy by multiple regression analysis. Conclusion: In the present study, atherogenic dyslipidaemia was observed in T2DM patients in combination with increased serum levels of TG, VLDL-C and decreased serum levels of HDL-C. Moreover, AIP index, a predictor cardiovascular risk, was found to be significantly higher in T2DM patients. Dyslipidaemia was found to be associated with dysregulation of autonomic nervous system in those patients. A positive association between noninvasive, surrogate markers of arterial stiffness with PBP and CBP indicates that enhanced arterial stiffness may elevate systemic arterial pressure. Therefore, early screening of T2DM patients for the estimation of serum lipid profile, arterial stiffness and cardiac autonomic neuropathy may be performed to unravel diabetic vasculopathy.

Formulation and evaluation of Buccal mucoadhesive tablets of diclofenac sodium using 23 factorial designs

Buccal tablets

Diclofenac sodium

Drug release

Mucoadhesion

Mucoadhesive tablets

Release kinetics

Effect of different suspension moxibustion methods on syndrome characteristics of rats with rheumatoid arthritis of heat bi syndrome based on "moxibustion can be used for heat syndrome" / 中国针灸

OBJECTIVE@#To observe the effects of different suspension moxibustion methods on the syndrome characteristics and inflammatory factors of rats with rheumatoid arthritis (RA) of heat bi syndrome and to prove the concept of "moxibustion can be used for heat syndrome".@*METHODS@#Among seventy Wistar rats, 12 rats were randomly selected as a normal group, and the remaining rats were induced by collagen combined with wind, dampness, and heat environmental stimulation to establish the RA model of heat bi syndrome. Forty-eight rats with successful model establishment were further randomly divided into a model group and three moxibustion groups (mild moxibustion group, rotating moxibustion group and sparrow-pecking moxibustion group), with 12 rats in each group. The acupoints "Quchi" (LI 11), "Dazhui" (GV 14) and ashi point were used in all moxibustion groups, with mild moxibustion, rotating moxibustion, and sparrow-pecking moxibustion intervention given respectively, each acupoint was treated with moxibustion for 10 min a day, and 6 days were considered one course of treatment, with a total of three courses. After the intervention, the arthritis index (AI), the Evans blue (EB) extravasated volume in the soft tissue of the right hind paw, and the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-10 in the serum were measured by ELISA in each group. The volume of the bilateral hind paw was measured; the infrared thermal imaging was collected to analyze the temperature of the plantar area of the bilateral foot pads, and the reaction time of plantar heat pain was calculated before and after modeling, as well as after the 1st, 2nd and 3rd courses of interrention. The ankle dorsiflexion angle of the right hind foot was also measured before and after modeling, as well as after the intervention.@*RESULTS@#After modeling, compared with the normal group, the rats in the model group had more high-temperature areas in the bilateral hind limbs, abnormal AI score, abnormal bilateral hind paw volume, abnormal temperature of the plantar area of the bilateral foot pads, abnormal foot pain response time, abnormal right hind ankle dorsiflexion angle, abnormal right hind paw soft tissue EB extravasation, and abnormal serum TNF-α and IL-10 levels (P<0.01, P<0.05). After the intervention, compared with the model group, the rats in each moxibustion group had decreased or disappeared high-temperature areas in the bilateral hind limbs, EB extravasated volume in the soft tissue of the right hind paw was reduced (P<0.05), and the right ankle dorsiflexion angle was increased (P<0.05), serum level of TNF-α was reduced, and level of IL-10 increased (P<0.05); the AI scores in the mild moxibustion group and the sparrow-pecking moxibustion group was decreased (P<0.01, P<0.05). After the 1st, 2nd and 3rd courses of intervention, compared with the model group, the bilateral hind paw volume of rats in each moxibustion group was decreased (P<0.05, P<0.01), and plantar heat pain reaction time was increased (P<0.05). After the 2nd course and the 3rd course of intervention, the temperature of the right hind paw pad area was decreased in each moribustion group (P<0.05); after the 3rd courses of intervention, the temperature of the left hind paw pad area was decreased in the mild moxibustion group (P<0.05).@*CONCLUSION@#Suspension moxibustion could adjust the serum levels of TNF-α and IL-10 to improve the syndrome characteristics of RA rats of heat bi syndrome, such as joint redness, swelling, heat, pain and activity restriction. The effect of mild moxibustion is the most prominent. The findings could provide scientific basis for "moxibustion can be used for heat syndrome".

SHENG Can-ruo's experience in treatment of goiter with integrated acupuncture and herbal medication / 中国针灸

The paper introduces professor SHENG Can-ruo's experience in treatment of goiter with the combination of acupuncture and herbal medication. Professor SHENG believes that this disease is mostly related with emotional injury, improper diet and geographical and climatic factors, as well as body constitution. Qi stagnation, phlegm retention, blood stagnation and interaction of phlegm and stasis are the essential pathogenesis of goiter. Either acupuncture or herbal medication should focus on "phlegm and stasis" in treatment. Besides, the theory of western medicine should also be considered. In western medicine, thyroid enlargement is classified into Ⅰ, Ⅱ and Ⅲ degrees of struma, thus, the pathogenesis and treatment with Chinese medicine should be adjusted accordingly. The created "four throat points", combined with acupuncture at distal points, relieve the local masses. The basic herbal formula is prepared and the couplet medicines are modified based on syndrome differentiation. The integrated acupuncture and herbal medication regulates emotions and provides a comprehensive treatment for goiter.

Prevalencia de trastornos respiratorios del sueño en pacientes asmáticos que se controlan en el Hospital Roberto del Río: estudio piloto / Prevalence of sleep breathing disorders in asthmatic patients monitored at Roberto del Río Hospital: a pilot study

Introducción. El asma es una de las enfermedades crónicas más frecuentes en niños. Múltiples estudios han sugerido que en la infancia presenta una asociación significativa con los trastornos respiratorios del sueño, con una prevalencia en niños asmáticos de un 24%. El objetivo fue determinar la prevalencia de trastornos respiratorios del sueño (TRS) en pacientes con asma controlados en un hospital pediátrico (6-15 años). Pacientes y Método. Estudio transversal descriptivo. Se aplicaron los cuestionarios de sueño pediátrico validado en español (pediatric sleep questionnaire, PSQ) y el Cuestionario de Control del Asma en Niños (CAN) a los padres de los niños con diagnósticos de asma controlados en Hospital Roberto del Río, vía telefónica y vía email. Resultados: La prevalencia de TRS fue de 34,8%. Un 20% presenta mal control de asma definido como CAN >8. Un 58,1% de los padres reportaron sobrepeso en los pacientes Conclusiones: la prevalencia de TRS en los niños estudiados es alta y obliga a investigar en cada consulta por estos síntomas. Aplicar la encuesta en cada consulta, de forma online podría aportar al conocimiento de estos pacientes y mantener la prevalencia del problema actualizada, para focalizar las intervenciones apropiadas.

Introduction. Asthma is one of the most frequent chronic diseases in children, multiple studies have suggested that in childhood it presents a significant association with sleep-disordered breathing, with a prevalence in asthmatic children of 24%.The objective was to determine the prevalence of sleep-disordered breathing (RRT) in patients with asthma controlled in a pediatric hospital (6-15 years). Patients and Methods. Descriptive cross-sectional study. The pediatric sleep questionnaire (PSQ) and the Child Asthma Control Questionnaire (CAN) were applied to the parents of children with controlled asthma diagnoses at Hospital Roberto del Río, by telephone and via e-mail. Results: The prevalence of RRT was 34.8%. 20% have poor asthma control defined as CAN> 8. 58.1% of parents reported overweight in patients Conclusions: the prevalence of RRT in the children studied is high and makes it necessary to investigate these symptoms at each visit. Applying the survey in each consultation, online, could contribute to the knowledge of these patients and keep the prevalence of the problem updated, in order to focalized the interventions.

The protective effect of cyclosporine A on daunorubicin injured H9c2 cardiomyoblasts / 中国药理学通报

Aim To study the protective effect of cyclosporine A (CsA) on daunorubicin (DNR) injured H9c2 cardiomyoblasts. Methods H9c2 cells were pre-treated with CsA for 2 hours, then co-cultured with 1 μmol · L

Clinical features and prognosis analysis of acute myeloid leukemia patients with DEK-CAN-positive / 白血病·淋巴瘤

Objective:To investigate the clinical features and prognosis of patients with acute myeloid leukemia (AML) with DEK-CAN-positive.Methods:The clinical data of 6 AML patients with DEK-CAN-positive admitted to the First Affiliated Hospital of Zhengzhou University from August 2014 to January 2018 were retrospectively analyzed. Their clinical features, treatment and outcomes were summarized.Results:All 6 patients were female with a median age of 29 years (4-64 years). Among 6 cases, 5 cases were primary granulocytic leukemia partially differentiated (M 2) and 1 case was acute monocyte leukemia (M 5). There were 5 patients with elevated count of white blood cells in peripheral blood, and 1 patient had bone marrow dysplasia, and 2 patients had basophilia. Immunophenotypic analysis showed that all 6 patients were positive for CD34, CD13, CD38 and CD33. Fusion gene detection showed that DEK-CAN was positive and NPM1 mutations were negative in 6 patients; FLT3-ITD mutation was detected in 3 patients and WT1 mutation was detected in 2 patients. Chromosomal karyotyping showed that 2 cases had no split phase and 4 cases carried t(6;9). Follow-up details were available for 6 patients, only 1 patient achieved complete remission after the first course of induction chemotherapy, and the remaining 5 patients had no complete remission after the first course of chemotherapy, and died of complications in a short time. Conclusion:AML patients with DEK-CAN-positive have a very poor prognosis, low primary induced remission rate and high mortality.

Professor / 中国针灸

This paper introduces the specific clinical experience of professor

Compare outcome in patients of ileostomy and colostomy closure with surgical stapler versus ileostomy and colostomy closure with hand sewn anastomosis: a prospective study

Background: Diverting temporary stoma is created to protect the primary bowel pathology and distal anastomosis. Once that primary pathology has been overcome or distal anastomosis gets healed, closure of temporary stomas can be carried out. Invention of stapling devices for intestinal anastomosis provided another dimension than hand sewn method to the stoma closure techniques. In this study, we have compared two methods of loop stoma closure-hand sewn method versus stapler method.Methods: This is prospective comparative study in which 50 cases of loop ileostomy/colostomy were taken. 25 patients underwent ileostomy/colostomy closure by hand sewn anastomosis (group A). Another 25 patients underwent ileostomy/colostomy closure by stapler anastomosis (group B). Time taken for operation, initiation of oral intake, anastomotic leak, post-operative wound infection and total hospital stay duration were compared between these two groups to conclude about which method is superior and in the best interest of patient and surgeon.Results: Mean operation time 105.96 minutes (group A) and 72.84 minutes (group B). Mean time to start oral intake 5.36 days (group A), 3.6 days (group B). 16% patients (4/25) group A and 4% patients (1/25) group B developed anastomotic leak. 28% patients (7/25) group A and 8% patients (2/25) group B had post-operative wound infection. Mean hospital stay 10.4 days in group A and 7.84 days in group B.Conclusions: Stapler method provides significant benefits in terms of less operative time, early oral intake and less hospital stay. Overall stapler method for stoma closure is more efficient and cost effective.

Detection of fetal malnutrition and its associated maternal factors in a rural setting

Background: The objectives of study were to analyse and compare the methods for detection of fetal malnutrition and to study the maternal factors associated with fetal malnutrition in babies born in rural hospitals.Methods: Periodic prospective cross-sectional case-control questionnaire-based study. Nursing home and Hospital based in rural population from January 2017-March 2018. There were 350 term newborns born in Shrinivasa Nursing Home, and Crawford General Hospital, Sakleshpur, were selected consecutively. Inclusion criteria: live, singleton term neonates. Exclusion criteria: Preterms, post-terms, those with congenital malformation, multiple gestations, cephalhematoma, subgaleal bleed. Anthropometry, fetal malnutrition assessed using clinical assessment of nutrition (CAN) score, Ponderal and Kanawati indices between 24–48 hours of birth. Newborns with fetal malnutrition (cases), and well-nourished babies (controls) assessed for maternal risk factors using standardised questionnaire from mothers.Results: CAN score identified 185 (52.9%) as malnourished and 165 (47.1%) as normal; Ponderal index classified 170(48.6%) as malnourished and 180 (51.4%) normal. Kanawati index grouped 151 (43.1%) as malnourished. Maternal factors:  age (91.7% among <20 yr mothers-malnourished, 25% among >35 yrs), socioeconomic status (status 3, 4 had 57.2%, 66.7% malnourishment), improper antenatal care(80.7% irregulars; 38.5% among regulars), primiparity (60%;against  38.3% among multipara), pre-eclampsia (78.7%; 41.3% in normotensives), anemia (55.4%), weight gain (83.2% in <10 kg; 33.33% in >10 kg), stature (73.5% in <145 cm; 39.7% in >145 cm), medical illness (55.81%).Conclusions: CAN score is simple, systematic, clinical method of identifying malnutrition; statistically superior as screening tool. Maternal factors: improper antenatal checkups, primiparity, pre-eclampsia, medical illness, inadequate weight gain, short stature had significant association with fetal malnutrition. Maternal age, socioeconomic status, anemia not statistically significant.

Can Score Versus Other Anthropometric Indices To Assess Nutritional Status In New-Borns

Background: Foetal malnutrition is one of the common cause of morbidity and mortality in neonates in a developing country like India and needs to be identified at birth. Objective: To assess foetal nutrition using CAN score and to compare it with other anthropometric indices. Methods: Prospective observational study consisting of 500 singleton full term neonates, assessed for foetal malnutrition using CAN score and then compared with other methods like Ponderal Index, MAC/OFC ratio and Weight for gestational age. Results: CAN score identified 66.4% babies as malnourished whereas Ponderal index identified 51.2% followed by MAC/OFC ratio as 45.6% babies. 62.8% babies were AGA and 37.2% babies were SGA according to weight for gestational age. Conclusion: CAN scoring system is a simple method of identifying foetal malnutrition which can be missed by other methods.

Research status and development of digestive system microecology and pancreatic cancer / 中华消化外科杂志

Pancreatic cancer is a highly malignant tumor of the digestive system, also known as "the king of cancer" . Its incidence is increasing year by year worldwide. At present, there is still a lack of effective screening methods for pancreatic cancer, and the early symptoms are not obvious. Most pancreatic cancer is diagnosed in the late stage, and the best time for surgery has been lost, and patients often have poor response to radiotherapy, chemotherapy and targeted therapy, so the prognosis is very poor. The occurrence and development of pancreatic cancer are closely related to genetic background, environmental factors, basic diseases and living habits. So far, although certain risk factors have been identified, such as smoking, obesity, alcohol, chronic pancreatitis, type 2 diabetes mellitus, and family history, the cause of pancreatic cancer is still not very clear. In recent years, more and more studies have shown that in addition to the already recognized risk factors for pancreatic cancer, there is a certain relationship between digestive microecological disorders and the progression of pancreatic cancer. The authors review the research status of digestive system microecology and pancreatic cancer, in order to understand the role of digestive system microecology disorders in the occurrence and development of pancreatic cancer, thus providing a new way to effectively improve the prognosis of pancreatic cancer.

Professor 's academic thoughts and acupoint selection experience for hot flashes / 中国针灸

Professor is a well-known national veteran doctor with over 70 years of clinical experience. He has unique academic thoughts and clinical experience for common diseases and some difficult and complicated diseases. This paper mainly introduces professor 's syndrome-differentiation thought and experience of acupoint selection for hot flashes. It is emphasized that common hot flashes, such as hot flashes and night sweats, are different between and . While regulating and , more attention should be paid to - harmony, which is not only suitable for women's perimenopausal syndrome, but also for a series of clinical diseases caused by refractory drugs such as endocrine therapy after breast cancer surgery. At the same time of acupoint selection based on syndrome differentiation, a more rational prescriptions should be made according to the duration of the disease and the experience acupoints to improve the clinical efficacy.

Introducción. Situación mundial del Cáncer de Mama / Introduction. World situation of Breast Cancer

El cáncer de mama es el tumor de la mujer más diagnosticado en la gran mayoría de los países. Los factores no hereditarios son los principales impulsores de las diferencias internacionales e in­ter­étnicas observadas en la incidencia de este cáncer. Las tasas de incidencia del cáncer de ma­ma han aumentado en la mayoría de los países en transición en las últimas décadas, en tanto que en la mayoría de los países más avanzados, las tasas de mortalidad por cáncer de mama han ido en descenso como resultado de la detección temprana de la enfermedad, los avances en el trata­ miento y mayor accesibilidad a los servicios de salud. Los principales factores de riesgo para el cáncer de mama no son fácilmente modificables porque se derivan de exposiciones hormonales endógenas prolongadas. La prevención a través de la promoción de la lactancia materna, parti­cularmente su mayor duración, pudiera ser beneficioso. La incidencia de cáncer de mama en Pa­namá se comporta de manera similar a los países con índice de desarrollo Humano en transición; ha ido en aumento en las últimas décadas como resultado del aumento en la prevalencia de los factores de riesgo conocidos y la mejoría en la recolección de datos.

Breast cancer is the most diagnosed woman's tumor in the vast majority of countries. The non­here­ ditary factors are the main drivers of the international and inter­ethnic differences observed in the incidence of this cancer. Breast cancer incidence rates have increased in most countries in transi­tion in recent decades, while in most of the more advanced countries, breast cancer death rates ha­ve been declining asa result of breast cancer. early detection of the disease, advances in treatment and greater accessibility to health services . The main risk factors for breast cancer are not easily modifiable because they are derived from prolonged endogenous hormonal exposures. Prevention through the promotion of breastfeeding, particularly its longer duration, could be beneficial. The inci­ dence of breast cancer in Panama behaves similarly to countries with a Human Development Index in transition; It has been increasing in recent decades as a result of the inc rease in the prevalence of k nown risk factors and the improvement in data collection.

Evaluación del Riesgo, Tamizaje, Diagnóstico Clínico ­ Patológico y Estadificación del Cáncer de Mama: 1er Consenso Nacional del Cáncer de Mama de la Sociedad Panameña de Oncología (SPO) / Risk Assessment, Screening, Clinical ­ Pathological Diagnos is and Staging of Breast Cancer: 1st National Consensus of Breast Cancer of the Panamanian Society of Oncology

El cáncer de Mama es el tumor más frecuente de la mujer y su incidencia va en aumento. En la atención primaria del paciente, se debe establecer el riesgo de padecer cáncer de mama durante la vida, a través de una historia clínica orientada a los factores de riesgo familiares e individuales, de tal forma que podamos implementar las estrategias de tamizaje apropiadas. Las estrategias de ta­mizaje deben ser aplicadas de manera sistemáticas, y los resultados anormales referidos a un cen­tro con experiencia en el diagnóstico. Los pacientes diagnosticados deben ser evaluador por un equipo multidisciplinario con experiencia en el manejo de la muestra, estadificación y tratamiento del cáncer de mama.

Breast cancer is the most frequent tumor in women and its incidence is increasing. In the primary care of the patient, the risk of suffering from breast cancer should be established during life, through a clinical history focused on family and individual risk factors, in such a way that we can implement the appropriate screening strategies. Screening strategies should be applied systematically, and ab­normal results referred to a center with experience in diagnosis . Patients diagnosed should be eva­luated by a multidisciplinary team with experience in the management of the sample, staging and treatment of breast cancer.