Factores de riesgo para cáncer gástrico: ¿cuál es su papel? / Risk factors for gastric cancer. What is their role?

Resumen El proceso de la carcinogénesis gástrica es multifactorial y secuencial. No lo comprendemos completamente, pero conocemos la historia natural de la enfermedad descrita por el Dr. Pelayo-Correa y también la existencia de múltiples factores de riesgo. La identificación de estos factores que participan en cada paso y el manejo apropiado de los mismos podría ayudar a reducir la incidencia del cáncer gástrico (CG). Probablemente, la infección por Helicobacter pylori (HP) es el factor de riesgo más conocido y discutido; sin embargo, existen otros factores como los relacionados con el estilo de vida, tipo de dieta, historia familiar de cáncer, entre otros, que también participan en el desarrollo e incidencia de este tipo de cáncer y tienen una amplia ventana de tiempo para ejercer su influencia. A nivel poblacional, la identificación y el conocimiento de estos factores de riesgo puede proporcionar un entendimiento en la etiología de la enfermedad y es esencial para planear, monitorizar y evaluar los planes, políticas y estrategias de prevención. Es necesario, por lo tanto, desarrollar una herramienta de estudio basada en la identificación de factores de riesgo que se pueda sumar a los hallazgos endoscópicos e histológicos y ser usada en la práctica clínica para la clasificación del riesgo de CG.

Abstract The process of gastric carcinogenesis is multifactorial and sequential. We do not fully understand this, but we know the natural history of the disease described by Dr. Pelayo Correa and the existence of multiple risk factors. Identifying the factors involved in each step and managing them appropriately could help reduce the incidence of gastric cancer (GC). Helicobacter pylori (HP) infection is probably the most widely known and discussed risk factor. However, there are other factors such as lifestyle, type of diet, family history of cancer, among others, that are also involved in the development and incidence of this cancer and have a wide window of time to exert their influence. At the population level, identification and awareness of these risk factors can provide insight into the etiology of the disease and are essential for planning, monitoring and evaluating prevention plans, policies and strategies. It is therefore necessary to develop a study tool based on risk factor identification that can be added to endoscopic and histological findings and used in clinical practice for GC risk classification.

Research progress on preventive measures for patients at high-risk for breast cancer / 中国肿瘤临床

As one of the most common malignant tumors, breast cancer seriously threatens women's lives and health. Strengthening science popularization, screening, and reasonable and effective preventive measures are important preventive measures for groups at high-risk for breast cancer. At present, the main preventive measures include advocating good lifestyle habits, reasonable preventive drugs, and surgical resection. Although the preventive effects of drugs and surgery are better, they are not easily accepted by those at high-risk for breast cancer due to adverse reactions such as drug toxicity, postoperative appearance changes, and psychological factors. The establishment of reasonable preventive measures has become a breakthrough point for the prevention of breast cancer in high-risk groups. This can not only reduce the risk of breast cancer in this group but also reduce unnecessary medical consumption. This can benefit patients and save social resources. This article will review the research progress on preventive measures for groups at high-risk for breast cancer.

Effects of Sanqi Huayu Oral Liquid on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups / 中成药

AIM To investigate the effects of Sanqi Huayu Oral Liquid (Notoginseng Radix et Rhizoma,Corydalis Rhizoma) on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups.METHODS One hundred and twenty patients meeting the inclusion criteria were randomly and equally divided into treatment group and control group.The control group was treated by low molecular weight heparin calcium injection,while the treatment group was additionally given Sanqi Huayu Oral Liquid.Two groups' levels of serum IL-6,TNF-α and D-D were detected on pre-operation and the 1 st,3rd,7th after operation,respectively.Additionally,the adverse drug reactions were also observed.RESULTS There were no statistically significant differences in the levels of serum IL-6,TNF-α and D-D between the two groups before operation.The first day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups showed increasing trends,which had similar elevated levels without statistically significant differences.The third day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups presented downward trends,but those in the treatment group were decreased more markedly with statistically significant differences.Furthermore,the seventh day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups were lower than those before the operation,and these indices in the treatment group were lower than those in the control group with statistically significant differences.CONCLUSION Sanqi Huayu Oral Liquid can not only effectively reduce the levels of serum IL-6,TNF-α and D-D in perioperative period of high-risk groups,but also prevent the formation of deep vein thrombosis.

Implementation of intervention programs on AIDS-related sexual transmission in China / 中华流行病学杂志

Objective To analyze the implementation of intervention programs targeted on AIDS high risk sexual transmission groups since 2008,when the relative prevention and control information systems on HIV/AIDS were developed.Methods Data from both aggregated interventions and sentinel surveillance programs from 2008 to the end of 2014 were used.Descriptive statistics were performed to analyze the trends of implementation on high risk groups including men who have sex with men,female sex workers (FSW) and migrant workers.Results From 2008 to 2012,the monthly average numbers receiving intervention programs and the average monthly coverage rate on intervention for MSM,increased from 49000 to 252000,and from 8.6％ to 78.5％ respectively.The FSW related indicators increased from 329 000 to 625 000,and from 30.9％ to 87.0％ respectively.Above indexes on the two populations had dropped slightly in 2013 and 2014.Sentinel surveillance data showed that knowledge and behavior indicators observed from the MSM and FSW populations increased annually.The coverage of intervention programs on migrant workers increased from 4.7％ to almost 10.0％,but the surveillance data on migrant men showed that the knowledge and behavior indicators were still lower than the other high-risk groups.Conclusion Intervention related to sexual transmission on HIV/AIDS among high-risk populations were effectively implemented,with some achievements seen.However,as sexual contact currently became the main route of AIDS epidemic,new challenges called for serious attention.

An analysis on the influencing factors of compliance in colorectal cancer screening among residents in Songjiang District / 预防医学

Objective To explore the influence factors of the compliance in colorectal cancer( CRC)screening. Methods A total of 140 096 local people were selected for fecal occult blood test( FOBT)in Songjiang District Shanghai City. They were over 40 years old and thought to be high risk groups of colorectal cancer. The participants with FOBT positive were asked to following colonoscopy. All the participants were interviewed by a questionnaire. The influencing factors of compliance on colorectal cancer screening were analyzed by multivariate regression. Results Of all the residents with high risk of colorectal cancer,The FOBT positive rate was 16. 83%. Of the FOBT positive residents,8 566 cases took the examination of colonoscopy,and the screening rate was 36. 33%. A total of 142 cases were diagnosed as colorectal cancer, with the detection rate of 1. 66%. Compared with the positive rate of FOBT in 2012 and 2013,the rate was significantly lower(18. 16%,15. 78%,p<0. 05),and the rate of colonoscopy examination increased(45. 66%,26. 04%,p<0. 05). Multivariate logistic regression showed that fear of pain( OR=3. 01 ),the thought of uselessness( OR=1. 89 )were risk factors for compliance in colorectal cancer screening( p <0. 05 ). Conclusion The compliance of colorectal cancer screening in Songjiang District is relatively low. High-risk groups with regular physical examination,high level education were prone to have good compliance,and fear of pain,think it useless were the main reason for incompliance.

Analysis on TCM Symptoms, Tongue and Pulse of High-risk Group of Stroke / 中国中医药信息杂志

Objective To investigate characteristics of symptoms, tongue and pulse of high-risk group of stroke, and provide evidence of differential treatment for stroke prevention, diagnosis and treatment of stroke, thus laying a solid foundation on further study of differential treatment system of high-risk groups of stroke. Methods With prospective observational method, 2536 cases of stroke were selected by multi-center screening, and characteristics of TCM symptoms, tongue, pulse and syndrome distribution in different gender and age were observed. Results The top five symptoms were:blurred vision (1670 cases, 65.9%), irritability (1458 cases, 57.5%), limp or pain on waist and knees (1445 cases, 57.1%), dizziness (1286 cases, 50.7%) and dry eyes (1274 cases, 50.2%). The top five tongue and pulse were:white moss (1401 cases, 55.2%), thin moss (1260 cases, 49.7%), string pulse (1201 cases, 47.4%), dark tongue (1168 cases, 46.1%) and red tongue (1027 cases, 40.5%). The detection rate of dizziness, insomnia, white coating, thin coating, etc. were higer in women than that in man (P<0.01). The detection rate of teeth shaking, greasy fur, yellow fur, string pulse, etc. were higher in man than that in woman (P<0.01). The detection rate of teeth shaking, dry eyes, thirst, dark tongue, red tongue, string pulse, etc. in the elderly group were higher than the middle-aged one (P<0.01). The detection rate of irritability, numbness, shortness of breath, scalloped tongue, thin coating, deep pulse, etc. in the middle-aged group was higher than the aged one (P<0.01). Conclusion The clinical manifestations of high-risk group of stroke are complicated. There were root deficiency such as deficiency of spleen and kidney, and branch excess such as wind-fire and phlegm-stasis. Difference and regularity were showed in different gender and different age groups to some extent.

Avanzando en la lucha contra la tuberculosis en Chile / Moving forward in the fight against tuberculosis in Chile

In 1973 Chile started a National Tuberculosis Control Programme based in the use of sputum smear for tuberculosis finding and proper treatment. Programme activities lead the country to achieve the threshold of tuberculosis elimination in year 2000. Since then the usual annual 7 percent decrease in the incidence of tuberculosis has leveled off. Between years 2009-2011 tuberculosis rate remained stationary in around 13.1 per 100.000 inhabitants. Such epidemiologic regression was related to a decrease in bacteriological case finding on primary health care and the existence of risk groups like the elderly, prisoners, migrants and HIV infected. The Metropolitan Region of Santiago represents 40 percent of the total incidence of tuberculosis of the country and has a higher proportion of high risk groups. We recommend to increase the tuberculosis detection rate focused in high risk groups, to increase preventive therapy of latent tuberculosis in HIV infected and close child contacts and improve treatment success. In year 2012 we have achieved a lower tuberculosis incidence rate of 12.6 per 100.000 inhabitants due to an increase in sputum smear detection. It is necessary to maintain this measures for the continuous progress in the control of tuberculosis.

Chile inició un programa de actividades de pesquisa bacteriológica y tratamiento de la tuberculosis a través de toda la red de salud nacional en 1973. Producto de esta iniciativa el país alcanzó el umbral de inicio de la eliminación de la enfermedad el año 2000. Desde entonces se ha enlentecido la velocidad de reducción de la incidencia de la enfermedad desde 7 por ciento anual hasta detenerse el año 2009. Entre el año 2009 y 2011 la incidencia se ha mantenido estacionaria con alrededor de 13,1 casos x 100.000 habitantes. Se han identificado algunos factores que han contribuido a esta detención epidemiológica, como por ejemplo la reducción de la pesquisa de los casos pulmonares bacilíferos, especialmente a nivel de atención primaria. También se ha encontrado una mayor concentración de casos entre población vulnerable constituida por grupos de riesgo como adultos mayores, personas privadas de libertad, migrantes e infectados por VIH. La Región Metropolitana aporta el 40 por ciento de los casos de tuberculosis y la proporción de población de riesgo de enfermar es mayor que en el resto del país. En el presente artículo se proponen estrategias para revertir esta situación. Las principales medidas son: incrementar la detección de casos en todos los niveles de salud con intensificación en los grupos de riesgo; aumentar las medidas preventivas con quimioprofilaxis en los infectados VIH y contactos infantiles y optimizar los resultados del tratamiento para interrumpir la cadena de transmisión de la enfermedad. Aún hay esperanzas. El año 2012 la incidencia se redujo a 12,6 x 100.000 y se incrementó la pesquisa baciloscópica después de varios años en que había disminuido. Mantener estas medidas se hace necesario para seguir avanzando en el control sanitario de la tuberculosis.

Knowledge of HIV/AIDS and HIV testing among the high risk groups (HRGs) population.

Background: Several factors put India in danger of experiencing rapid spread of HIV if effective prevention and control measures are not scaled up throughout the country. Aims & Objective: (1) To assess the level of basic knowledge about HIV/AIDS among the study population; (2) To analyze the HIV testing among them. Material and Methods: It was a cross sectional study carried out during April –May, 2010 amongst 3125 subjects of high risk groups (HRGs) comprising of IDUs (Injectable Drug Users), Female Sex workers (FSWs), MSMs (Male having Sex with Males) and Single Male Migrants (SMMs) covered by 13 Targeted Interventions (TIs) of Ahmedabad city. Ten percent of registered HRGs were assessed by systematic sampling. Data was analyzed using Epi info version 3.5.1. Results: Mean age of HRGs was 28.69 years and about half of HRGs were educated up to primary standard. More than half of them were married.85% HRGs had heard of HIV and 51% correctly knew what HIV positive means. Knowledge about AIDS was 76% and understanding of AIDS was 66% among them .About 38% HRGs knew that HIV is infectious and 72.8% knew that HIV is incurable. About 65% HRGs knew that there is no effective vaccine for HIV. About 65% HRGs had been tested ever tested and in last 6 months about 52.2% of HRGs were tested for HIV. Age and education were statistically significantly associated with the knowledge about incurability of HIV, non-existence of vaccine, and ever testing of HIV and in last six months also with disclosure of HIV positive status. Additionally age was also statistically significantly associated with infectious nature of HIV. Conclusion: Young and literate HRGs are better aware about the disease and are more concerned about their HIV status. They are also more open about disclosing their HIV/AIDS status.

Tuberculosis en Chile: del control a la eliminación, un camino difícil / Tuberculosis in Chile: from control to elimination, a difficult road

En este artículo se plantea nuevamente el tema de la factibilidad de lograr el objetivo de eliminación de la Tuberculosis y él, en cierto modo es la continuación de otro artículo presentado hace tres años en esta revista por el mismo autor. El análisis se centra ahora, principalmente, en la revisión de los obstáculos que se han debido superar para proseguir los esfuerzos destinados a alcanzar la meta llamada “de eliminación avanzada”, tasa de incidencia de 10 x 100.000, para el año 2010, previa consideración de las dificultades concretas encontradas una vez superado el “umbral de eliminación”. Se hacen presente las líneas de trabajo técnico del programa para los años que siguen y se insiste en que lo principal es que se mantenga la voluntad política de apoyar el Programa de TBC y que los Directores de los Servicios de Salud asuman la responsabilidad central que les corresponde en la consecución de la meta 2010 que es un Objetivo Sanitario del Ministerio.

The feasibility of ing reach the goal of elimination of Tuberculosis in Chile is again discussed. This goal is now a Ministry of Health objective. The intermediate goal, “advanced elimination”, incidence rate of 10 x 100.000 for the year 2010, was designed as, a “Heath Objetive” for the decennium 2000 – 2010. As regards the future perspectives, we analize the obstacles faced in Chile in relation to the possible effects of the new health system structure on the evolution of Tuberculosis in the country. Furthermore, or the possibility of reaching the final goal, will depends on several factors especially related to the growing importance of high risk groups as the total incidence is reduced. It is imperative to develop specific programs for these groups.

Sudden cardiac death

Sudden cardiac death (SCD) continues to be a major health issue in many countries including Malaysia due to its large magnitude in all-cause mortality as well as the emotional and socioeconomic impact of the deceased leaving the love ones behind in an abrupt manner. Data in Malaysia shows that the majority of sudden natural deaths are due to sudden cardiac death and are in the productive age group of 41 to 50 years. A study in Germany pointed out that about 90% people who died of SCD actually had warning signs such as chest pain, breathlessness, nausea, vomiting, dizziness and fainting before they collapsed. The majority belonged to the high-risk group for SCD having had previous medical histories including coronary artery disease, cardiomyopathies, valvular heart disease, congenital heart disease, underlying electrophysiological abnormalities or are taking drugs which are capable of provoking ventricular tachyarrhythmias. The key step is to define a sequence of risk stratifiers that will identify patients who are at risk but in whom implantation of expensive devices will be cost-effective. Amongst the investigative tools proven to be helpful to achieve this are ECG screening for left ventricular hypertrophy, increased QRS width, T-wave alternans, heart rate variability, baroreceptor responsiveness, QT dispersion, and T-wave heterogeneity; Holter monitoring to demonstrate ventricular arrhythmias; and stress test in identifying ischaemia. Prompt action is crucial since restoring circulation as fast as possible improves the chances of survival. Family members and caregivers of people with heart disease and at increased risk should be trained to recognize symptoms and perform cardiopulmonary resuscitation (CPR) to reduce the likelihood of death from cardiac arrest. Training and prevention efforts should focus on how to recognize the emergency, CPR training, and automated external defibrillator (AED) use. An implantable cardioverter-defibrillator (ICD) is the preferred therapeutic modality in most survivors of SCD. The incidence of SCD can be reduced by improving the current situation through selection of high risk groups for initiation of therapies, education to the public awareness of early warning symptoms and early emergency management that should be readily available in the community.