Nivel de conocimientos sobre lesiones premalignas bucales en pacientes geriátricos

Fundamento: El nivel de conocimiento sobre lesiones premalignas en la población geriátrica es un factor significativo que incide en la prevención, evitando la progresión a un cáncer bucal. Objetivo: Identificar el nivel de conocimiento de los pacientes geriátricos sobre las lesiones premalignas bucales. Metodología: Entre septiembre de 2019 y junio de 2021 se realizó un estudio observacional descriptivo transversal en el Consultorio Médico de la Familia # 12 del municipio Cabaiguán, provincia Sancti Spíritus. La población estuvo constituida por 158 pacientes geriátricos y mediante un muestreo probabilístico aleatorio simple la muestra quedó conformada por 80. Se aplicaron métodos del nivel teórico, empírico, estadístico y matemático. Las variables utilizadas fueron edad, sexo, escolaridad, nivel de conocimiento sobre factores de riesgo y signos clínicos, conocimientos sobre el autoexamen bucal y la conducta a seguir. Resultados: Se constató que el nivel de conocimientos sobre factores de riesgo fue regular y sobre signos clínicos y forma y frecuencia del autoexamen bucal fue mal. La mayoría de la muestra en estudio conocía donde acudir y afirmó haber recibido información al respecto. Conclusiones: En su mayoría el nivel de conocimientos sobre lesiones premalignas se observó entre regular y mal con un descenso significativo del nivel de conocimientos en los pacientes de edades más avanzadas.

Background: The knowledge level about premalignant lesions in the geriatric population is a significant factor that influences on prevention, avoiding progression into mouth neoplasms. Objective: To diagnose the knowledge level in geriatric patients about buccal premalignant lesions. Methodology: A cross-sectional descriptive observational study was conducted between September 2019 and June 2021 at the Family Medical Office # 12 of Cabaiguán municipality, Sancti Spíritus province. The population was constituted by 158 geriatric patients and by means of a simple random probabilistic sampling, the sample was made up by 80. Theoretical, empirical, statistical and mathematical methods were applied. The used variables were age, sex, schooling, risk factors and clinical signs knowledge, knowledge of buccal self-examination and conduct to be followed. Results: The knowledge level about risk factors was found to be regular and on clinical signs and form and frequency of buccal self-examination was bad. The majority of the sample under study knew where to go and affirmed that they had received information about it. Conclusions: Mostly the knowledge level of premalignant lesions was observed to be regular to bad with a significant decrease in the knowledge level in more elderly patients.

Queilite actínica ("Lábios de Marinheiro"): uma Revisão para o Clínico / Actinic cheilitis ("sailor's lips"): A review for the clinician

A Queilite Actínica (QA), também conhecida como "lábios de marinheiro", é uma patologia com potencial de malignização e, ainda que seja de fácil diagnóstico e prevenção, casos diagnosticados tardiamente podem evoluir para carcinoma de lábios. Seu principal fator etiológico é a exposição aos raios ultravioletas, e por este motivo, indivíduos que se expõem muito ao sol, incluindo militares, podem ser considerados grupo de risco para a doença. O objetivo principal deste trabalho foi descrever os principais fatores de risco e prognósticos da QA e apresentar uma revisão para o cirurgião-dentista, facilitando a identificação e conduta. Para tal, foi realizada busca de artigos pertinentes ao tema nas bases de dados Medline, Lilacs, SciELO e PubMed, de 1987 a 2022. O seguinte perfil do paciente com QA foi identificado: homem, na quinta década de vida, pele clara, com lesões no lábio inferior e com histórico de longo tempo de atividades ocupacionais ao ar livre/intensa exposição solar. O cirurgião-dentista possui papel fundamental na identificação dos grupos de risco, no reconhecimento precoce da doença e, em casos mais avançados, realizar o diagnóstico e o correto encaminhamento para atendimento especializado.

Actinic Cheilitis (AC), also known as "sailor's lips", is a premalignant pathology, and although it is easy to diagnose and prevent, late diagnosed cases may progress to lip carcinoma. Since its main etiological factor is exposure to ultraviolet rays, individuals often exposed to the sun, including military personnel, can be considered a risk group for the disease. The aim of this study was to describe the main risk and prognostic factors of AC and to create a clinical protocol for dental surgeons, making easier to identify and conduct each case. For this purpose, a search for articles relevant to the topic was carried out in Medline, Lilacs, SciELO and PubMed databases, from 1987 to 2022. The following AC patient profile was identified: male, in the fifth decade of life, fair skinned, with lesions on the lower lip and with a long history of outdoor occupational activities/intense sun exposure. The dentist has a fundamental role in identifying risk groups, early recognition of the disease and in more advanced cases, making the correct diagnosis and recommendation to specialized care.

Manifestaciones clínicas e histopatológicas de la eritroplasia bucal en pacientes fumadores de tabaco

Fundamento la eritroplasia es la lesión precancerosa más agresiva de la cavidad oral, con un gran potencial de transformación maligna. Al momento de practicar la biopsia y analizar la muestra, puede aparecer una displasia severa o un carcinoma invasivo. Objetivo describir las manifestaciones clínicas e histopatológicas de la eritroplasia bucal en pacientes fumadores activos de tabaco. Métodos se realizó un estudio descriptivo y transversal, con 12 fumadores diagnosticados clínica e histopatológicamente con eritroplasia bucal, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Saturnino Lora Torres, de Santiago de Cuba. Para la recolección del dato primario se confeccionó una encuesta con las variables: edad, sexo, diagnóstico clínico, tiempo en el hábito de fumar, diferentes formas de consumir tabaco, localización anatómica y estudio histopatológico de la enfermedad. Resultados prevaleció el sexo masculino, el grupo etario de 60 y más años, y los fumadores convencionales de 21 y más años. El infiltrado inflamatorio crónico intenso y la displasia epitelial severa resultaron los cambios hísticos más comunes. Los signos displásicos tisulares mayormente implicados fueron la alteración de los clavos interpapilares, pérdida de la polaridad de las células basales e hiperplasia de las células del estrato basal; mientras que los displásicos citológicos más relevantes resultaron la hipercromasia de núcleos y nucleolos, el pleomorfismo nuclear y el aumento de la relación núcleo-citoplasma, siendo el paladar blando el sitio más frecuente. Conclusiones todos los pacientes fumadores mostraron lesiones eritroplásicas al examen clínico bucal, lo cual fue confirmado por estudio histopatológico.

Foundation erythroplasia is the most aggressive precancerous lesion in the oral cavity, with great potential for malignant transformation. At the time of performing the biopsy and analyzing the sample, severe dysplasia or invasive carcinoma may appear. Objective to describe the clinical and histopathological manifestations of oral erythroplasia in patients who are active tobacco smokers. Methods a descriptive and cross-sectional study was carried out, with 12 smokers clinically and histopathologically diagnosed with oral erythroplasia, attended in the Specialties Polyclinic stomatological consultation of the Saturnino Lora Torres Hospital, in Santiago de Cuba. For the collection of the primary data, a survey was made with the variables: age, sex, clinical diagnosis, time in the smoking habit, different ways of consuming tobacco, anatomical location and histopathological study of the disease. Results the male sex, the age group of 60 years old and over, and conventional smokers of 21 and over prevailed. Intense chronic inflammatory infiltrate and severe epithelial dysplasia were the most common tissue changes. The tissue dysplastic signs most involved were alteration of the interpapillary nails, loss of polarity of the basal cells, and hyperplasia of the basal layer cells; while the most relevant cytological dysplastics were hyperchromasia of nuclei and nucleoli, nuclear pleomorphism and increased nucleus-cytoplasm ratio, with the soft palate being the most frequent site. Conclusions all the smoking patients showed erythroplastic lesions on oral clinical examination, which was confirmed by histopathological study.

Sistema OLGA (Operative Link on Gastritis Assessment) como marcador para cáncer gástrico y displasia en una población colombiana de alto riesgo: estudio multicéntrico

Introducción. En Asia y Europa, el sistema OLGA ha sido útil como marcador de riesgo de cáncer gástrico. Sin embargo, su utilidad en poblaciones de alto riesgo en Colombia aún se desconoce. Objetivo. Establecer si los estadios OLGA se asocian con un mayor riesgo de cáncer y displasia en una población de alto riesgo en Colombia y determinar la capacidad diagnóstica de la escala para evaluar dicho riesgo. Materiales y métodos. Se realizó un estudio multicéntrico con pacientes con cáncer gástrico y displasia (casos), y pacientes con atrofia y metaplasia intestinal (controles), provenientes de tres centros de una zona de alto riesgo de cáncer gástrico en Colombia. Se incluyeron 506 pacientes cuyo estudio endoscópico e histopatológico fue realizado mediante el sistema de Sydney y la estadificación de OLGA propuesta por Rugge. El efecto de cada variable de interés sobre la enfermedad (cáncer gástrico y displasia) se evaluó mediante modelos bivariados y multivariados. Un valor de p menor de 0,05 se consideró estadísticamente significativo. Resultados. Los estadios elevados del sistema OLGA (III-IV) se asociaron con un mayor riesgo de displasia y cáncer gástrico (OR ajustado = 8,71; IC95 % = 5,09-14,9; p=0,001) con una sensibilidad del 54,9 %, especificidad del 89,3 % y una razón de probabilidad positiva de 5,17. Conclusiones. El estadio OLGA es un marcador de riesgo de cáncer gástrico y displasia en la población de estudio. Se recomienda su implementación como estrategia para optimizar el diagnóstico oportuno y el seguimiento de pacientes con mayor riesgo.

Introduction. The OLGA system has been proved to be useful in Asia and Europe as a risk marker of gastric cancer. However, its usefulness in high-risk populations in Colombia is still unknown. Objective. To assess potential associations between the OLGA staging system and an increased risk of gastric cancer and dysplasia in a high-risk Colombian population and to establish diagnostic capacity of the scale to assess the risk. Materials and methods. We carried out a multicenter study including patients with cancer and dysplasia (cases) and patients with atrophy and intestinal metaplasia (controls). A total of 506 patients were recruited from three centers in an area with a high risk population in Colombia. The endoscopic and histopathologic studies were evaluated according to the Sydney system and the OLGA staging system proposed by Rugge. The effect of each variable on the disease (gastric cancer and dysplasia) was evaluated using bivariate and multivariate models. Statistical significance was set considering a p value inferior to 0.05. Results. Advanced stages of the OLGA system (III-IV) were associated with a higher risk of dysplasia and gastric cancer (adjusted OR = 8.71; CI95% = 5.09-14.9; p=0.001), sensitivity=54.9%, specificity=89.3% and positive likelihood ratio=5.17. Conclusions. The OLGA staging system is a risk marker for gastric cancer and dysplasia in the studied population. We recommend its implementation to improve the timely diagnosis and follow-up of patients with the highest cancer risk.

Efectividad de la crioterapia suministrada por enfermeras para lesiones preneoplásicas del cuello uterino

Introducción. El cáncer de cuello uterino es un problema de salud pública relevante en países de ingresos medios y bajos. El seguimiento de mujeres con tamización positiva y el acceso a tratamiento para neoplasia intraepitelial cervical (NIC) son retos mayores en estos países. Objetivo. Evaluar la efectividad de la crioterapia suministrada por enfermeras en casos de neoplasia intraepitelial de cérvix. Materiales y métodos. Se hizo la inspección visual directa con ácido acético y solución yodada (VIA-VILI), y se practicó colposcopia con biopsia, a mujeres entre los 25 y los 59 años, residentes en zonas de bajos ingresos de Bogotá. Profesionales de enfermería entrenados ofrecieron tratamiento inmediato con crioterapia a mujeres positivas en la inspección visual. Se les practicó colposcopia con biopsia antes del tratamiento y en un control a los 12 meses. Se evaluó la efectividad mediante tasas de curación (resultado: sin lesión) y regresión de NIC2/3 (resultado: ≤NIC1), por verificación colposcópica e histológica. Resultados. Se tamizaron 4.957 mujeres. En total, 499 fueron positivas y 472 aceptaron el tratamiento inmediato. Recibieron crioterapia por enfermería 365 mujeres (11 NIC2/3). La tasa de curación fue del 72 % (IC95%: 39-94 %) por verificación colposcópica, y del 40 % (IC95%: 22-85 %) por histología. Las tasas de regresión fueron del 100 y el 60 %, respectivamente. Se reportaron dos eventos adversos no graves relacionados. Conclusiones. Las tasas de curación y regresión por verificación colposcópica son similares a las reportadas con crioterapia administrada por médicos. El tamaño de la muestra con NIC2/3 dificulta la comparación por tipo de verificación. Los hallazgos apoyan la implementación de estrategias de "ver y tratar" por parte de enfermería en poblaciones con acceso limitado a servicios de salud.

Introduction. Cervical cancer is a relevant public health problem for low- and middleincome countries. Follow-up of positive-screened women and compliance with treatment of precancerous lesions are major challenges for these settings. Objective. To evaluate the efficacy of cryotherapy delivered by nurses for cervical intraepithelial neoplasia (CIN). Materials and methods. Direct visual inspection with acetic acid and lugol iodine (VIA- VILI), and colposcopy/biopsy were performed on women 25 to 59 years old, residents of low-income areas in Bogotá, Colombia. Trained nurses offered immediate cryotherapy to every woman with positive visual inspection. Colposcopy/biopsy was performed before treatment and at a 12-month follow-up. The effectiveness was measured as cure (outcome: no-lesion) and regression (outcome: CIN1) rates of CIN2/3 using colposcopic and histological verification. Results. A group of 4.957 women with VIA/VILI was valuated. In total, 499 were screen positive and 472 accepted immediate treatment. A total of 365 women (11 CIN2/3) received cryotherapy by nurses. Cure rate was 72% (95%CI: 39%-94%) and 40% (95%CI: 22%- 85%) by colposcopic and histological verification, respectively. Regression rates were 100% and 60%. There were two related non-serious adverse events. Conclusions. Cure and regression rates by colposcopic verification are like those reported for cryotherapy delivered by doctors. The sample size (CIN2/3) hinders comparisons by type of verification. Our findings support the implementation of screen-and-treat algorithms by nurses among populations with limited access to health services.

Aspectos histológicos, genéticos y moleculares de las lesiones preneoplásicas de la mucosa gástrica / Histological, genetic and molecular aspects of preneoplastic lesions of the gastric mucosa

Siendo el cáncer gástrico la 3ª causa de muerte por cáncer en Chile, y existiendo estrategias de tamizaje consistentes en pesquisa de lesiones preneoplásicas de la mucosa gástrica, es relevante conocer los aspectos genéticos y moleculares que puedan ser aplicados, en la optimización de dichas estrategias a grupos de mayor riesgo. El objetivo de este manuscrito fue revisar la evidencia actual en los aspectos señalados, y de la inmunohistoquímica de 4 marcadores (p53, CDX2, MUC2 y S100A9) en la mucosa gástrica normal y en las lesiones preneoplásicas de la misma.

SUMMARY: Since gastric cancer is the 3rd leading cause of death from cancer in Chile, and there are screening strategies consisting of screening for preneoplastic lesions of the gastric mucosa, it is important to know certain genetic and molecular aspects that can be applied in optimizing these strategies for higher risk groups. The aim of this manuscript was to review the current evidence on the aforementioned aspects, and on the immunohistochemistry of 4 markers (p53, CDX2, MUC2 and S100A9) in normal gastric mucosa and in its preneoplastic lesions.

Intervenciones endoscópicas para mejorar la tasa de detección de lesiones serradas durante la colonoscopia

El cáncer colorrectal (CCR) es una de las causas más frecuentes de mortalidad por cáncer en el mundo. Las lesiones serradas son responsables de 10 a 20% de todos los CCR. Los pólipos serrados, en particular los adenomas serrados sésiles (ASS) y adenomas serrados tradicionales (AST), tienen una apariencia sutil y localización proximal, y por ello presentan una alta tasa de lesiones perdidas. El objetivo de la presente revisión fue evaluar la evidencia disponible sobre el uso de diversas intervenciones endoscópicas para mejorar la tasa de detección de las lesiones serradas, para de esta forma, disminuir la mortalidad relacionada al CCR.

Colorectal cancer (CRC) is one of the most common causes of cancer mortality in the world. Serrated lesions are responsible for 10 to 20% of all CRCs. Serrated polyps, particularly sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA), have a subtle appearance and proximal location, and therefore have a high miss rate. The objective of this review was to evaluate the available evidence on the use of various endoscopic interventions for improving serrated lesion detection rate, thus reducing CRC related mortality.

Genome sequencing reveals molecular subgroups in oral epithelial dysplasia

Abstract This study aimed to analyze the molecular characteristics of oral epithelial dysplasia (OED), highlighting the pathways and variants of genes that are frequently mutated in oral squamous cell carcinoma (OSCC) and other cancers. Ten archival OED cases were retrieved for retrospective clinicopathological analysis and exome sequencing. Comparative genomic analysis was performed between high-grade dysplasia (HGD) and low-grade dysplasia (LGD), focusing on 57 well-known cancer genes, of which 10 were previously described as the most mutated in OSCC. HGD cases had significantly more variants; however, a similar mutational landscape to OSCC was observed in both groups. CASP8+FAT1/HRAS, TP53, and miscellaneous molecular signatures were also present. FAT1 is the gene that is most affected by pathogenic variants. Hierarchical divisive clustering showed division between the two groups: "HGD-like cluster" with 4HGD and 2LGD and "LGD-like cluster" with 4 LGD. MLL4 pathogenic variants were exclusively in the "LGD-like cluster". TP53 was affected in one case of HGD; however, its pathway was usually altered. We describe new insights into the genetic basis of epithelial malignant transformation by genomic analysis, highlighting those associated with FAT1 and TP53. Some LGDs presented a similar mutational landscape to HGD after cluster analysis. Perhaps molecular alterations have not yet been reflected in histomorphology. The relative risk of malignant transformation in this molecular subgroup should be addressed in future studies.

Active search screening for oral potentially malignant disorders and oral cancer in the city of Piracicaba

Abstract Oral cancer is a public health problem worldwide with approximately 300,000 new cases diagnosed every year and more than 170,000 deaths annually. Squamous cell carcinoma (SCC) accounts for approximately 90% of all oral malignancies and it is frequently preceded by lesions known as oral potentially malignant disorders (OPMDs). Screening programs for early detection of oral lesions have been conducted. Therefore, the objective of this research was to carry out an active search in a screening program in the city of Piracicaba, Brazil. High-risk patients were identified at the city's health center through their medical records and referred for dental consultation. Other patients who opportunistically sought dental care were also seen and if they did not present risk factors for SCC, they were considered low-risk. A total of 756 patients were examined, and 445 met the criteria for the high-risk group and 311 for the low-risk group. It was possible to diagnose 27 OPMDs and six SCCs - 21 OPMDs and six SCCs occurred in high-risk patients and six OPMDs in low-risk patients. A chi-square test was applied and a statistically significant value (p = 0.006) was obtained for the detection of OPMD and SCC in patients of the high-risk group. Screening of high-risk patients through active search proved to be an effective program for diagnosing OPMD and SCC. Therefore, we encourage its implementation on a large scale to reduce the current scenario of this disease.

Detection rate and clinical characteristics of vulvar squamous intraepithelial lesion / 中华妇产科杂志

Objective:To explore the detection rate, clinical characteristics of vulvar squamous intraepithelial lesion (SIL).Methods:Women diagnosed with vulvar high-grade squamous intraepithelial lesions (HSIL) through colposcopy-guided biopsy from January 1, 2018 to August 31, 2022 in Obstetrics and Gynecology Hospital of Fudan University were included in a 1∶1 ratio with patients diagnosed with vulvar low-grade squamous intraepithelial lesions (LSIL) during the same period. Clinical characteristics including human papillomavirus (HPV) infection rate, genotype, cytology result, colposcopy impression, and lesion location were retrospectively analyzed.Results:(1) The proportion of vulvar SIL detected by colposcopy-guided biopsy increased annually from 2018 to 2022, with rates of 1.64% (740/45 057), 2.34% (1 110/47 402), 2.68% (1 108/41 335), 3.26% (1 536/47 078), 3.31% (667/20 155), with an average rate of 2.57% (5 161/201 027). (2) A total of 1 096 cases of vulvar HSIL and 1 096 cases of vulvar LSIL were included. The overall infection rate of HPV was 92.7% (1 993/2 150), with higher infection rate in vulvar HSIL patients than that in vulvar LSIL patients [96.0% (1 012/1 054) vs 89.5% (981/1 096); χ2=33.62, P<0.001]. Among vulvar HSIL patients, the common HPV genotype from high to low were HPV 16 (66.7%), HPV 52 (14.3%), and HPV 58 (10.0%). For vulvar LSIL patients, the most common HPV genotype were respectively HPV 16 (24.9%), HPV 6 (20.1%) and HPV 52 (17.1%). The overall sensitivity rate of cytology was 53.6%, with no significance difference between vulvar LSIL and HSIL groups (54.3% vs 52.9%; χ2=0.40, P=0.526). The accuracy of colposcopy impression for vulvar HSIL was lower than that for vulvar LSIL [40.2% (163/405) vs 81.7% (380/465); χ2=158.72, P<0.001]. About 57.3% (1 257/2 192) of the patients had concomitant cervical and vaginal lesions, with a higher rate in vulvar HSIL group than that in vulvar LSIL group [62.6% (686/1 096) vs 52.1% (571/1 096); χ2=24.67, P<0.001]. Unifocal lesion was the main type, with no significance difference between vulvar LSIL and HSIL groups [81.4% (381/468) vs 82.5% (386/468); χ2=0.18, P=0.671]. The most common lesion locations were the posterior commissure, followed by labia minora, vaginal vestibule, labia majora, perianal and clitoris. Conclusions:The detection rate of vulvar SIL under colposcopy is about 3%, and the infection rate of HPV is 92.7%. Vulvar SIL, especially vulvar HSIL, is likely to cause concomitant cervical and vaginal lesions. The accuracy of colposcopy in diagnosing vulvar HSIL is low. Therefore a comprehensive and careful examination of the vulva is necessary and suspicious vulvar lesions should be undergone colposcopy-guided biopsy for diagnosis.

Vacuna del virus del papiloma humano: valoración bioética de la discriminación por sexo

La infección por el virus del papiloma humano (VPH) constituye la causa necesaria, aunque no suficiente, de la enfermedad de transmisión sexual más frecuente en el mundo, responsable del 4,5 % de todos los cánceres en ambos sexos. La vacunación frente al VPH, con niveles de eficacia y seguridad similares en ambos sexos, está dirigida básicamente a mujeres, para reducir la incidencia de infección y sus consecuencias, como el cáncer de cérvix. La transmisibilidad del virus en ambos sexos y la inmunidad colectiva que proporciona la vacunación universal hace que su extensión al sexo masculino constituya una cuestión no solo de salud pública, sino también un dilema bioético relacionado con la protección de la salud y la equitativa distribución de los recursos. Este trabajo aborda el análisis bioético de la extensión de la vacunación contra VPH a ambos sexos.

Human Papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide, responsible for 4.5 % of all cancers in both sexes. HPV vaccination, with similar levels of efficacy and safety in both sexes, is aimed at women to prevent cervical cancer. The transmissibility of the virus in both sexes and the herd immunity provided by universal vaccination makes its extension to the male sex a matter not only of public health but also a bioethical dilemma related to the protection of health and the equitable distribution of resources. This research addresses the bioethical analysis of the extension of HPV vaccination to both sexes.

A infecção pelo vírus do papiloma humano (HPV, na sigla em inglês) constitui a causa principal, ainda que não suficiente, da doença de transmissão sexual mais frequente no mundo, responsável por 4,5 % de todos os cânceres em ambos os sexos. A vacinação contra o HPV, com níveis de eficácia e segurança semelhantes em ambos os sexos, está orientada basicamente a mulheres, para reduzir a incidência de infecção e suas consequências, como o câncer do colo do útero. A transmissão do vírus em ambos os sexos e a imunidade coletiva que a vacinação universal promove fazem com que sua extensão ao sexo masculino constitua uma questão não apenas de saúde pública, mas também um dilema bioético relacionado com a proteção da saúde e a equitativa distribuição dos recursos. Nesse sentido, neste trabalho, é abordada a análise bioética da extensão da vacinação contra o HPV em ambos os sexos.

Comportamiento de las alteraciones citológicas en mujeres atendidas en una IPS de la ciudad de Medellín / Behavior of cytological alterations in women treated at an IPS in the city of Medellín

Resumen Objetivo: Analizar las características relacionadas con el diagnóstico de cáncer de las pacientes que consultan una IPS de la ciudad de Medellín. Metodología: Estudio observacional analítico. La población fueron todas las mujeres atendidas en la IPS Unidad Video Diagnóstica de la Mujer, institución que se dedica a realizar confirmación diagnóstica de mujeres con citologías alteradas. Se analizaron todos los registros de la base de datos de la institución correspondientes a las mujeres que consultaron durante el período 2012- 2017, un total de 55655 mujeres. Resultados: Se analizaron los registros de 55655 usuarias, la mediana de edad fue de 40 años (RIQ 19) y el 66.1% (36812) pertenecen al régimen subsidiado. La principal indicación para la realización de la colposcopia fueron las alteraciones citológicas con un 89.8% (49984) y más frecuente fue el LIEBG 35.3% (19649). El principal cáncer diagnosticado fue el escamocelular con 0.5% (284) y los factores asociados fueron residir en el Valle de Aburrá (OR 0.60 IC 0.42-0.84) y el resultado de citología LIEAG (OR 3.31 IC 2.22-4.94). Conclusiones: Se encontró una prevalencia de cáncer de cérvix de 7.8 por cada 1000 pacientes que consultan en la IPS.

Abstract Objective: To analyze the characteristics related to the diagnosis of cancer of the patients who consult an IPS in the city of Medellín. Methodology: Analytical observational study. The population consisted of all the women treated at the IPS Unidad Video Diagnóstica de la Mujer, an institution dedicated to performing diagnostic confirmation of women with altered cytologies. All the records of the institution's database corresponding to the women who consulted during the period 2012-2017 were analyzed, a total of 55,655 women. Results: The records of 55,655 users were analyzed, the median age was 40 years (RIQ 19) and 66.1% (36,812) belonged to the subsidized regime. The main indication for performing colposcopy was cytological alterations with 89.8% (49984) and the most frequent was LIEBG 35.3% (19649). The main cancer diagnosed was squamous cells with 0.5% (284) and the associated factors were residing in the Valle de Aburrá (OR 0.60 IC 0.42-0.84) and the LIEAG cytology result (OR 3.31 IC 2.22-4.94). Conclusions: A cervical cancer prevalence of 7.8 was found for every 1000 patients who consulted the IPS.

Leucoplaquias laríngeas: Análisis de las lesiones y resultados vocales en una unidad de voz terciaria

Introducción: Las leucoplaquias laríngeas (LL) pueden corresponder a lesiones precancerosas. La aproximación diagnóstica es endoscópica y en caso de persistir, se debe estudiar con biopsia. Objetivo: Describir las características biodemográficas, clínicas, endoscópicas, histológicas y evolutivas de pacientes diagnosticados con leucoplaquias glóticas. Material y Método: Estudio prospectivo no-concurrente de pacientes diagnosticados con leucoplaquias glóticas en la Unidad de Voz del Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile, entre 2012 y 2019. Resultados: Se incluyeron 29 pacientes, 65,5% hombres, con edad promedio de 61 años y seguimiento promedio de 21,1 meses. El principal motivo de consulta fue disfonía, en un 86,2% de los casos. El 38% presentó compromiso del pliegue vocal (PV) izquierdo, 24,1% derecho, 24,1% bilateral y 13,8% bilateral incluyendo comisura anterior. El 41,4% de las lesiones comprometían más del 50% del PV y 68% presentaba una onda mucosa alterada en la estroboscopia. Un 89,7% requirió biopsia, identificando carcinoma en 26,9%, displasia en 34,6% y otro diagnóstico en 38,5%. El 25,9% presentó recurrencias, del cual 28,6% progresó a cáncer. Se identificó asociación significativa en un análisis bivariado entre la edad (p = 0,030) y compromiso mayor al 50% del PV (p = 0,016) con displasia de alto riesgo o cáncer. En el análisis multivariado, solo la edad mostró ser significativa (p = 0,038; OR 1,27; IC 95% 1,01-1,59). Conclusión: El estudio de las LL es esencial para el diagnóstico precoz de cáncer laríngeo. La edad y el compromiso mayor al 50% del PV en la estroboscopia podría predecir un riesgo mayor de displasia de alto riesgo o cáncer.

Introduction: Laryngeal leukoplakia (LL) may correspond to precancerous lesions. The diagnostic approach is endoscopic, and if LL persist, a biopsy should be performed. Aim: To describe the biodemographic, clinical, endoscopic, histological, and developmental characteristics of patients diagnosed with glottic leucoplakia. Material and Method: Prospective non-concurrent study of patients diagnosed with glottic leukoplakia in the Voice Unit at the Otolaryngology Department of the Pontificia Universidad Catolica de Chile, between 2012 and 2019. Results: Twenty-nine patients were included, 65.5% men, with an average age of 61.7 years, and average follow-up of 21.1 months. Dysphonia was the chief complaint, present in 86.2% of the cases. The left vocal fold (VF) was involved in 38.0%, right in 24.1%, bilateral in 24.1%, and bilateral including anterior commissure in 13.8%. Only 41.4% compromised over 50% of the VF and 68.0% presented an altered mucosal wave in the videostroboscopy. A biopsy was performed in 89.7%, identifying carcinoma in 26.9%, dysplasia in 34.6% and other diagnosis in 38.5%. During follow-up 25.9% recurred, of which 28.6% progressed to cancer. A significant association was found in the bivariate analysis between age (p = 0.030) and extension over 50% of the VF (p = 0.016) with high-risk dysplasia or cancer. In the multivariate analysis only, the age was found to be significative (p = 0.038; OR 1.27; CI 95% 1.01-1.59). Conclusions: A thorough evaluation is essential in LL, favoring an early diagnosis for laryngeal cancer. Age and an involvement greater than 50% of the VF in the videostroboscopy could predict an increased possibility for high-risk dysplasia or cancer.

Efficacy of chemiluminescence in the diagnosis and screening of oral cancer and precancer: a systematic review and meta-analysis / Eficácia da quimioluminescência no diagnóstico e rastreamento de câncer oral e pré-câncer: uma revisão sistemática e metanálise

Abstract Introduction Early detection of potentially malignant oral cavity disorders is critical for a good prognosis, and it is unclear whether the use of chemiluminescence as an adjunctive diagnostic screening method improves diagnostic accuracy. Objective This systematic review and meta-analysis was performed to assess the accuracy of chemiluminescence for diagnosis of oral cancer and precancerous lesions. Methods Sixteen prospective and retrospective studies from PubMed, Cochrane database, SCOPUS, Web of Science, Embase, and Google Scholar were reviewed. Oral mucosal disorder, as detected by chemiluminescence, was compared with oral mucosal disorder detected by toluidine blue or visual examination. True-positive, true-negative, false-positive, and false-negative rates were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool (ver. 2). Results Sensitivity, specificity, negative predictive value, and diagnostic odds ratio (DOR) of the use of toluidine blue were 0.832 (95% confidence interval [CI] 0.692-0.917), 0.429 (95% CI 0.217-0.672), 0.747 (95% CI 0.607-0.849), and 4.061 (95% CI 1.528-10.796; I2 = 9.128%), respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.743. Compared with toluidine blue, as used in 12 studies, chemiluminescence had a higher sensitivity (0.831 vs. 0.694); it had a lower specificity (0.415 vs. 0.734), negative predictive value (0.674 vs. 0.729), and DOR (3.891 vs. 7.705). Compared with clinical examination, as used in three studies, chemiluminescence had lower DOR (4.576 vs. 5.499) and area under the curve (0.818 vs. 0.91). Conclusion Although chemiluminescence itself has good sensitivity for diagnostic work-up of oral cancer and precancer, the diagnostic accuracy of chemiluminescence is comparable to or worse than toluidine blue and clinical examination. Diagnostic accuracy was therefore insufficient for reliable use of chemiluminescence alone.

Resumo Introdução A detecção precoce de distúrbios orais potencialmente malignos é fundamental para um bom prognóstico e não está claro se o uso da quimioluminescência como método auxiliar de triagem diagnóstica melhora a eficácia do diagnóstico. Objetivo Avaliar a precisão da quimioluminescência para o diagnóstico de câncer oral e pré-câncer. Método Foram revisados 16 estudos prospectivos e retrospectivos dos bancos de dados PubMed, Cochrane, Scopus, Web of Science, Embase e Google Scholar. Os distúrbios da mucosa oral detectados por quimioluminescência foram comparados com os distúrbios da mucosa oral detectados pelo azul de toluidina ou pelo exame visual. Taxas de resultados verdadeiro-positivos, verdadeiro-negativos, falso-positivos e falso-negativos foram extraídas de cada estudo. A qualidade metodológica foi avaliada com a ferramenta Quality Assessment of Diagnostic Accuracy Studies-versão 2 (QUADAS-2). Resultados Sensibilidade, especificidade, valor preditivo negativo e odds ratio diagnóstico do uso do azul de toluidina foram 0,832 (intervalo de confiança de 95%: 0,692-0,917), 0,429 (IC95%: 0,217-0,672), 0,747 (IC95%: 0,607-0,849) e 4,061 (intervalo de confiança 95%: 1,528-10,796; I2 = 9,128%), respectivamente. A área sob a curva SROC, do inglês summary receiver operating characteristic, foi de 0,743. Comparada ao azul de toluidina, como usado em 12 estudos, a quimioluminescência apresentou uma sensibilidade mais alta (0,831 vs. 0,694) e especificidade (0,415 vs. 0,734), valor preditivo negativo (0,674 vs. 0,729) e odds ratio diagnóstico (3,889 vs. 7,705) mais baixos. Comparado com o exame clínico, como usado em três estudos, a quimioluminescência apresentou menor odds ratio diagnóstico (4.576 vs. 5.499) e área sob a curva (0,818 vs. 0,91). Conclusão Embora a quimioluminescência em si tenha boa sensibilidade para o diagnóstico de câncer oral e pré-câncer, sua precisão diagnóstica é comparável ou pior do que o azul de toluidina e o exame clínico. A precisão do diagnóstico foi, portanto, insuficiente para o uso isolado confiável da quimioluminescência.

Clinical and mechanism research progress of chronic atrophic gastritis treated with TCM / 国际中医中药杂志

Traditional Chinese Medicine (TCM) alone or combined with western medicine has obvious clinical therapeutic effects on chronic atrophic gastritis, especially in improving symptoms and reversing lesions, based on the basic pathogenesis of chronic atrophic gastritis with deficiency in origin and excess in superficiality. The therapeutic methods include invigorating spleen, activating blood circulation and detoxification. The main mechanism is to inhibit cell proliferation, induce apoptosis, change the micro-environment, reduce the degree of inflammation, repair damaged mucosa and improve immune function.

Genetic polymorphisms and protein levels in vocal fold leukoplakia: a systematic review

Vocal fold leukoplakia (VFL) has a risk of malignant transformation. Therefore, patients can have symptoms such as dysphonia, vocal strain, difficulty breathing, and dysphagia. Additionally, there is a genetic predisposition that can be associated with genetic polymorphisms. We aimed to evaluate the influence of genetic polymorphisms and protein levels in the etiology of VFL. Our study followed the PRISMA checklist and was registered on PROSPERO database. The questions were: "Are genetic polymorphisms involved in the etiology of VFL? Are protein levels altered in patients with VFL?". Eligibility criteria were case control studies that compared the presence of polymorphisms or/and protein levels of subjects diagnosed with VFL and healthy controls. Of the 905 articles retrieved, five articles with a total of 1038 participants were included in this study. The C allele of the single nucleotide polymorphisms (SNP)-819 T/C IL-10, A allele of the SNP -592 A/C IL-10, CT genotype of the SNP rs11886868 C/T BCL11A, GG genotype of the SNP rs4671393 A/G BCL11A, LL genotype, and L allele of (GT)n repeat polymorphisms of the HO-1 were risk factors for VFL development. Nevertheless, there was a lack of association between VFL and the -1082 A/G IL-10, rs14024 CK-1, and -309 T/G Mdm2 SNPs. The concentrations of the MDM2, BCL11A, and HO-1 proteins were modified, while IL-10 levels were normally expressed in these subjects. In conclusion, most markers evaluated in this review could be potential indicators to develop effective therapies, avoiding a malignant transformation of the lesion.

Clinical characteristics of human papillomavirus infection in young women and progress in diagnosis and treatment of cervical precancerous lesions / 中国基层医药

Cervical cancer is a serious threat to women's life and health. Studies have shown that the incidence of cervical cancer in China ranks second in the world. With increasing application of cervical cancer screening technology, cervical cancer mortality shows a downward trend, but the incidence of cervical cancer in young women shows an upward trend. The affected population tends to be young. Young women are the population at high risk for a human papillomavirus (HPV) infection because they have high levels of estrogen and active sexual behavior. Persistent high-risk HPV infection is the key factor that promotes development of precancerous lesions toward cervical cancer. This paper reviews the clinical characteristics of HPV infection in young women and the research progress in diagnosis and treatment strategy of precancerous lesions.

Effect of Yipi Yanggan prescription on malignant transformation of liver stem cells in rats with liver precancerous lesion and its mechanism of action / 临床肝胆病杂志

Objective To investigate the effect of Yipi Yanggan prescription on the malignant transformation of liver stem cells in liver precancerous lesion induced by diethylnitrosamine (DEN) and its possible molecular mechanism. Methods A total of 35 male Sprague-Dawley rats were randomly divided into normal control group (blank group), DEN model group (model group), DEN+Yipi Yanggan prescription group (Yipi Yanggan prescription group), and DEN+Hugan tablet group (Hugan tablet group), with 5 rats in the blank group and 10 rats in the other three groups. Intraperitoneal injection of DEN was performed to establish a model of liver precancerous lesion, the rats were sacrificed after 16 weeks of administration. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (Alb) were measured; liver tissue was collected to observe the changes in size and appearance and calculate liver weight ratio (liver index); HE staining and Sirius Red staining were used to observe the pathological and morphological changes of rat liver tissue; immunohistochemistry was used to measure the expression of OV6 and glutathione S-transferase-Pi (GST-Pi); RT-PCR was used to measure the mRNA expression of EpCAM, CD133, and CD90, and Western blot was used to measure the protein expression of PI3K, Akt, and mTOR and their phosphorylation level. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t -test was used for further comparison between two groups. Results Compared with the model group, the Yipi Yanggan prescription group and the Hugan tablet group had significant improvements in liver pathology and morphology, significant reductions in liver index and the levels of ALT and AST, and a significant increase in the level of Alb (all P < 0.05), as well as significant reductions in the protein expression levels of GST-Pi, OV6, p-PI3K, p-Akt, and p-mTOR and the mRNA expression levels of EpCAM, CD133, and CD90 (all P < 0.05). Compared with the Hugan tablet group, the Yipi Yanggan prescription group showed a more significant protective effect on the liver, with significant reductions in liver index and the levels of ALT and AST, and a significant increase in the level of Alb (all P < 0.05), as well as significant reductions in the protein expression levels of GST-Pi, OV6, p-PI3K, p-Akt, and p-mTOR and the mRNA expression levels of EpCAM, CD133, and CD90 (all P < 0.05). Conclusion Yipi Yanggan prescription can improve liver precancerous lesion induced by DEN in rats by inhibiting the malignant transformation of liver stem cells, and its mechanism of action may be associated with the PI3K/Akt/mTOR signaling pathway.

Clinical research progress of Traditional Chinese Medicine treating precancerous lesions of gastric cancer with syndrome differentiation / 国际中医中药杂志

Traditional Chinese Medicine (TCM) has certain advantages in the treatment of precancerous lesions of gastric cancer (PLGC) based on the holistic concept and the thought of syndrome differentiation. Currently, it is generally divided into 6 kinds of syndromes: liver and stomach qi stagnation syndrome, liver and stomach heat stagnation syndrome, spleen and stomach weakness syndrome (including spleen and stomach qi deficiency syndrome with coldness), spleen and stomach damp heat syndrome, stomach yin deficiency syndrome and blood stasis in stomach collateral syndrome. Clinically, the doctor should treat PLGC patients according to different syndrome types by using Chinese medicine prescription, which could improve the gastric mucosal pathological state, gastroscopy and clinical symptoms, to rehibit the development of precancerous lesions, reduce the incidence rate of gastric cancer. In the future, the doctors shouldreach the consensus of treating PLGC with TCM diagnosis, and focus on the research of TCM compounds or monomers with obvious curative effect, increase the times of follow-up, and evaluate the long-term curative effect.

Serrated polyps: innocent or guilty? / Pólipos serrados: ¿inocente o culpable?

ABSTRACT Serrated lesions represent a group of lesions with different genetic and biological features causing important clinical repercussions. Three types of serrated lesions are identified: hyperplastic, sessile adenomas (with and without dysplasia) and traditional serrated adenomas. Such lesions are now recognized as precancerous lesions.The carcinogenic process of serrated lesions follows a pathway including: alterations concerning activation of mitogen and protein kinase regulating the extracellular signal of other intracellular kinases (MAPK-ERK), inhibition of the apoptosis and hypermethylation of DNA and instability of microsatellites. Like for adenomatous polyps, the risk factors for serrated lesions are environmental factors, related to lifestyle and diet. The cancerogenic risk is increased by excessive alcohol consumption, obesity and poor intake of folate. When a high number of colorectal polyps with architecture serrated is diagnosed, it could be considered as serrated polyposis syndrome (SPS). According the most recent ESGE guidelines, the diagnostic criteria of the SPS, are: at least 5 polyps resected proximal to the sigmoid colon, 2 of which> 10 mm, or >20 serrated lesions of any size distributed in the entire colon. This condition presents a high risk for personal and/or familiar CRC, for this reason a regular screening colonoscopy should be performed in these patients and in their first-degree relatives.

RESUMEN Las lesiones serradas representan un grupo de lesiones con diferentes características genéticas y biológicas que provocan importantes repercusiones clínicas. Se identifican tres tipos de lesiones serradas: adenomas hiperplásicos, sésiles (con y sin displasia) y adenomas serrados tradicionales. Estas lesiones se reconocen actualmente como lesiones precancerosas.El proceso carcinogénico de las lesiones serradas sigue una vía que incluye: alteraciones relativas a la activación del mitógeno y de la proteína quinasa reguladora de la señal extracelular de otras quinasas intracelulares (MAPK-ERK), inhibición de la apoptosis e hipermetilación del ADN e inestabilidad microsatelital. Al igual que en el caso de los pólipos adenomatosos, los factores de riesgo de las lesiones serradas son factores ambientales, relacionados con el estilo de vida y la dieta. El riesgo cancerígeno aumenta con el consumo excesivo de alcohol, la obesidad y la ingesta deficiente de folatos. Cuando se diagnostica un número elevado de pólipos colorrectales con arquitectura serrada, puede considerarse como síndrome de poliposis serrada (SPS). Según las guías más recientes de la ESGE, los criterios diagnósticos del SPS, son: al menos 5 pólipos resecados proximalmente al colon sigmoides, 2 de los cuales> 10 mm, o > 20 lesiones serradas de cualquier tamaño distribuidas en todo el colon. Esta condición presenta un alto riesgo de CCR personal y/o familiar, por lo que debe realizarse una colonoscopia de cribado periódica en estos pacientes y en sus familiares de primer grado.