Indicadores del proceso de tamizaje de cáncer de mama en México: un estudio de caso / Breast cancer screening process indicators in Mexico: a study case

Objetivo. Identificar, medir y comparar indicadores de desempeño de productividad, acceso efectivo y calidad en el servicio del programa de detección oportuna de cáncer de mama en México. Material y métodos. Mediante un estudio de caso basado en datos del Sistema de Información de Cáncer de la Mujer (Sicam) 2011, se midieron y compararon los indicadores con la Norma Oficial Mexicana NOM-041-SSA2-2011 y con estándares internacionales. Resultados. El análisis mostró capacidad instalada insuficiente (37%), bajas coberturas en tamizaje (15%), evaluación diagnóstica (16%), biopsia (44%) y tratamiento (57%) y muy baja efectividad en la detección de casos confirmados por número de mastografías realizadas (0.04%). En el Sicam no existe información para estimar el resto de indicadores propuestos. Conclusiones. Se requieren sistemas de información en salud eficientes para monitorear indicadores y generar observatorios del desempeño de los programas de detección.

Objective. To identify, measure and compare the performance indicators of productivity, effective access and quality service for the early detection breast cancer program in Mexico. Material and methods. By means of a study case based on the 2011 Women Cancer Information System (Sicam), the indicators were measured and compared with the Mexican official standard NOM-041-SSA2-2011 and international standards. Results. The analysis showed insufficient installed capacity (37%), low coverage in screening (15%), diagnostic evaluation (16%), biopsy (44%) and treatment (57%), and very low effectiveness in confirmed cases by the total number of screening mammograms performed (0.04%). There was no information available, from Sicam, to estimate the rest of the indicators proposed. Conclusions. Efficient health information systems are required in order to monitor indicators and generate performance observatories of screening programs.

Acute Effects of Intravenous Administration of Pamidronate in Patients with Osteoporosis

We investigated acute effects of intermittent large dose bisphophonate therapy in osteoporotic patients. Peripheral blood mononuclear cells were incubated with alendronate (100 micrometer) for 18 hr, in vitro and cytokine expressions were measured by real-time RT-PCR. Pamidronate 30 mg was administered on 26 osteoporotic patients; and acute phase reactants, inflammatory cytokines and bone biomarkers were measured. The in vitro study showed significant increase in mRNA expression of IL-6, TNF-alpha and IFN-gamma. A notable rise in serum C-reactive protein (CRP) was observed over 3 days after pamidronate infusion (P=0.026). Serum levels of TNF-alpha, IL-6 and IFN-gamma were also significantly increased (P=0.009, 0.014, 0.035, respectively) and the increase in IL-6 levels were strongly correlated with CRP levels (P=0.04). Serum calcium and c-telopeptide levels rapidly decreased after the treatment (P=0.02, <0.001, respectively). This study showed that mRNA expression of inflammatory cytokines at peripheral blood mononuclear cells (PBMC) level were observed within 18 hr and marked elevation of inflammatory cytokines and acute phase reactants were demonstrated after pamidronate infusion at the dose for osteoporosis. Our studies confirmed that intermittent large dose aminobisphosphonate causes acute inflammation.

Expression of Neutrophil Gelatinase-Associated Lipocalin in Calcium-Induced Keratinocyte Differentiation

In a previous search for the differentially expressed genes in keratinocyte differentiation, we identified neutrophil gelatinase-associated lipocalin (NGAL) as a calcium- induced gene. In this study, we further verified the expression of NGAL in cultured keratinocytes as well as in several skin diseases. Reverse transcription-polymerase chain reaction (RT-PCR), Western blot, and ELISA clearly showed that NGAL expression was markedly increased in calcium-induced keratinocyte differentiation in vitro. However, in our previous report, NGAL expression was not detected in normal skin tissue except for hair follicle by in situ hybridization and immunohistochemistry, indicating the difference of cell status between in vitro and in vitro conditions. Interestingly, NGAL expression was highly increased in psoriasis-like inflammatory disorders (lichen planus and pityriasis rubura pilaris) and skin cancers (keratoacanthoma and squamous cell carcinoma), implying that NGAL may be related with the epidermal hyperplasia. Collectively, these results reveal the potential importance of NGAL in the maintenance of skin homeostasis.

C-Reactive protein: re-evaluation of a diagnostic laboratory test

C-reactive protein has been a measure of acute phase reactions to inflammatory for 40 years. Recently improved quantitative assays in serum and cerebrospinal fluid (CSF) have allowed a re-evaluation of its potential as a diagnostic laboratory test. The main advances in the newer methods have been that they can provide rapid (hours) information on the hepatocyte synthesis of this molecule during immune response. We have tested its value in patients with presumed bacterial meningitis. Based on our experience, newer standardized, quantitative assessments of C-reactive protein can be very useful in distinguishing between bacterial and other forms of meningeal irritation during during the first few days of hospitalization. Other investigators have indicated that by serial measurement important information on the resolution or continuation of inflammatory processes can be obtained. We recommend improved standardization of this test, and recalculation of its usefulness as a diagnostic laboratory test.

Niveles séricos de prealbúmina en niños desnutridos y controles con y sin infección clínica asociada / Serum levels of prealbumin in undernourished children and controls with or without associated clinical infection

Debido a su vida media corta, su elevado contenido en triptófano y su pequeño "pool" corporal, los niveles séricos de prealbúmina han sido considerados como un indicador sensible de la deficiencia proteica y/o calórica. Además, la prealbúmina disminuye durante la respuesta de fase aguda desencadenada por infección o injuria tisular. Se determinaron los niveles séricos de prealbúmina en niños desnutridos con o sin infección clínica asociada y en sus controles infectados o no infectados comparables por edad, sexo, raza y condición socieconómica. En los grupos sin infección clínica asociada, los niveles séricos de prealbúmina eran significativamente menores en los niños desnutridos, que en los controles. Los niveles de prealbúmina también se encontraron significativamente desprimidos en presencia de infección asociada, disminuyendo a niveles casi similares en los niños desnutridos y controles con infección clínica, al compararlos con los observados en niños pertenecientes al mismo estadío nutricional, pero sin infección manifiesta. Se encontró correlación positiva significativa entre la prealbúmiba sérica y tanto el score-Z de peso-edad como de talla-edad y peso-talla en el grupo sin infección manifiesta, las cuales desaparecían en presencia de infección. Portanto, la prealbúmina es un marcador adecuado de desnutrición en ausencia de infección y podría ser un indicador más precoz y sensible de desnutrición actual, causada por los efectos metabólicos de citoquinas inflamatorias producidas durante la infección, que las medidas antropométricas aquí utilizadas

Tumour necrosis factor alpha in stools as a marker in colonic diseases

This study was conducted on 40 patients with different inflammatory bowel diseases depending on the clinical examination, colonoscopic findings and histopthological reports. We aimed at measuring local stool TNF alpha and serum CRP in an attempt to explore their usefulness in assessing inflammatory bowel diseases. The patients were 10 colonic schistosomal patients [CS], 10 active ulcerative colitis [AUC], 10 cancer colon [CC], 5 irritable bowel syndrome [IBS], 3 inactive ulcerative colitis [lUC] and 2 with colonic diverticulosis [DV]. It was found that serum CRP in the different groups of patients were insignificantly different either from the control group or the IBS group. The TNF alpha level in the stool of patients with schistosomal polyposis, AUC and CC were significantly higher than the control group [P< 0.001]. From this data we concluded that serum CRP is of little value in the evaluation of inflammatory bowel diseases, while local TNF alpha may monitor disease activity and even low values exclude active inflammatory bowel diseases, cancer colon and polyposis of any aetiology

Effect of ricin on acute phase response in rats.

Ricin, a highly toxic protein from castor beans was administered (ip) to rats in a dose of 1.25 micrograms/100 g to selectively deplete at least 60-70% of Kupffer cells. This dose spared hepatocytes. This rat model was used to study acute phase protein synthesis and the role of Kupffer cells in acute phase response (APR). Ricin itself induced an APR, similar in pattern but of lower magnitude, than that induced by turpentine. However, the effect of combination of ricin and turpentine on APR was not additive. Kupffer cells appear to play permissive role in APR through mediators like hepatocytes stimulating factors.