Aplicabilidad del análisis por causa múltiple de muerte para el cáncer cervicouterino: la experiencia en México / Applicability of the analysis by multiple cause of death by cervical cancer: the experience in Mexico

Objecto. Explora-se a aplicabilidad da análise por causa múltipla de morte para o estudo do cancro cervicouterino. Métodos. Desenho de mortalidade proporcional para analisar todas as causas consignadas na totalidade dos certificados de morte por cancro cervicouterino de mulheres maiores de 18 anos do Estado de México (367), e 515 certificados de mulheres falecida por outras causas. Resultados. Encontrou-se uma razão de causa básica/múltipla de 2.9 nos certificados de morte, isto é pela cada causa básica encontraram-se 2.9 As mulheres falecidas por cancro cervicouterino morrem cinco anos dantes que as que morrem por outras causas (p<0.05). Ao ajustar as análise por causa múltipla para cancro cervicouterino por idade, escolaridad, estado civil, e direito habiencia, destaca a participação dos tumores malignos de lugares mau definidos como causas contribuintes e condicionantes [OR=14.24 (1.67-121.0) e OR=18.98 (2.28-157.56, respectivamente]; seguido pela diabetes mellitus também como contribuintes e sócias [OR=1.82 (1.02-3.27) e OR=7.78(1.46-41.37)] e a hipertensión arterial sistémica como causa sócia [OR = 3.0 (1.39-6.47)]. Conclusões. Causa múltipla é uma análise adequada para observar as doenças que intervêm, contribuem, condicionan e se associam ao cancro cervicouterino no momento da morte.

Objective. The study explores the applicability of the multiple-cause-of-death analysis for cervical-uterine cancer. Methods. A proportional mortality hazard design and the analysis of all causes of death due to cervical-uterine cancer from 367 death certificates of women older than 18 years of age from the State of Mexico, and 515 age and year adjusted sample of death certificates of women from the same region who died from other causes. Results. A basic multiple cause of death of 2.9 was observed in the death certificates, i.e., for every basic cause there were 2.9 multiple causes. When adjusting the multiple-causes-of-death analysis for cervical-uterine cancer by age, education, marital and insurability status, the most contributing and associated causes of death were malignant tumors from unspecified sites [OR=18.98 (2.28-157.56) and OR=14.25 (1.67-121.0)] respectively; Diabetes Mellitus as a contributing [OR=1.82 (1.02-3.27) and associated cause [OR=7.78 (1.46-41.37], and systemic arterial hypertension as an associated cause [OR=3.00 (1.40-6.47)]. Conclusions. The multiple-cause-of-death analysis is an adequate to observe the diseases that contribute condition and are associated to the cervical-uterine cancer.

Exposición prenatal a los plaguicidas organoclorados y criptorquidia / Prenatal exposure to organochlorine pesticides and cryptorchidism

Los productos en desarrollo y los niños son particularmente vulnerables a los tóxicos ambientales. Nuestro objetivo es determinar los niveles de plaguicidas organoclorados (HCB, ß-HCH, pp'DDT, op'DDT y pp'DDE) en lípidos séricos de madres de niños con criptorquidia y comparar los niveles con un grupo control de madres de niños con testículos descendidos. El grupo de los casos fue constituido por recién nacidos con diagnóstico de criptorquidia (n=41). El grupo control (n=41) se conformó por niños con testículos descendidos. A las madres de ambos grupos se les determinaron los niveles de plaguicidas organoclorados. La criptorquidia fue diagnosticada al nacimiento por neonatólogo. Residuos de plaguicidas organoclorados fueron encontrados en lípidos séricos de ambos grupos. Los niveles de la mediana (mgkg-1 en base lipídica) fueron mayores para los metabolitos pp'DDT (0.464 vs. 0.269) y ß-HCH (0.263 vs. 0.192) en el grupo con criptorquidia comparado con el grupo control. (p<0.01). Los niveles de los metabolitos pp'DDT y ß-HCH son mayores entre las madres de los recién nacidos con criptorquidia. Es posible que sustancias con efectos antiandrogénicos puedan producir disrupción endocrina y criptorquidia durante el desarrollo fetal.

Fetuses and children are more susceptible to the effects of environmental toxins. The objective of this article is to determine the levels of organochlorine pesticides (HCB, ß-HCH, pp'DDT, op'DDT and pp'DDE) in the serum lipids of mothers of newborns with cryptorchidism and compare the levels to a control group of mothers of newborns with descended testicles. The cases were composed of newborns with cryptorchidism (n=41), and the controls (n=41) newborns with descended testicles. Blood samples from both groups of mothers were used to determine the organochlorine pesticide levels. Cryptorchidism was diagnosed at birth by a neonatologist. The results showed that the organochlorine pesticide residues were found in the serum lipids of both groups of mothers. The median serum lipid levels (mgkg-1 lipid-based) were statistically higher for the metabolites pp'DDT (0.464 vs. 0.269) and ß-HCH (0.263 vs. 0.192) in the cryptorchidism group compared to the control group (p<0.01). It could be concluded that the levels of the metabolites pp'DDT and ß-HCH are higher among mothers of newborns with cryptorchidism. It is possible that substances with anti-androgenic effects could produce endocrine disruption, such as cryptorchidism, during fetal development.

Maternal MTHFR polymorphisms and risk of spontaneous abortion / Polimorfismos maternos MTHFR y riesgo de aborto espontáneo

OBJECTIVE: To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA) according to the maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C). MATERIAL AND METHODS: We conducted a nested case-control study within a perinatal cohort of women recruited in the state of Morelos, Mexico. Twenty-three women with SA were compared to 74 women whose pregnancy survived beyond week 20th. Intake of folate and B vitamins respectively, was estimated using a validated food frequency questionnaire. Maternal MTHFR polymorphisms were determined by PCR-RFLP and serum homocysteine levels by HPLC. RESULTS: Carriers of MTHFR 677TT and 1298AC genotypes respectively showed an increased risk of SA (OR 677TT vs. CC/CT=5.0; 95 percent CI: 1.2, 20.9 and OR 1298 AC vs. AA=5.5; 95 percent CI: 1.1, 26.6). CONCLUSIONS: Our results support the role of MTHFR polymorphisms as a risk factor for SA, regardless of dietary intake of B vitamins.

OBJETIVO: Evaluar la asociación entre aborto espontáneo (AE) y el consumo dietético de vitaminas B en mujeres mexicanas portadoras de los polimorfismos de la metilentetrahidrofolato reductasa (MTHFR) (677 C>T y 1298 A>C). MATERIAL Y MÉTODOS: Mediante un diseño de casos y controles anidados en una cohorte, se comparó la ingesta dietética materna de vitaminas B y folato, los polimorfismos maternos de la MTHFR y la concentración sérica de homocisteina de 23 casos de AE (< 20 semanas) y 74 controles (mujeres con embarazos > 20 semanas). RESULTADOS: Las portadoras de los genotipos MTHFR 677TT y 1298AC presentaron un incremento significativo en el riesgo de AE (RM 677TT vs. CC/CT=5.0; IC 95 por ciento: 1.2, 20.9 RM 1298 AC vs. AA=5.5; IC95 por ciento: 1.1, 26.6), respectivamente. CONCLUSIONES: Nuestros resultados apoyan el papel de la mutación de la MTHFR como posible factor de riesgo para el AE, independientemente del consumo de vitaminas B.