Association of reproductive risk factors and comorbidities among molecular subtypes of Breast cancer in a Tertiary care Hospital

The reasons for the recently observed increase in the incidence of breast cancer in the Indian population are not clearly understood, but thought to be largely explained by westernization of lifestyles and changes in reproductive behavior, which characterize exposure to hormones. Our aim is to review the reproductive risk factors and comorbidities and evaluate the association between molecular subtypes of breast cancer. A hospital-based analytical case-control study was conducted among the breast cancer cases with controls in a multispecialty teaching hospital for a period of one year. Totally, 130 subjects were recruited and an interview was conducted using a structured questionnaire to obtain demographic and risk factor data, including tissue marker status (ER, PR and HER-2) obtained from case files. Data were analyzed with SPSS-20 version. Results: The highest age group reported in this study was 51- 60 years which has a 3.8 times increased risk compared to other age and the age group of 31- 40 have a decrease risk of 0.33. In this study, the percentage of post menopause (68%) and mothers not breastfeeding (10%) was higher in cases compared to controls and a noted increase in the risk of breast cancer with odds ratio (OR) of 2.745 (p= <0.0001) and 9.08 (p=0.01) respectively. Duration of breastfeeding showed significantly (p=<0.0001)) moderate positive correlation (r=0.549, 0.457, 0.418 and 0.636) for luminal A, luminal B, HER+, and triple negative respectively. This study found that all the reproductive risk factors do not have correlation with a molecular subtype of breast cancer except breastfeeding. Post menopause and breastfeeding were common factors associated with all people and could be modifiable to prevent the occurrence of breast cancer through lifestyle change

Prevalence, predictors and outcomes of potential drug-drug interactions in left ventricular failure: considerable factors for quality use of medicines

Hospitalized patients with left ventricular failure (LVF) are at high risk for potential drug-drug interactions (pDDIs) and its related adverse effects owing to multiple risk factors such as old age, comorbidities and polypharmacy. This cross-sectional study conducted in two tertiary care hospitals aim to identify frequency, levels and predictors of pDDIs in LVF patients. Data about patients' demographic, hospital stay, medication therapy, sign/symptoms and laboratory test results were collected for 385 patients with LVF. Micromedex Drug-Reax® was used to screen patients' medication profiles for pDDIs. Overall prevalence and severity-wise prevalence of pDDIs were identified. Chi-square test was performed for comparative analysis of various variables. Logistic regression was applied to determine the odds-ratios (OR) for predictors of pDDIs. The prevalence of pDDIs was 96.4% (n=371). Overall 335 drug-interacting pairs were detected, which were presented in a total of 2870 pDDIs. Majority of pDDIs were of major- (48.9%) and moderate-severity (47.5%). Logistic regression analysis shows significant association of >6 all types of pDDIs with >12 drugs as compared with <8 drugs (OR=16.5; p=<0.001). Likewise, there was a significant association of >4 major-pDDIs with men as compared with female (OR=1.9; p=0.007) and >12 drugs as compared with <8 drugs (OR=10.9; p=<0.001). Hypotension (n=57), impaired renal function (23) and increased blood pressure (22) were the most frequent adverse outcomes associated with pDDIs. This study shows high prevalence of pDDIs in LVF patients. Majority of pDDIs were of major- and moderate-severity. Male patients and those prescribed greater number of medicines were more exposed to major-pDDIs

Características sociodemográficas y clínicas de pacientes con diagnóstico nuevo de VIH / Sociodemographic and clinical characteristics of patients with new HIV diagnosis

Objetivo: Caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 - 2016. Materiales y métodos: Se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4. Resultados: La mediana para la edad fue 41 años (RIC 31 - 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4<200 células/mm3 , no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE. Conclusión: Para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.

Purposes: To characterize sociodemographic and clinical aspects in newly diagnosed HIV patients that were hospitalized at a university health center between 2010 - 2016. Methods: We made an observational descriptive cross - sectional study reviewing clinical records, including patients older than 14 years old, who were diagnosed with HIV infection during hospitalization and at least a CD4 count. Results: Median age at diagnosis was 41 years old (IQR 31 - 51), 85% were men. The main symptoms were general/systemic (70.2%). 99 patients (61.5%) had opportunist infections, being tuberculosis the most frequent (34.3%). The median CD4 were 88 cells/mm3 (IQR 27 - 327) and 77% were classified as AIDS. 29 patients died (18%), finding as a risk factor for mortality don't having a good health care insurance, low CD4 count, having respiratory symptoms, pneumonia diagnosis, multiple organic failure's criteria and ICU admission. Conclusion: In our case, the majority of patients with a new diagnosis of HIV were in advanced stages of immunosuppression with a high burden of AIDS defining diseases. It is important to strengthen public health policies to diagnose HIV infection earlier.

Detección del virus Epstein Barr en escolares adolescentes en la ciudad de Cali, Colombia / Detection of epstein barr virus in adolescent students in the city of cali, colombia

Objetivo: Detectar el virus Epstein-Barr en estudiantes de secundaria entre los 14 y 17 años de la ciudad de Cali, Colombia y su posible asociación con la edad, sexo y grado escolar. Métodos: Estudio retrospectivo de corte transversal en donde se analizaron 374 muestras de saliva, tomadas entre el año 2015 y 2016, mediante PCR convencional y PCR en Tiempo real. Se evalúo la asociación entre la detección del ADN viral y las características demográficas, además de un análisis de razón de oportunidades para evaluar la medida de la asociación. Resultados: El ADN viral fue detectado en el 45% (167/374) de las muestras orales, encontrándose una presencia viral mayor en los escolares de los grados octavo y noveno (p=0,004); en donde los estudiantes de 14 años presentaron un riesgo de 2,4 veces mayor para la detección del virus (IC 95%:1,12-4,9) en comparación con los estudias de más edad. Conclusión: En el presente estudio se evidencio la exposición del VEB en la cavidad oral de estudiantes de secundaria, lo cual hace necesario que se tomen acciones de vigilancia que permitan monitorear las implicaciones de estos hallazgos en la salud de los escolares.

Objective: To detect the Epstein Barr virus in adolescent students between 14 and 17 years old in the city of Cali, Colombia and its possible association with age, gender and school grade. Methods: Retrospective cross-sectional study where 374 mouthwash samples collected between the years 2015 and 2016 was analyzed through conventional and real-time PCR. Association between viral DNA detection and sociodemographic characteristics were evaluated. The odds ratio analysis was used to assess the extent of this association. Results: The viral DNA was present in 45% (167/374) of the samples, with a higher DNA detection in the students of eighth and ninth grades (p=0.004); where the 14 years old students present a 2.4 times higher risk of detecting the virus (IC 95%: 1,12-4.9) in comparison with older students. Conclusion: In the present study, the Epstein Barr virus exposition in the oral cavity was evidenced, which make necessary to take actions on surveillance that allow monitoring the implications of these fndings in the teenage student's health.

Range extension of Diclidurus scutatus (Chiroptera, Emballonuridae) to southwestern Amazonia / Extensão da distribuição de Diclidurus scutatus (Chiroptera, Emballonuridae) para o sudoeste da Amazônia

ABSTRACT Diclidurus scutatus is an aerial insectivore bat endemic of South America and considered rare throughout its distribution range. We present the first record of this species in Rondônia State, northern Brazil, expanding its distribution more than 1000 km into southwestern Amazonia. Including this record, D. scutatus is known for 20 localities from eight countries (Brazil, Colombia, Ecuador, French Guiana, Guyana, Peru, Suriname, Venezuela), and two biomes-Amazonia and Atlantic Forest.

RESUMO Diclidurus scutatus é um morcego insetívoro aéreo, endêmico da América do Sul e considerado raro em toda sua área de distribuição. Apresentamos o primeiro registro dessa espécie para o estado de Rondônia, norte do Brasil, expandindo sua distribuição em mais de 1000 quilômetros para o sudoeste da Amazônia. Incluindo o presente registro, D. scutatus é conhecido para 20 localidades em oito países (Brasil, Colômbia, Equador, Guiana Francesa, Guiana, Peru, Suriname, Venezuela) e dois biomas-Amazônia e Mata Atlântica.

Populations of Odontesthes (Teleostei: Atheriniformes) in the Andean region of Southern South America: body shape and hybrid individuals

The original distribution area of the Patagonian 'pejerrey' Odontesthes hatcheri has been subjected to the introduction of a related species; the Bonaerensean 'pejerrey' Odontesthes bonariensis. This species currently coexists with O. hatcheri in lakes and reservoirs, and can interbreed and produce fertile hybrid offspring. The purposes of this study were; a) the extensive sampling of Patagonian and Andean-Cuyan populations of pejerrey, b) the species identification according to taxonomic key, c) validation of taxonomic results on the basis of mitochondrial DNA composition, and d) applying morphometric analysis to explore the effects of hybridization and environmental conditions on body shape. Cytochrome b sequence analysis showed a high degree of genetic divergence between species and low intraspecific variation in O. hatcheri. Geometric Morphometric Analyses detected shape differences in agreement with diagnostic characteristics of each species. Putative hybrids exhibiting intermediate diagnostic characteristics were identified by Geometric Morphometric Analysis. Significant regressions between body shape and total phosphorus and altitude were found, suggesting a dependence on trophic web structure. This multi-level approach suggests the introgression of O. bonariensis into several O. hatcheri populations throughout Patagonia. Managers should take this into account when considering further exotic introductions into regions where non-native fishes have not yet become established.

La distribución original del 'pejerrey' patagónico Odontesthes hatcheri ha sido sometida en las últimas décadas a la introducción de una especie relacionada; el 'pejerrey' Bonaerense Odontesthes bonariensis. Ambas especies coexisten actualmente en algunos lagos y embalses debido a prácticas de siembra y pueden cruzarse y producir progenie híbrida y fértil. Los propósitos de este estudio fueron a) un amplio muestreo de las poblaciones patagónicas y andino-cuyanas del pejerrey, b) la identificación de las especies de acuerdo con la clave taxonómica, c) la validación de los resultados taxonómicos sobre la base de la composición del ADN mitocondrial y d) aplicar el análisis morfométrico para explorar los efectos de la hibridización y las condiciones ambientales sobre la forma corporal. El análisis de la secuencia del Citocromo b mostró un alto grado de divergencia genética entre ambas especies y una muy baja variación intraespecífica en O. hatcheri. El análisis de la Morfometría Geométrica detectó diferencias de forma coincidentes con las características diagnósticas de cada especie. Presuntos híbridos exhibiendo características diagnósticas intermedias fueron identificados por el análisis de la Morfometría Geométrica. Regresiones significativas entre la forma corporal y la concentración total de fósforo y la altitud fueron halladas, sugiriendo una dependencia con la estructura de la trama trófica. Este enfoque múltiple sugiere la introgresión de genes de O. bonariensis dentro de varias poblaciones de O. hatcheri a lo largo de la Patagonia. Las autoridades de aplicación deberían tomar en cuenta estos riesgos al momento de considerar nuevas introducciones de especies exóticas en regiones donde estas especies no se encuentren previamente establecidas.

Clinical and Epidemiological Characteristics of Suicides Committed in Medellin, Colombia / Características clínicas y epidemiológicas del suicidio consumado en Medellín, Colombia

Background: The purpose of this study was to identify the characteristics of individuals who committed suicide in Medellín between 2008 and 2010, and to identify variables related to the type of events. Methods: A retrospective and descriptive analysis was conducted on data provided by the National Institute of Legal Medicine and Forensic Sciences. In addition, a univariate and bivariate analysis was used to identify the sociodemographic and medical-legal characteristics of the deceased. Multiple correspondence analysis was also used in order to establish typologies. The information was analyzed using STATA 11.0. Results: Of the 389 cases occurring between 2008 and 2010, 84.6% (n = 329) were men. The male to female ratio was 5:1; 64% of the cases occurred in people aged 18-45 years; 6.7% occurred in children under 18, with hanging being the method most chosen by the victims (48.3%). Exploratory analysis was used to identify a possible association between the use of violent methods and events occurring in the housing and social strata 1, 2 and 3. Conclusions: Some factors could be associated with suicide, providing data that could consolidate health intervention strategies in our population.

Antecedentes: El propósito del estudio es identificar las características de los individuos que cometieron suicidio en la ciudad de Medellín entre 2008 y 2010, además de identificar variables relacionadas con la tipología de los eventos. Métodos: Análisis descriptivo retrospectivo de los datos suministrados por el Instituto Nacional de Medicina Legal y Ciencias Forenses. Además, análisis univariable y bivariable para identificar las características sociodemográficas y médico-legales de los fallecidos. Para establecer posibles tipologías, se utilizó el análisis de correspondencias múltiples. La información se analizó utilizando el programa STATA 11.0. Resultados: De los 389 casos ocurridos entre 2008 y 2010, el 84,6% (n = 329) correspondió a varones. La razón varones:mujeres es 5:1. El 64% de los casos ocurrió en personas de 18-45 anños y el 6,7%, en menores de 18 años. El ahorcamiento fue el método más elegido por las víctimas (48,3%). El análisis exploratorio permitió identificar una posible asociación entre el uso de métodos violentos con los eventos que ocurren en la vivienda y los estratos sociales 1, 2 y 3. Conclusiones: Se pudo delinear algunos factores asociados al suicidio consumado, aportando elementos que pueden consolidar estrategias de intervención en la salud de nuestra población.

Definição do status taxonômico do complexo Shannoni (Diptera: Psychodidae:Phlebotominae) no Brasil / Definition of taxonomic status of the complex shannoni (Diptera: Psychodidae: Phlebotominae) in Brazil

Alguns táxons inseridos na série Shannoni do gênero Psathyromyia ((Diptera, Psychodidae, Phlebotominae) apresentam grande semelhança morfológica: Psathyromyia cuzquena, Pa. abonnenci, Pa. pestanai e Pa. shannoni o que têm levado a proposição de várias sinonímias e identificações errôneas. Psathyromyia shannoni apresenta vários sinônimos-júniores: Phlebotomus limai, Ph. bigeniculata, Ph. microcephala e Ph. pifanoi, e ampla distribuição geográfica, desde os Estados Unidos até a Argentina. Além destas espécies, uma afim de Pa. pestanai, ainda não descrita, foi encontrada no Vale do Ribeira. O objetivo foi discutir o status taxonômico e distribuição geográfica das espécies do complexo. Foram realizados estudos morfológicos e morfométricos de espécimes depositados em coleções e obtidos em coletas no alto e baixo Vale do Ribeira e Serra da Cantareira no Estado de São Paulo. Os espécimes foram analisados de forma individual, ignorando a identificação inicial contida na etiqueta de cada lâmina. Posteriormente foram separados em grupos de morfoespécie e após esse processo, foram feitas medidas as quais foram submetidas à análise de variância. A análise possibilitou revalidar as quatro espécies consideradas sinônimos júniores de Pa. shannoni e um sinônimojúnior foi proposto. Uma espécie nova é descrita e um táxon afim de Pa. microcephala foi identificado. Portanto, o complexo Shannoni passou a ter a seguinte composição: Pa. abonnenci, Pa. shannoni, Pa. microcephala stat. rev.; comb. nov., Pa. pifanoi stat. rev.; comb. nov., Pa. bigeniculata stat. rev.; comb. nov., Pa. limai stat. rev.; comb. nov. (Pa. pestanai syn. nov.) e Psathyromyia sp. nov. Psathyromyia cuzquena possivelmente é sinônimo-júnior de Pa. pifanoi, no entanto, mais estudos são necessários. O táxon que ocorre no baixo Vale do Ribeira corresponde a Pa. limai, e no alto Vale do Ribeira, pertence à nova espécie. O táxon afim de Pa. microcephala ocorre nas regiões Sul e Sudeste do Brasil, Argentina e Colômbia. A ampla distribuição de Pa. shannoni, em parte, corresponde a de Pa. bigeniculata, Pa. abonnenci, Pa. limai e Pa. aff. microcephala. O desconhecimento do atual local de depósito do tipo de Pa. microcephala e a descrição sucinta dos holótipo não possibilitam a sua diferenciação do táxon afim desta espécie. Estudos de espécimes da localidade-tipo de Pa. microcephala são necessários para definição do status de Pa. aff. microcephala

Características clínicas y sociodemográficas de los casos con tuberculosis resistente en el municipio de Armenia, Quindío (Colombia) / Clinical and socio-demographic characteristics of tuberculosis with antimicrobial resistance in Armenia, Quindio (Colombia)

Objetivo: Analizar los factores sociodemográficos y clínicos de los pacientes con diagnóstico de tuberculosis resistente en el municipio de Armenia durante el período 2006-2009. Métodos: Se realizó un estudio descriptivo y retrospectivo con base en la notificación de pacientes con tuberculosis resistentes durante el período de estudio. Los datos fueron tomados de los registros consignados en las fichas de notificación y las tarjetas individuales de tratamiento categoría IV. Resultados: Entre 2006 y 2009, 678 pacientes ingresaron en el programa de control de la tuberculosis. De ellos, 14 casos (2,0%) fueron resistentes al menos a un medicamento, y entre estos, 7 (50%) fueron multirresistentes. El 21% estuvo asociado a infección por virus de la inmunodeficiencia humana. La tasa de fallecimientos en pacientes con tuberculosis con farmacorresistencia múltiple fue del 71%. Se encontró amplificación de la resistencia en 2 casos, quienes presentaron deterioro en el estado de salud y deceso. Conclusión: La situación en Armenia de resistencia a antituberculosos es de proporción similar a la del resto del país. Se encontraron factores de riesgo conocidos en los casos de resistencia (coinfección con virus de la inmunodeficiencia humana, farmacodependencia, abandono social) en la mayoría de casos, pero también de resistencia primaria y sin factores de riesgo con farmacorresistencia múltiple y una alta mortalidad, lo que llama la atención para mejorar la vigilancia y el control de los casos en tratamiento en la ciudad.

Objective: To analyze the socio-demographic and clinical diagnosis of patients with resistant tuberculosis in the municipality of Armenia in the period 2006-2009. Methods: We performed a retrospective descriptive study based on the notification of patients with resistant tuberculosis during the study period, data were taken from registrations under notification forms and individual treatment cards category IV. Results: 678 patients were admitted to the program of tuberculosis control between 2006 and 2009, 14 cases (2,0%) were resistant to at least one drug and from these cases 7 were multidrug resistant (MDR). In 21% of cases there was co-infection with HIV. The death rate in patients with MDR-TB was 71%. Amplification in resistance was observed in two cases which lead to further deterioration in the health status and death. Conclusion: Armenia has levels of resistance to anti tuberculosis drugs similar to the reported in the rest of Colombia. We found factors already know to be associated with resistance (drug addiction, social abandon, HIV co infection) but there were also cases without these factors and with primary MDR and high mortality, therefore is urgent to improve the public health measures for cases under treatment in this city.

Revision of the New World bee fly genus Heterostylum Macquart (Diptera, Bombyliidae, Bombyliinae)

The genus Heterostylum Macquart and five Neotropical species (H. ferrugineum (Fabricius, 1805), H. hirsutum (Thunberg, 1827), H. rufum (Olivier, 1789), H. haemorrhoicum (Loew, 1863) and H. pallipes Bigot, 1892) are redescribed. The other species, recently redescribed or described are only diagnosed, except for H. deani Painter, 1930, whose spermathecae are described and illustrated for the first time. The main characters of the external morphology were photographed and the male genitalia and female spermathecae illustrated. An identification key to all included species is also presented.

O gênero Heterostylum Macquart e cinco espécies Neotropicais (H. ferrugineum (Fabricius, 1805), H. hirsutum (Thunberg, 1827), H. rufum (Olivier, 1789), H. haemorrhoicum (Loew, 1863) e H. pallipes Bigot, 1892) são redescritas. As demais espécies recentemente redescritas ou descritas tem sua diagnose apresentada, com exceção de H. deani Painter, 1930, cuja espermateca foi descrita e ilustrada pela primeira vez. Os principais caracteres da morfologia externa foram fotografados e a genitália masculina e espermateca feminina ilustradas. Uma chave de identificação para todas as espécies também é apresentada.