Photoprotection Knowledge, Habits, and Attitudes Among Spanish and Italian Medical Students. / Conocimientos y hábitos sobre fotoprotección en estudiantes de Medicina españoles e italianos.

Exposure to UV radiation is a major risk factor for the development of malignant skin neoplasms. Currently, there are no studies available on sun-exposure habits among different countries. We conducted a cross-sectional survey among medical students from the University of Rome, Italy and the University of Granada, Spain to compare their photoprotection knowledge, habits, and attitudes. A total of 215 medical students (114 Spanish, and 101 Italian) were included. Spanish students considered the Sun to be the main cause of skin cancer (83.3% vs 61.4%, P=.003) and they looked at their skin more often than Italian students did (32.5% vs 9.9%, P <.001). The latter received information on photoprotection mainly from their dermatologist (34.7%, 35/101) vs Spaniards who received such information from their university (39.5%, 45/114; P <.001). After studying dermatology, Spaniards used sunscreen more frequently than Italians did (76.8% before vs 88.1% after; P=.007), and recognised the need to implement other measures as well (44.9% vs 67.2%; P=.025).

DNA oxidative damage in oral cancer: 8-hydroxy-2´-deoxyguanosine immunoexpression assessment.

BACKGROUND: The development and establishment of oral squamous cell carcinoma are confined to carcinogenesis, which involves oxidative stress via oxygen-free radical production as a hydroxyl radical (HO•), considered the most important cause of oxidative damage to basic biomolecules since it targets DNA strands. 8-Hydroxy-2´-deoxyguanosine (8-OHdG) is considered a free radical with a promutagenic capacity due to its ability to pair with adenosine instead of cytosine during replication. MATERIAL AND METHODS: We collected 30 paraffin-embedded tissue samples of OSCC from patients treated between 2013 and 2018. We recorded risk habits, disease stage, disease free survival and death with at least 3 years of follow-up. 8-Hydroxyguanosine was evaluated by immunohistochemistry and subsequently classified as weak-moderate or strong positive expression. Additionally, we noted whether it was expressed in the cytoplasm and/or nucleus. RESULTS: Most of the cases expressed 8-OHdG with a strong intensity (80%). All neoplastic cells were preferentially stained in only the cytoplasm (70.0%), but nuclear positivity was found in 30%, independent of the intensity. Based on the location in the cytoplasm and/or nucleus, tumors >4 cm showed a high frequency (95.5%) of 8-OHdG expression in only the cytoplasm, with a significant difference (p value 0.001). Additionally, overall survival was affected when immunoexpression was present in the cytoplasm and nucleus because all deaths were in this group were statistically significant (p value = 0.001). CONCLUSIONS: All tumors showed DNA oxidative damage, and 8-OHdG was preferentially expressed in the cytoplasm. This finding was associated with tumor size and, when present in the nucleus, might also be related to death.

Patients with advanced oral squamous cell carcinoma have high levels of soluble E-cadherin in the saliva.

BACKGROUND: The objective of this study was to assess the potential clinical value of the concentration of soluble salivary E-cadherin (sE-cadherin) compared with the clinical value of the presence of membranous E-cadherin (mE-cadherin) in oral squamous cell carcinoma tumor tissues. MATERIAL AND METHODS: Data regarding patient demographics, clinical stage, saliva and tumor tissue samples were collected. The saliva was analyzed for sE-cadherin protein levels and was compared to the mE-cadherin immunohistochemical expression levels in tumor tissues, which were assessed via the HercepTest® method. Patients without cancer were included in the study as a control group for comparisons of the sE-cadherin levels. RESULTS: sE-cadherin levels in the saliva of patients without cancer were lower than those in patients with cancer, and the difference was statistically significant (p=0.031). Low mE-cadherin expression was statistically significantly associated with lymph node positivity (p=0.015) and advanced clinical stage (p=0.001). The inverse relationship between mE-cadherin and sE-cadherin was significant in terms of lymph node positivity (p=0.014) and advanced clinical stage (p=0.037). CONCLUSIONS: The results suggest that sE-cadherin levels are significantly increased in patients with oral cancer and that its low expression within the membrane as well as the progression of the disease appear to be inversely associated with levels of sE-cadherin in the saliva.

[Referral to internal medicine for alcoholism: influence on follow-up care]. / Influencia de la derivación a un Servicio de Medicina Interna en el seguimiento de pacientes alcohólicos.

BACKGROUND AND AIMS: The problem of high rates of patient drop-out in alcohol treatment programs is frequently reported in the literature. Our aim was to investigate if internal medicine referral could improve abstinence and retention rates in a cohort of alcoholic patients. PATIENTS AND METHODS: A retrospective observational study was conducted comparing 200 alcoholic patients attending a psychiatric unit (group 1) with 100 patients attending both this unit and an internal medicine unit (group 2). We collected sociodemographic and clinical variables and analysed differences regarding abstinence and retention rates by means of univariate and multivariate analysis. RESULTS: At 3 and 12 months follow-up, group 2 patients had higher retention and abstinence rates than group 1 patients. Multivariate analysis including potential confounding variables showed that independent predictors of one-year retention were internal medicine referral and being married. Independent predictors of one-year abstinence were being married, age > 44 years and receipt of drug treatment. CONCLUSIONS: The higher retention rate found among patients referred to Internal Medicine specialists, a result that has not been previously reported to the best of our knowledge, emphasizes the importance of a multidisciplinary team approach in the treatment of alcoholism.

Influencia de la derivación a un Servicio de Medicina Interna en el seguimiento de pacientes alcohólicos / Referral to Internal Medicine for alcoholism: influence on follow-up care

Fundamento y objetivo. El alto grado de abandonode los programas de tratamiento constituye uno delos principales problemas terapéuticos delalcoholismo. El objetivo de nuestro trabajo fueanalizar la eficacia de la inclusión de especialistasen Medicina Interna en la tasa de abstinencia y deretención de los pacientes alcohólicos tratados deforma ambulatoria.Pacientes y método. Estudio retrospectivolongitudinal que compara 200 pacientes atendidospor una unidad de psiquiatras y psicólogos con 100pacientes atendidos de forma conjunta por esaunidad y por especialistas en Medicina Interna. Seanalizaron las diferencias en la abstinencia y laretención de los pacientes según su derivación o noa Medicina Interna, incluyendo como factoresde confusión variables sociodemográficas y decomorbilidad.Resultados. A los 3 y 12 meses de seguimiento,los pacientes atendidos conjuntamente porpsiquiatras e internistas presentaron unas tasas deretención y abstinencia significativamente mayoresque los pacientes no derivados a Medicina Interna.Los factores que se asociaron de formaindependiente y significativa con la retención a los12 meses fueron la propia derivación a MedicinaInterna y estar casado. Los factores asociados conla abstinencia a los 12 meses fueron estar casado,una edad mayor de 44 años y recibir tratamientopara el alcoholismo.Conclusiones. La mayor retención en pacientesderivados a Medicina Interna, resultado nocomunicado previamente, refuerza la importancia deun abordaje multidisciplinar en el tratamiento delalcoholismo

Background and aims. The problem of high ratesof patient drop-out in alcohol treatment programs isfrequently reported in the literature. Our aim was toinvestigate if internal medicine referral couldimprove abstinence and retention rates in a cohortof alcoholic patients.Patients and methods. A retrospectiveobservational study was conducted comparing 200alcoholic patients attending a psychiatric unit (group1) with 100 patients attending both this unit and aninternal medicine unit (group 2). We collectedsociodemographic and clinical variables andanalysed differences regarding abstinence andretention rates by means of univariate andmultivariate analysis.Results. At 3 and 12 months follow-up, group 2patients had higher retention and abstinence ratesthan group 1 patients. Multivariate analysisincluding potential confounding variables showedthat independent predictors of one-year retentionwere internal medicine referral and being married.Independent predictors of one-year abstinencewere being married, age > 44 years and receipt ofdrug treatment.Conclusions. The higher retention rate foundamong patients referred to Internal Medicinespecialists, a result that has not been previouslyreported to the best of our knowledge, emphasizesthe importance of a multidisciplinary team approachin the treatment of alcoholism

Análisis temático y metodológico de la investigación en la revista Fisioterapia (1991-1999) / Thematic and methodological analysis research in the Fisioterapia journal (1991-1999)

Objetivo. Analizar la temática y la metodología de los artículos publicados en la revista Fisioterapia durante el periodo 1991-1999 para identificar los principales problemas que interesan a los profesionales de la Fisioterapia. Diseño. Estudio descriptivo, retrospectivo y longitudinal. Material y método. La población de estudio fueron los 162 artículos de la sección de originales de la revista Fisioterapia unido a los 30 publicados en la sección de docencia. Los artículos han sido clasificados por su aportación a las diferentes funciones de los fisioterapeutas reconocidas por la A.E.F., por los aparatos y sistemas del organismo humano más relevantes para los fisioterapeutas así como sus deficiencias asociadas (A.P.T.A.). Finalmente, se ha llevado a cabo un análisis de las palabras clave. El análisis metodológico ha descrito el diseño empleado en los artículos de investigación. Se cuantificaron las frecuencias absolutas y relativas de las variables descritas utilizando el programa estadístico Spss 10.0. Resultados. El área asistencial recoge más de la mitad de los artículos originales estudiados 100 (52,1 %), seguida del área de investigación con un 27,6 %, docencia 16,1 % y gestión 4,2 %. En las principales áreas (asistencia e investigación) destaca el aparato musculoesquelético (49 %) seguido por el neuromuscular (16,3 %). Las deficiencias en la movilidad articular, función motora, acción muscular y rango de movilidad e integridad de los reflejos asociados a desordenes espinales son las más frecuentemente estudiadas. El número total de palabras clave empleadas ha sido de 585 con una media de 3,05 y una desviación típica de 1,76. El 90,6 % de los estudios tienen un carácter observacional y sólo el 9,4 % son experimentales. Conclusiones. El área asistencial es la más estudiada por los fisioterapeutas españoles. Entre los diferentes aparatos/sistemas orgánicos que se recogen en los artículos asistenciales y de investigación, el aparato musculoesquelético es el más frecuentemente analizado. Las deficiencias del aparato musculoesquelético más estudiadas son las relativas a "deficiencias en la movilidad articular, función motora, acción muscular y rango de movilidad, e integridad de los reflejos asociados a desordenes espinales". La alta variabilidad en el número de palabras clave empleadas por los autores para identificar sus estudios dificultan el proceso de recuperación de la información. Los estudios observacionales predominan sobre los experimentales

Objective. Analyze the thematic and the methodology of the articles published in the Physiotherapy during the period 1991-1999 to identify the main problems that interest the professionals of the Physiotherapy. Design. Study descriptive, retrospective and longitudinal. Material and method. The study population was the 162 articles of the section of original of the magazine Physiotherapy together to the 30 published in the docencia section. The articles have been classified by their contribution to the different functions of the physiotherapist recognized by the A.E.F., for the apparatuses and systems of the most excellent human organism for the physiotherapist as well as their associate impairments (A.P.T.A.). Finally, it has been carried out an analysis of the key words. The methodological analysis has described the design used in the investigation articles. The absolute and relative frequencies of the described variables were quantified using the statistical program Spss 10.0. Results. The assistance area picks up more than half of the studied original articles 100 (52.1 %), followed by the investigation area with 27.6 %, docencia 16.1 % and administration 4.2 %. In the main areas (attendance and investigation) the muscle-skeletal (49 %) continued by the neuromuscular (16.3 %). Impairments in mobility, motor function, muscular action and range of motion and integrity of the reflections associated to disorder spinal they are most frequently described ones. The total number of key words employees has been of 585 with a mean of 3.05 and a typical deviation of 1.76. 90.6 % of the studies has an observational character and 9.4 % is only experimental. Conclusions. The assistance area is the more studied by the Spanish physiotherapist. Among the different organic apparatus/sistem that are picked up in the assistance articles and of investigation, the apparatus muscle-skeletal is the most frequently analyzed one. The deficiencies of the apparatus more studied muscle-skeletal are the relative ones to deficiencies in the mobility to articulate, function motorboat, muscular action and range of mobility, and integrity of the reflections associated to you disorder spinal". The high variability in the key number of words used by the authors to identify their studies hinders the process of recovery of the information. The observational studies prevail on the experimental ones

[Effectiveness of venlafaxine in the treatment of alcohol dependence with comorbid depression]. / Efectividad de la venlafaxina en el tratamiento de la dependencia de alcohol con depresión comórbida.

INTRODUCTION: There are no conclusive data on the effectiveness of antidepressant drugs in the treatment of comorbid cases of alcohol dependence and depression. OBJECTIVES: To determine the effectiveness of venlafaxine on depression and on severity (need of treatment) of alcohol dependence and related problems. METHODS: Observational, open-label, multicenter, 24-week follow-up study. PATIENTS: 90 outpatients with diagnosis of alcohol dependence and associated major depression disorder (DSMIV criteria). OUTCOMES MEASURES: the Hamilton Rating Scale for Depression (HAM-D17), European Addiction Severity Index (EuropASI) and Clinical Global Impression, severity and improvement subscales, (CGI-S and CGI-I). Evaluations were performed at baseline and at weeks 2, 4, 8 and 24. RESULTS: Mean age 44.94+/-9.74 years; 73.3 % man. HAM-D17 mean scores significantly decreased from baseline (24.85+/-5.94) to week 24 (5.976+/-4.68) and at each of the follow-up visits vs previous visit (p < 0.0005). Significant decreases from baseline to week 24 were obtained in four areas of EuropASI: medical status (2.12+/-2.45 to 1.07+/-1.68), alcohol use (5.29+/-2.24 to 3.04+/-2.35), family/ social relationships (3.68+/-2.36 to 1.71+/-2.06) and psychiatric status (5.61+/-1.81 to 2.67+/-2.03). Tolerance was excellent or good in 76.7% of the patients. CONCLUSIONS: Venlafaxine demonstrated to be effective in the treatment of depressive alcoholic patients. Furthermore, it seems to be useful to decrease the severity of problems related with the alcohol use.

Efectividad de la venlafaxina en el tratamiento de la dependencia de alcohol con depresión comórbida / Effectiveness of venlafaxine in the treatment of alcohol dependence with comorbid depression

Introducción. Faltan datos concluyentes sobre la efectividad de los antidepresivos en el tratamiento de los casos comórbidos de dependencia de alcohol y depresión. Objetivos. Determinar la efectividad de la venlafaxina sobre la depresión y sobre la gravedad (necesidad de tratamiento) de la dependencia de alcohol y problemas relacionados. Métodos. Estudio observacional, abierto, multicéntrico de 24 semanas de seguimiento. Pacientes. Noventa pacientes ambulatorios con diagnóstico de dependencia de alcohol y trastorno depresivo mayor (criterios DSM-IV). Medidas de resultados: escala de Hamilton de depresión (HAM-D17), Índice Europeo de Severidad de la Adicción (EuropASI) e Impresión Clínica Global (subescalas de gravedad y mejoría) (ICG-S e ICG-M). Evaluaciones basal y en las semanas 2, 4, 8 y 24. Resultados. Edad media: 44,94+-9,74 años; 73,3 % varones. Disminución significativa de las puntuaciones en la HAM-D17 desde la visita basal (24,85+-5,94) a la semana 24 (5,97+-4,68) y en cada una de las visitas de seguimiento frente a la visita previa (p<0,0005). Reducciones significativas en el EuropASI desde la basal a la semana 24 en las áreas: situación médica (2,12 ± 2,45 a 1,07+-1,68), uso de alcohol (5,29+-2,24 a 3,04+-2,35), relaciones familiares/sociales (3,68+-2,36 a 1,71+-2,06) y estado psiquiátrico (5,61+-1,81 a 2,67+-2,03). La tolerancia fue excelente o buena en el 76,7% de los casos. Conclusiones. La venlafaxina demostró ser efectiva en el tratamiento de la depresión en pacientes dependientes de alcohol. Además parece ser útil para reducir la gravedad

Introduction. There are no conclusive data on the effectiveness of antidepressant drugs in the treatment of comorbid cases of alcohol dependence and depression. Objectives. To determine the effectiveness of venlafaxine on depression and on severity (need of treatment) of alcohol dependence and related problems. Methods. Observational, open-label, multicenter, 24-week follow-up study. Patients. 90 outpatients with diagnosis of alcohol dependence and associated major depression disorder (DSMIV criteria). Outcomes measures: the Hamilton Rating Scale for Depression (HAM-D17), European Addiction Severity Index (EuropASI) and Clinical Global Impression, severity and improvement subscales, (CGI-S and CGI-I). Evaluations were performed at baseline and at weeks 2, 4, 8 and 24. Results. Mean age 44.94+-9.74 years; 73.3 % man. HAM-D17 mean scores significantly decreased from baseline (24.85+-5.94) to week 24 (5.976+-4.68) and at each of the follow-up visits vs previous visit (p < 0.0005). Significant decreases from baseline to week 24 were obtained in four areas of EuropASI: medical status (2.12+-2.45 to 1.07+-1.68), alcohol use (5.29+-2.24 to 3.04+-2.35), family/ social relationships (3.68+-2.36 to 1.71+-2.06) and psychiatric status (5.61+-1.81 to 2.67+-2.03). Tolerance was excellent or good in 76.7% of the patients. Conclusions. Venlafaxine demonstrated to be effective in the treatment of depressive alcoholic patients. Furthermore, it seems to be useful to decrease the severity of problems related with the alcohol use

Polymorphism in the interleukin-1 receptor antagonist gene is associated with alcoholism in Spanish men.

BACKGROUND: A polymorphism located in intron 2 of the interleukin-1 receptor antagonist (IL1RN) gene recently has been associated with the development of hepatic fibrosis in Japanese alcoholics. In the present study, we analyzed whether there is an association between this polymorphism, alcoholism, and alcoholic liver disease in a Spanish male population of alcoholics. METHODS: The IL1RN genotype was assessed by polymerase chain reaction by using oligonucleotides that flank a variable nucleotide tandem repeat polymorphism located in intron 2 of this gene in 90 male alcoholic patients from Spain: 30 alcohol-dependent men, 30 alcohol abusers, and 30 alcoholics with liver cirrhosis. We also studied 40 healthy subjects. RESULTS: The distribution of the IL1RN allelic frequencies in Spanish healthy subjects is similar to that previously reported in White subjects. However, the A1 allele is overrepresented in Spanish alcoholics when compared with healthy subjects. No significant differences in allelic frequencies were observed between alcoholics with liver cirrhosis and alcoholics without liver disease or between alcohol-dependent subjects and alcohol abusers. CONCLUSION: The presence of the A1 allele of the IL1RN gene is associated with a higher risk of alcoholism in Spanish men.

Fibronectin gene polymorphisms associated with fibrosing alveolitis in systemic sclerosis.

Systemic sclerosis (SSc), a multisystem immunologic disease of unknown etiology, is commonly manifested in the lung as fibrosing alveolitis (FASSc). There is evidence to support the role of genetic factors in the predisposition to pulmonary fibrosis in SSc (HLA DR3/DR52a). This association is not complete and other candidate genes are likely involved. Of these, fibronectin is a growth factor known to play a crucial role in lung fibrosis. Our study investigated whether polymorphisms of the fibronectin gene are associated with lung fibrosis in SSc. Using the polymerase chain reaction and the restriction enzymes HaeIII, MspI, HindIII, and TaqI, we assessed the restriction fragment length polymorphisms (RFLPs) in 161 patients with SSc and 253 healthy control subjects from the United Kingdom. For each restriction enzyme, three genotypes were possible corresponding to the presence of the cutting site on neither, one, or both chromosomes (HaeIII AA, AB, BB; MspI CC, CD, DD; HindIII EE, EF, FF; TaqI GG, GH, HH). There was a significant decrease of genotype BB (FASSc: 17%, control: 34%; Pcorr = 0.006) with a reciprocal increase of genotype AB (FASSc: 62%, control: 46%; Pcorr = 0.022) in FASSc with the HaeIII RFLP. A significant decrease of genotype DD was observed in FASSc (FASSc: 28%, control: 41%; Pcorr = 0.038) with the MspI RFLP. The coassociation of genotypes AB (HaeIII RFLP) and CD (MspI RFLP) was present in 45% of the FASSc group (P = 0.0059), with an increased relative risk of developing fibrosing alveolitis of 1.988. We conclude that genotypes of the fibronectin gene are useful prognostic factors in SSc, helping to predict individuals likely to develop pulmonary fibrosis.

Rapid genotyping of transforming growth factor beta1 gene polymorphisms in a UK Caucasoid control population using the polymerase chain reaction and sequence-specific primers.

Transforming growth factor (TGF) beta1 is a growth factor which has multiple functions including the promotion of matrix deposition during wound healing and scar formation. Gene polymorphisms within or close to the 5' region of TGFbeta1 have been identified; three in the upstream region, one in the non-translated region, two in the signal peptide sequence and one in a region of the gene coding for the precursor protein. We have developed a method using 14 polymerase chain reaction-sequence-specific primer reactions to characterise six of these polymorphisms. In the upstream region, both forward and reverse allele-specific primers were used to demonstrate the cis/trans orientation of alleles at adjacent polymorphisms (haplotypes). We report the allele and genotype frequencies of TGFbeta1 genes in two sets of UK Caucasoid control subjects.

Aspectos cutáneos de la lepra / Skin manifestations of the leprosy

En el presente trabajo se ha tratado de destacar las características clínicas más salientes de los aspectos cutáneos que configuran la enfermedad Lepra, en sus distintos tipos y grupos. Se pone especial énfasis en la forma indeterminada por ser ésta la más común del comienzo de la afección, detallando los distintos aspectos que pueden presentar las lesiones desmatológicas en esta forma clínica. Se señalan algunas cifras estadísticas al respecto. Ponemos de manifiesto el carácter inestable de las mismas, que hace que en su evolución puedan virar hacia cualquiera de sus tipos polares. Se establecen los diagnósticos diferenciales y se hace notar la eficacia del tratamiento en esta etapa precoz de la enfermedad. Se destaca además la importancia que tiene el detectar cada vez con mayor frecuencia y precocidad a este grupo indeterminado, ya que al hacerlo se permite cortar la cadena epidemiológica, poniendo en evidencia la eficacia de toda labor asistencial y campañas antileprosas. Se describen las distintas lesiones cutáneas correspondiente a la lepra lepromatosa, como así también las que caracterizan a la lepra tuberculoide y dimorfa, enfatizando que este último grupo confiere unidad nosológica a la enfermedad. Por último se describen los caracteres clínicos, especialmente los cutáneos que acompañan a la reacción leprosa

Aspectos cutáneos de la lepra / Skin manifestations of the leprosy

En el presente trabajo se ha tratado de destacar las características clínicas más salientes de los aspectos cutáneos que configuran la enfermedad Lepra, en sus distintos tipos y grupos. Se pone especial énfasis en la forma indeterminada por ser ésta la más común del comienzo de la afección, detallando los distintos aspectos que pueden presentar las lesiones desmatológicas en esta forma clínica. Se señalan algunas cifras estadísticas al respecto. Ponemos de manifiesto el carácter inestable de las mismas, que hace que en su evolución puedan virar hacia cualquiera de sus tipos polares. Se establecen los diagnósticos diferenciales y se hace notar la eficacia del tratamiento en esta etapa precoz de la enfermedad. Se destaca además la importancia que tiene el detectar cada vez con mayor frecuencia y precocidad a este grupo indeterminado, ya que al hacerlo se permite cortar la cadena epidemiológica, poniendo en evidencia la eficacia de toda labor asistencial y campañas antileprosas. Se describen las distintas lesiones cutáneas correspondiente a la lepra lepromatosa, como así también las que caracterizan a la lepra tuberculoide y dimorfa, enfatizando que este último grupo confiere unidad nosológica a la enfermedad. Por último se describen los caracteres clínicos, especialmente los cutáneos que acompañan a la reacción leprosa

Analysis of the family structure in a case of psychogenic purpura.

The case deals with an 18-year-old female patient suffering from psychogenic purpura who was successfully treated with individual and family oriented dynamic psychotherapy. Emphasis is placed on family dynamics and their possible bearing on the origin of the illness.