Factores asociados a multidrogorresistencia en pacientes con tuberculosis en el departamento de Lambayeque / Factors associated with multidrug resistance in patients with tuberculosis in the department of Lambayeque

Objetivo: Determinar los factores asociados a Multidrogoresistencia en pacientes con Tuberculosis. Materiales y métodos: Estudio analítico, retrospectivo y transversal de casos y controles realizado en 41 pacientes Multidrogorresistentes (casos) y 3 controles por cada caso (Tuberculosis Pulmonar no MDR). Se recolectaron los datos directamente de las historias clínicas y de las fichas empleadas por la DIRESA de Lambayeque. Se realizó el análisis a través del programa estadístico SPSS 13. Resultados: Se encontró que la irregularidad en el tratamiento es un factor de riesgo con OR = 6,857 (IC: 95%, [2,480 - 18,961]). La presencia de comorbilidad mostró un OR = 3,068 (IC: 95%, [1,439 - 6,541]), mientras que el contacto con TB tuvo un OR = 2,119 (IC: 95%, [1,004 -4,472]) y el desempleo un OR = 2,143 (IC: 95%, [1,035 - 4,439]). Conclusiones: La mayor fuerza de asociación para el desarrollo de Multidrogorresistencia corresponde a la irregularidad en el Tratamiento. Además, el desempleo, el contacto con TB y, la presencia de comorbilidad son también factores de riesgo en paciente con TB para desarrollar TB-MD

Alpha1-antichymotrypsin and kallistatin hydrolysis by human cathepsin D.

In the present paper, we demonstrate that alpha1-antichymotrypsin, a serpin with high inhibitory specificity toward cathepsin G, and kallistatin, a human serpin with high specificity toward tissue kallikrein, are digested by cathepsin D. Alpha1-Antichymotrypsin was hydrolyzed essentially in the reactive center loop at L-S, A-L, or L-V bonds; kallistatin was split into small fragments, but we detected the cleavage at F-F and F-S bonds in its reactive center loop in the first 15 min of digestion. In contrast to alpha1-antichymotrypsin, kallistatin is irreversibly inactivated at pH 4.0. Synthetic internally quenched fluorescent peptides containing sequences similar to the reactive center loops of these serpins were hydrolyzed by cathepsin D. The peptides derived from kallistatin were hydrolyzed more efficiently, and particularly relevant was the high susceptibility of the substrates Abz-AIKFFSAQTNRHILRFNRQ-EDDnp (Km = 0.08 microM, kcat = 2.4 s(-1)) and Abz-AIKFFSAQTNRQ-EDDnp (Km = 0.8 microM, kcat = 17.8 s(-1)), which were hydrolyzed at the F-F bond. Therefore, besides the description of a new class of very efficient internally quenched substrates for cathepsin D, we give evidence for the downregulation role of this proteinase on alpha1-antichymotrypsin and kallistatin. The acidification of extracellular milieu by tumor cells can result in activation of cathepsin D; as a consequence, kinins can be released, improving blood supply and leaving more cathepsin G available for the degradation of extracellular matrix.

Fatty foods and the risk of lung cancer: a case-control study from Uruguay.

To examine whether fatty-food consumption modifies lung-cancer risk, a case-control study involving 377 patients with lung cancer and 377 controls was conducted in Uruguay. The study was restricted to men. Dietary patterns were assessed in detail using a 64-item food-frequency questionnaire, which allowed the calculation of total energy intake. After adjustment for potential confounders (body-mass index, family history of lung cancer, total energy intake and tobacco smoking), an increase in risk for fatty-food consumption was observed. In particular, fried foods (OR, 1.54; 95% CI, 1.01-2.35), dairy products (OR, 2.85; 95% CI, 1.73-4.69) and desserts (OR, 2.52; 95% CI, 1.54-4.12) were associated with increases in lung-cancer risk and significant dose-response patterns. The association with dairy products was more evident for adenocarcinoma of the lung (OR, 4.18; 95% CI, 1.87-9.36), whereas increased risks for fried-meat and dessert consumption were observed in each cell type. The association with fried-meat consumption was more pronounced for current smokers and for heavy smokers, whereas dairy products and desserts were associated with risk both in current and in past smokers. In conclusion, fat-rich foods and sucrose-rich foods were positively associated with an increased risk of lung cancer. Although the relationship between fat consumption and lung cancer has been reported, the direct association of lung cancer with sucrose-rich foods should be further investigated.

The effect of alcohol on the risk of lung cancer in Uruguay.

A hospital-based case-control study of the association between alcohol drinking and lung cancer was carried out in Uruguay between January 1988 and December 1990. The sample included 327 men with lung cancer and 350 male controls. Personal interviews were conducted in the Institute of Oncology by trained personnel using a structured questionnaire. The results showed a significant positive association between beer intake and the risk of lung cancer. The odds ratio for beer drinkers in the highest quartile was 3.4 (95% confidence limits, 1.3-6.6) after adjustment for tobacco. The association between beer and lung cancer was consistent for all the cell types, analyzed separately. A moderate effect for total alcohol consumption was also observed, with a relative risk of 2.2 for those subjects in the highest quartile.

Black tobacco, maté, and bladder cancer. A case-control study from Uruguay.

A case-control study of bladder cancer involving interviews with 111 incident cases and 222 controls was carried out in Montevideo, Uruguay. The analysis was conducted separately for each sex. Point estimates of relative risk associated with smoking variables, ingestion of infusions of the herb Ilex paraguariensis (maté), and selected dietary items were obtained by stratified and logistic regression analysis. Among men, smokers of black tobacco showed a relative risk (RR) 2.7 higher than blond tobacco smokers and maté exposure showed a significant dose-response, after adjustment for age, residence, social class, hospital, type of tobacco, smoking intensity, smoking duration, and vegetable consumption, with a seven-fold increase in risk for heavy consumers. Joint exposure to type of tobacco and maté consumption showed a multiplicative effect. Women showed a similar increase in risk with maté consumption. The results suggest that the high mortality rates of bladder cancer observed in Uruguay could be explained by the combined effect of black tobacco smoking and maté ingestion.

Risk factors of gastric precancerous lesions in a high-risk Colombian population. I. Salt.

A case-control study for stomach cancer was conducted in a high-risk population in Nariño, Colombia to determine the risk of gastric precancerous lesions associated with salt intake measured by sodium-to-creatinine ratio of a single urine sample. Gastric biopsies and urine samples were collected from 263 individuals. Urinary sodium-to-creatinine ratios were studied in relation to histological data from the biopsies. Significantly high odds ratios for precancerous lesions (chronic atrophic gastritis, intestinal metaplasia, and dysplasia) were associated with higher sodium-to-creatinine ratios. Adjusted odds ratios (OR) of 2.50 for chronic atrophic gastritis and 7.24 for dysplasia were found. The association with intestinal metaplasia was weaker and not significant (OR = 1.57). Furthermore, an excess risk associated with adding salt to food at the table was found among patients with precancerous lesions (OR = 1.80). These findings support the two-step involvement of salt in the process of gastric precancerous lesions.

Risk factors of gastric precancerous lesions in a high-risk Colombian population. II. Nitrate and nitrite.

Gastric nitrite content was studied in relation to precancerous lesions of the stomach in a case-control study conducted in a high-risk Colombian population. The proportion of detectable nitrite in gastric juice and the mean pH were significantly higher among those with precancerous lesions (chronic atrophic gastritis, intestinal metaplasia, and dysplasia) than among the controls (normal and superficial gastritis); the proportion and mean pH increased with the progression of histological changes from normal to dysplasia. Nitrite was not detectable in gastric juice with a pH less than 5.0. A positive association was found between the proportion of detectable nitrite and the risk of gastric precancerous lesions. Odds ratios of 4.39 for intestinal metaplasia and 24.72 for dysplasia remained significant after controlling for confounders. This finding suggests that nitrite may be a precursor of a mutagen that targets gastric epithelial cells.

Esophageal cancer in Uruguay: a case-control study.

Esophageal cancer has constituted a major public health problem in Uruguay, with age-adjusted death rates of 14.5 X 10(5) for males and of 3.8 X 10(5) for females. A case-control study was undertaken to ascertain the possible association of the local custom of drinking infusions of Ilex paraguariensis ("maté") with cancer of the esophagus, after controlling for well-known risk factors, such as alcohol and tobacco consumption. Two hundred twenty-six patients with esophageal cancer and 469 controls (control:case = 2.1) were interviewed at the time of admission or consultation at the Oncology Institute of Montevideo from 1979 through 1984. Males showed elevated risks of esophageal cancer associated with heavy tobacco [relative risk (RR) = 10.8] and alcohol (RR = 10.3) exposures. Among females, the independent effects of tobacco and alcohol were nonsignificant. Maté consumption had an independent effect in both males and females, with odds ratios of 6.5 and 34.6, respectively, for heavy users. Moreover, a well-defined dose response was evident in both sexes.