Mutational Landscape and Actionable Target Rates on Advanced Stage Refractory Cancer Patients: A Multicenter Chilean Experience.

Major advances in sequencing technologies and targeted therapies have accelerated the incorporation of oncology into the era of precision medicine and "biomarker-driven" treatments. However, the impact of this approach on the everyday clinic has yet to be determined. Most precision oncology reports are based on developed countries and usually involve metastatic, hard-to-treat or incurable cancer patients. Moreover, in many cases race and ethnicity in these studies is commonly unreported and real-world evidence in this topic is scarce. Herein, we report data from a total of 202 Chilean advanced stage refractory cancer patients. Retrospectively, we collected patient data from NGS tests and IHC in order to determine the proportion of patients that would benefit from targeted treatments. Overall >20 tumor types were included in our cohort and 37% of patients (n = 74) displayed potentially actionable alterations, including on-label, off-label and immune checkpoint inhibitor recommendations. Our findings were in-line with previous reports such as the cancer genome atlas (TCGA). To our knowledge, this is the first report of its kind in Latin America delivering real-world evidence to estimate the percentage of refractory tumor patients that might benefit from precision oncology. Although this approach is still in its infancy in Chile, we strongly encourage the implementation of mutational tumor boards in our country in order to provide more therapeutic options for advanced stage refractory patients.

Tuberculous Meningitis: Impact of Timing of Treatment Initiation on Mortality.

We conducted a retrospective cross-sectional study of adult hospitalized patients with confirmed tuberculous meningitis to determine the impact of the timing of treatment initiation on mortality. The mortality of tuberculous meningitis patients was high and was associated with delay in initiation of treatment, older age, HIV infection, and higher disease severity at admission.

Production of Protein Hydrolysates Using Marine Catfish Bagre panamensis Muscle or Casein as Substrates: Effect of Enzymatic Source and Degree of Hydrolysis on Antioxidant and Biochemical Properties.

Protein hydrolysates from fishery byproducts have resulted to be nutraceutical ingredients with potential to be applied in human nutrition; however, critical quality attributes are dependent on some process parameters such as enzyme source and degree of hydrolysis. This study analyzed the biochemical properties and in vitro antioxidant activity (using DPPH, ABTS, and FRAP assays), of protein hydrolysates at 10, 20, and 30% degree of hydrolysis (DH), measured by pH-STAT and prepared from sea catfish (Bagre panamensis) muscle and casein as protein sources by treatment with alcalase (ALC) and a semi-purified protease extract (SPE) from B. panamensis intestinal tissues as enzyme sources. With SPE, the DH was reached faster than ALC regardless of the protein substrate used. Sea catfish muscle (MUSC) hydrolysate made with SPE at 30% DH showed the highest antioxidant activity (DPPH: 118.8 µmoles TE/mg; ABTS: EC50 of 1.5 mg/mL). In FRAP assay, the MUSC hydrolysates produced with SPE or ALC at 20% DH showed the higher activity (0.38 and 0.40 µmoles TE/mg, respectively). MUSC hydrolysates made with SPE contained the highest proportion of peptides with MW < 1.35 kDa and had a high protein content (72 to 78%), and almost 50% of the amino acids were essential. These results suggest that intestinal proteases and muscle of marine catfish represent a potential source to elaborate antioxidant protein hydrolysates. Our results promote the full utilization of this fish species and offer a biotechnological strategy for the management and valorization of its byproducts.

Life cycle assessment of cane sugar production: The environmental contribution to human health, climate change, ecosystem quality and resources in México.

The cane sugar industry in Mexico depends heavily on the supply of energy, fossil fuels and material resources for its proper operation. The overuse of these resources plus the technical and technological deficiency causes severe environmental consequences. This scientific work aims to analyze the environmental damage attributable to cane sugar production following the life cycle assessment (LCA) methodology. System boundaries include sugarcane growing and harvesting, sugarcane transportation, sugar milling and electricity cogeneration from bagasse. The associated emissions were acquired from the SimaPro-Ecoinvent database, the Roundtable on Sustainable Biofuels (RSB) and the Agroscope Reckenholz-Tänikon Research Station (ART). The life cycle impact assessment (LCIA) was carried out by SimaPro 8.3.0 software and the characterization method used was IMPACT 2002+. The results show that sugarcane growing and harvesting stage provides the most harmful environmental impacts (52%) followed by electricity cogeneration (25.7%), sugarcane transportation (12.1%) and finally, sugar milling (10.2%). Regarding the environmental contributions at the endpoint categories, the highest percentage of impacts is found in the Human health category (53%), followed by Climate change (21%), Ecosystem quality (16%) and Resources (10%). The LCA in cane sugar production can support the decision-making process to deal with this environmental problem.

Anestesia espinal unilateral para cirugía ortopédica ambulatoria: evaluación de una dosis mínima de bupivacaína hiperbara asociada a lateralización: ¿es posible el éxito? / Unilateral spinal anaesthesis for orthopaedic ambulatory surgery: evaluation of a mininal dose of hyperbaric bupivacaine associated with side positioning: Is success posible?

INTRODUCCIÓN: la anestesia espinal unilateral (AEU) es una alternativa para el desarrollo de la cirugía ortopédica ambulatoria (COA). el OBJETIVO de este ensayo clínico fue el evaluar una dosis baja de bupivacaína hiperbara (BHB), asociada a fentanilo intratecal (FI) para obtención de AEU en COA. MATERIALES Y MÉTODOS: ensayo clínico, prospectivo, controlado en pacientes ASA I a II. la AEU se efectuó con el paciente en decúbito lateral (DL), con el lado operatorio hacia abajo, a nivel de L3-L4. se inyectó 5 mg de BHB 0,75% asociado a 20 µg de FI. se evaluó el bloqueo sensitivo (BS) y motor (BM) cada 3 minutos, los primeros 20 minutos y luego cada 15 minutos. Se midió el nivel máximo alcanzado, el tiempo de regresión a T12 y el tiempo de regresión de dos segmentos. se registró la incidencia de complicaciones. RESULTADOS: 50 pacientes fueron incluidos, 66% de sexo masculino. Se obtuvo anestesia unilateral en el 84% y BM total unilateral en el 86%. La altura del BS osciló entre T9 y T11. la duración del BS fue 116 min. (SD± 23). la regresión a T12 fue de 47 min (SD±19). No se encontró correlación entre talla, dosis y duración de bloqueo. ningún paciente necesitó anestesia general. 1 paciente presentó bradicardia. DISCUSIÓN: la AEU con dosis bajas de BHB asociado a FI es eficiente en COA. se obtuvo adecuados BS y BM en la mayoría de los pacientes. la AEU mostró ser confiable, permitiendo una alta precoz y segura.

INTRODUCTION: The unilateral spinal anesthesia (USA) is an alternative for orthopedic ambulatory surgery (OAS). The AIM of this study was to evaluate a low dose of hyperbaric bupivacaine (HB) associated with intrathecal fentanyl (ITF) to produce USA. MATERIALS AND METHODS: Prospective, controlled clinical trial in ASA I ­II patients. The USA was developed in lateral position with the operating side downwards between L3-L4 space with 5 mg of HB + 20 µg ITF. We evaluated sensitive level block (SB), motor level block (MB), maximum level obtained, discharge time (DT) and collateral effects incidence. RESULTS: 50 patients were included, 66% male. The USA was obtained in 84% and total BM was present in 86% of cases. The level obtained of SB was between T9-T11 and the duration was 116 min (SD± 23). No correlation was obtained between patients height, BH dose and block duration. 1 patient presented bradycardia. No general anesthesia was necessary. DISCUSSION: The USA with a low dose of HB and ITF it's safe to developed OAS. Only 11 min were necessary to obtain a good SB and MB.

The Burden of Dengue and the Financial Cost to Colombia, 2010-2012.

Data on the burden of dengue and its economic costs can help guide health policy decisions. However, little reliable information is available for Colombia. We therefore calculated the burden of the disease, expressed in disability-adjusted life years (DALYs), for two scenarios: endemic years (average number of cases in non-epidemic years 2011 and 2012) and an epidemic year (2010, when the highest number of dengue cases was reported in the study period). We also estimated the total economic cost of the disease (U.S. dollars at the average exchange rate for 2012), including indirect costs to households derived from expenses such as preventing entry of mosquitos into the home and costs to government arising from direct, indirect, and prevention and monitoring activities, as well as the direct medical and non-medical costs. In the epidemic year 2010, 1,198.73 DALYs were lost per million inhabitants versus 83.88 in endemic years. The total financial cost of the disease in Colombia from a societal perspective was US$167.8 million for 2010, US$129.9 million for 2011, and US$131.7 million for 2012. The cost of mosquito prevention borne by households was a major cost driver (accounting for 46% of the overall cost in 2010, 62% in 2011, and 64% in 2012).

The current situation for gastric cancer in Chile.

Gastric cancer is a neoplasm with a high incidence and mortality rate in Chile where more than 3000 people die every year from this type of cancer. This study shows the clinical and epidemiological considerations of this disease, information about translational research on this pathology in Chile, the contribution of Chilean doctors to the development of gastric cancer management awareness and the general situation of gastric cancer in Chile.

Hepatocellular carcinoma in identical twins in Chile: case report.

Liver cancer is the second leading cause of cancer death worldwide, with hepatocellular carcinoma (HCC) being the most common type of primary malignant liver tumour, with a typically poor prognosis, growing incidence and a well-documented relationship with chronic inflammation factors of the liver tissue. Despite the fact that family medical history has been identified as a risk factor for the development of HCC, its significance in terms of etiopathogenesis and prognosis is not well documented. With a view to contributing to this discussion, we will report the clinical case of two identical twins with HCC, both diagnosed within a short period of time, by providing relevant clinical data, and relating this to other medical literature reports that could contribute to a deeper understanding of this illness.

[Recommendations for the management of pancreatic cancer type adenocarcinoma: A consensus statement reached during the 2015 Latin American Symposium on Gastroenterological Oncology]. / Recomendaciones sobre el manejo del cáncer de páncreas tipo adenocarcinoma en Latinoamérica: Reunión del Consenso del Simposio Latinoamericano de Gastroenterología Oncológica (SLAGO) y de la Asociación Ibero Latinoamericana de Terapia Radiante (ALATRO), Viña del Mar, Chile 2015.

Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.

Costs of dengue to the health system and individuals in Colombia from 2010 to 2012.

Dengue fever (DF) is an important health issue in Colombia, but detailed information on economic costs to the healthcare system is lacking. Using information from official databases (2010-2012) and a face-to-face survey of 1,483 households with DF and dengue hemorrhagic fever (DHF) patients, we estimated the average cost per case. In 2010, the mean direct medical costs to the healthcare system per case of ambulatory DF, hospitalized DF, and DHF (in Colombian pesos converted to US dollars using the average exchange rate for 2012) were $52.8, $235.8, and $1,512.2, respectively. The mean direct non-medical costs to patients were greater ($29.7, $46.7, and $62.6, respectively) than the mean household direct medical costs ($13.3, $34.8, and $57.3, respectively). The average direct medical cost to the healthcare system of a case of ambulatory DF in 2010 was 57% of that in 2011. Our results highlight the high economic burden of the disease and could be useful for assigning limited health resources.

Report from the First Latin American Urological Oncology Symposium (SLAURO) 19-21 June 2014, Viña del Mar, Chile.

Cancer is one of the most important diseases in Chile, with alarming incidence and mortality rates that are among the highest in Latin America. Economic growth in South America has led to demographic change, with an aging population typical of developed countries, but also a growing population with cancer. The incidence and mortality of urological cancers in Chile is significant, and has led to the formulation of health laws and policies promoting the early treatment of urological cancers. It is also well known that there are regions of Chile with extremely high incidence and mortality of bladder cancer caused by arsenic exposure. SLAURO (Simposio Latinoamericano de Urología Oncológica [Latin American Oncological Urology Symposium]) is a new Latin American forum for discussing and promoting knowledge of urological cancers across the region.

Continuous popliteal block for postoperative analgesia in total ankle arthroplasty.

BACKGROUND: Total ankle arthroplasty is associated with severe postoperative pain. Development of analgesic techniques such as a block with continuous infusion at the popliteal level has been shown to result in good pain control, a decrease in the use of rescue analgesia and a low rate of complications. We reviewed our experience with this method of analgesia in patients who underwent total ankle arthroplasty. METHODS: A prospective study of 30 patients undergoing total ankle arthroplasty was carried out. Twenty-two of these received and maintained a block at the popliteal level with a continuous infusion of bupivacaine, while the remaining eight received no such block. RESULTS: The visual analog scale evaluation (VAS) showed a significant improvement in pain control in the group with the popliteal block after 6, 12, 18, and 24 hours postsurgery, with pain levels peaking and being most different between 6 and 12 hours postsurgery for the two groups. The group with the popliteal block also exhibited a significantly lower consumption of morphine and a greater degree of patient satisfaction. CONCLUSION: The block with continuous infusion at the popliteal fossa was a safe technique for total ankle arthroplasty postoperative analgesia, which provided good pain control, a lower requirement of opiates and a higher level of patient satisfaction.

[Radio and chemotherapy in gallbladder cancer: a Latin American Consensus]. / Terapias perioperatorias en el cáncer de vesícula biliar resecable: conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar.

No randomized controlled trials have been conducted in gallbladder cancer to establish standard treatments. We therefore conducted the first Latin American Consensus meeting for the management of gallbladder cancer. In this paper we report the conclusions of the experts' panel for (neo) adjuvant treatment of resectable gallbladder cancer. These are based on the review of the literature, the discussion of the participating experts and the vote of the assistants (surgical oncologists, medical oncologists, radiation oncologists and others). The reviewed topics were the role or adjuvant radiochemotherapy in T1 bN0M0, T2-3 N0-1M0 and T4 N0-1 M0 disease and doses, schedules and drugs for radiochemotherapy.

[Palliative treatment for locally advanced or metastatic gallbladder cancer: conclusions of the Latin American Consensus meeting for the management of gallbladder cancer]. / Manejo paliativo del cáncer de vesícula biliar irresecable o metastásico: conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar.

Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: (1) Gallbladder cancer and cholangiocarcinoma--are they the same disease?; (2) Palliative chemotherapy: indications, drugs and schedules; (3) Palliative radiotherapy; (4) Palliative Surgery; (5) Management of malignant biliary obstruction.

Manejo paliativo del cáncer de vesícula biliar irresecable o metastásico: Conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar / Palliative treatment for locally advanced or metastatic gallbladder cancer: conclusions of the Latin American Consensus meeting for the management of gallbladder cancer

Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: 1.- Gallbladder Cancer and Cholangiocarcinoma -are they the same disease?; 2. - Palliative Chemotherapy: Indications, Drugs and Schedules; 3. - Palliative Radiotherapy; 4.- Palliative Surgery; 5.-Management of Malignant Biliary Obstruction.

Conocimiento y actitudes acerca de la transmisión y prevención de la tuberculosis en pacientes con tuberculosis multidrogorresistente / Knowledge and attitudes about the transmission and prevention of tuberculosis in patients with multidrug tuberculosis

Objetivo: Describir el nivel de conocimiento y actitudes acerca de la transmisión y prevención de la tuberculosis en pacientes con tuberculosis multidrogorresistente (TB-MDR), compararlo por sexo, grado de instrucción y especificar las fuentes principales de información acerca de la tuberculosis. Material y métodos: Estudio observacional de corte transversal. Se estudiaron 70 pacientes con diagnóstico de TB-MDR en tratamiento durante el año 2009, pertenecientes a cinco centros de salud de la DISA V Lima-Ciudad, los cuales fueron elegidos mediante consulta a expertos. Las variables fueron agrupadas en tres categorías: 1. Datos generales (edad, sexo, estado civil, grado de instrucción, ocupación, diagnóstico actual, medio principal de adquisición de la información y momento de la adquisición del conocimiento), 2. Conocimiento sobre la transmisión y medidas preventivas acerca de la tuberculosis y 3. Actitudes frente a su enfermedad. Se utilizó una encuesta para recolectar la información necesaria. Resultados: La media de la edad fue de 32.1±12.9 años, 55.7% y 44.3% fueron de sexo masculino y femenino respectivamente. El 82.9% de los pacientes obtuvo un conocimiento adecuado sobre la transmisión de la tuberculosis, el 51.4% obtuvo un conocimiento adecuado sobre las medidas preventivas y el 60% fue catalogado con una actitud adecuada con respecto a su enfermedad. La distribución por sexo y grado de instrucción no fue significativa en ninguna de las categorías de conocimiento y actitudes (p>0.05). Conclusiones: La mayoría de pacientes presentó un nivel adecuado de conocimiento sobre la transmisión de la tuberculosis, existiendo una infravaloración de este conocimiento. En contraparte, encontramos una sobrevaloración del conocimiento sobre las medidas preventivas y aproximadamente sólo la mitad de los pacientes presentó un nivel adecuado de este conocimiento. La actitud de los pacientes con respecto a su enfermedad fue adecuada en la mayoría de casos...

Objective: To describe the level of knowledge and attitudes about the transmission and prevention of tuberculosis in patients with multidrug-resistant tuberculosis (MDR-TB), compared by sex and education level, and specify the main sources of information about tuberculosis. Methods: Observational, cross-sectional study. We studied 70 patients diagnosed with MDR-TB in treatment during 2009, from five health centers, DISA V Lima-Ciudad, which were chosen by consulting experts. Variables were grouped into three categories: 1. general information (age, sex, marital status, education level, occupation, current diagnosis, primary means of acquiring information and time of the acquisition of knowledge), 2. knowledge about the transmission and preventive measures on tuberculosis and 3. attitudes towards their disease. We used a survey to collect the necessary information. Results: The mean age was 32.10±12.92 years, 55.7% and 44.3% were male and female respectively. 82.9% of patients achieved an adequate knowledge about TB transmission, 51.4% had adequate knowledge on prevention and 60% were classified as having a proper attitude towards their disease. The distribution by sex and educational level was not significantly different in any of the categories of knowledge and attitudes (p> 0.05). Conclusion: Most patients had an adequate level of knowledge about transmission of tuberculosis, there was an understatement of this knowledge. Nevertheless, we found an overestimation of knowledge about preventive measures, and only about half of the patients had an adequate level of this knowledge. The patient's attitude regarding their disease was adequate in most cases. There was not significant difference in the level of knowledge and patients attitudes by sex nor educational level. The main source of information was the local health center.