Terapia de estrógenos vaginales y riesgo de recurrencia en mujeres con antecedente de cáncer de mama

El cáncer de mama sigue siendo la neoplasia maligna más frecuente y una de las mortales en mujeres, considerándose un importante objetivo de la salud global y prioridad en salud pública. Con el uso de terapias innovadoras, ha mejorado la supervivencia, apareciendo condiciones asociadas, como el síndrome genitourinario menopaúsico. La terapia hormonal, se utiliza para el manejo de esta condición, mejorando sustancialmente la sintomatología, e incluso, siendo en algunos casos la única solución. La más utilizada, es la terapia de estrógenos vaginales. Sin embargo, se ha descrito un posible riesgo de recurrencia de cáncer de mama con su uso. En habla hispana, no existe evidencia que haya discutido este tópico. Se llevó a cabo una búsqueda en las bases PubMed, ScienceDirect y MEDLINE, utilizando los términos "Terapia de estrógenos vaginales", "Recurrencia" y "Cáncer de mama". Se encontró, que, de forma global, la terapia de estrógenos vaginales es una opción terapéutica eficaz y segura en el manejo del síndrome genitourinario menopaúsico en mujeres con antecedente de cáncer de mama, sin incrementar el riesgo de recurrencia, a excepción de aquellas tratadas con inhibidores de la aromatasa, en quienes se recomienda el uso de otras terapias para evitar acarrear este riesgo.

Breast cancer remains the most common malignant neoplasm and one of the leading causes of mortality in women, making it a significant target for global health efforts and a public health priority. Through the use of innovative therapies, survival rates have improved, leading to the emergence of associated conditions such as genitourinary menopausal syndrome. Hormonal therapy is employed for managing this condition, significantly alleviating its symptoms and, in some cases, serving as the sole solution. The most commonly utilized approach is vaginal estrogen therapy. Nevertheless, there have been reports of a potential risk of breast cancer recurrence associated with its use. In the Spanish-speaking context, there is limited evidence discussing this topic. A search was conducted across PubMed, ScienceDirect, and MEDLINE databases, using the terms "Vaginal Estrogen Therapy", "Recurrence" and "Breast Cancer." It was determined that, on a global scale, vaginal estrogen therapy is an effective and safe therapeutic option for managing genitourinary menopausal syndrome in women with a history of breast cancer. This therapy does not appear to increase the risk of recurrence, with the exception of those undergoing treatment with aromatase inhibitors. For these individuals, alternative therapies are recommended to mitigate this potential risk.

In Vitro Antiviral Activity of Nordihydroguaiaretic Acid against SARS-CoV-2.

The coronavirus infectious disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been spreading rapidly worldwide, creating a pandemic. This article describes the evaluation of the antiviral activity of nordihydroguaiaretic acid (NDGA), a molecule found in Creosote bush (Larrea tridentata) leaves, against SARS-CoV-2 in vitro. A 35 µM concentration of NDGA was not toxic to Vero cells and exhibited a remarkable inhibitory effect on the SARS-CoV-2 cytopathic effect, viral plaque formation, RNA replication, and expression of the SARS-CoV-2 spike glycoprotein. The 50% effective concentration for NDGA was as low as 16.97 µM. Our results show that NDGA could be a promising therapeutic candidate against SARS-CoV-2.

Synthesis and Anti-Mycobacterium tuberculosis Activity of Imidazo[2,1-b][1,3]oxazine Derivatives against Multidrug-Resistant Strains.

The emergence of multidrug-resistant strains of M. tuberculosis has raised concerns due to the greater difficulties in patient treatment and higher mortality rates. Herein, we revisited the 2-nitro-6,7-dihydro-5H-imidazo[2,1-b][1,3]oxazine scaffold and identified potent new carbamate derivatives having MIC90 values of 0.18-1.63 µM against Mtb H37Rv. Compounds 47-49, 51-53, and 55 exhibited remarkable activity against a panel of clinical isolates, displaying MIC90 values below 0.5 µM. In Mtb-infected macrophages, several compounds demonstrated a 1-log greater reduction in mycobacterial burden than rifampicin and pretomanid. The compounds tested did not exhibit significant cytotoxicity against three cell lines or any toxicity to Galleria mellonella. Furthermore, the imidazo[2,1-b][1,3]oxazine derivatives did not show substantial activity against other bacteria or fungi. Finally, molecular docking studies revealed that the new compounds could interact with the deazaflavin-dependent nitroreductase (Ddn) in a similar manner to pretomanid. Collectively, our findings highlight the chemical universe of imidazo[2,1-b][1,3]oxazines and their promising potential against MDR-TB.

Malaria asociada al embarazo: revisión narrativa / Malaria in pregnancy: Narrative review

Las infecciones por malaria incrementan el riesgo de presentar complicaciones en el binomio madre-feto. En Venezuela, la casuística de este grupo vulnerable no se ha actualizado en los últimos años. El objetivo de esta revisión narrativa fue describir exhaustivamente qué es la malaria asociada al embarazo y sus efectos maternos, fetales y neonatales; tratando de contestar la siguiente pregunta de investigación. Todas las formas de la malaria asociada al embarazo, incluyendo malaria gestacional, placentaria y congénita, causan alteraciones materno-fetales y neonatales que, de progresar, podrían llevar a la muerte de este binomio. La fisio-patología e inmuno-patología logran explicar la sintomatología de las gestantes y del feto, así como sus complicaciones; dependiendo de la forma parasitaria afectante. Existen nuevas actualizaciones en el diagnóstico, prevención y tratamiento de esta entidad(AU)

Malaria infections increase the risk of complications in the mother-fetus binomial. In Venezuela, the casuistry of this vulnerable group has not been updated in recent years. The objective of this narrative review was to comprehensively describe what pregnancy-associated malaria is and its maternal, fetal and neonatal effects; trying to answer the following research question. All forms of pregnancy-associated malaria, including gestational, placental and congenital malaria, cause maternal-fetal and neonatal alterations that, if they progress, could lead to the death of this binomial. Physiopathology and immunopathology can explain the symptoms of pregnant women and the fetus, as well as their complications; depending on the parasitic form affecting. There are new updates in the diagnosis, prevention and treatment of this entity(AU)

Effects of lipografts in immune-driven lipoatrophies. Case studies

Lipodystrophy is a pathological condition associated with an abnormal body adipose tissue redistribution. Facial lipoatrophy can be a consequence of congenital, acquired, or involutional. The lipograft is an autologous fat transplant, which constitutes a treatment option that provides volume, tissue regeneration, and advantages in relation to other fillers in autoimmune diseases. The aim is to highlight the filling action and the metabolic effect of facial lipotransfer, due to the grafted adipocytes survival, and the adipose tissue derived stem cells regenerative activity obtained by nano-fat in patients with facial lipoatrophy. Lipoinjection improves the architecture of the new dermis and increases its functional capacity. It is a treatment with autologous tissue (fatty graft) with great efficacy in relation to other alloplastic filler materials capable of exacerbating an inflammatory response mediated by antibody production.

La lipodistrofia es una condición patológica asociada a una redistribución anómala del tejido adiposo en el cuerpo. La lipoatrofia facial puede ser consecuencia de defectos congénitos, adquiridos o involutivos. El lipoinjerto es el trasplante de grasa autógena y constituye una opción de tratamiento que aporta volumen, regeneración tisular y ventajas en relación con otros materiales de relleno en enfermedades autoinmunes. Se busca resaltar la acción de relleno y el efecto metabólico de la lipotransferencia facial, por la supervivencia de los adipocitos injertados y la actividad regenerativa de las células madre provenientes del tejido adiposo obtenidas por nanofat en pacientes con lipoatrofia facial. La lipoinyección mejora la arquitectura de la nueva dermis y aumenta su capacidad funcional, es un tratamiento con tejido autógeno (injerto graso) con gran eficacia en relación con otros materiales de relleno aloplásticos capaces de exacerbar una respuesta inflamatoria mediada por la producción de anticuerpos.

In vitro inhibition of SARS-CoV-2 Infection by dry algae powders.

Chlorella spp., Spirulina spp., and fucoidan dry powders, are commercialized as food supplements and are considered safe for human consumption. Their broad-spectrum antiviral properties have been studied, however, their effect against SARS-CoV-2 remains unknown. We investigated the potential antiviral activity of three algae powders: Chlorella vulgaris, Arthrospira maxima (Spirulina) and fucoidan purified from marine brown algae Sargassum spp. against SARS-CoV-2 infection in vitro. Vero cells were incubated with 70 µg/ml of each algae powder and either 50 or 100 TCID50/ml of SARS-CoV-2, in two types of experiments (pretreatment and simultaneous) and comparing two kinds of solvents (DMEM and DMSO). Chlorella vulgaris powder, inhibited SARS-CoV-2 infection in all assays; viral RNA was significantly reduced in supernatants at 24, 48, 72, and 96 h post-infection, the highest difference in viral load (8000-fold) was observed after 96 h. Arthrospira maxima powder inhibited SARS-CoV-2 infection using 50 TCID50/ml for both experimental schemes, but protection percent was lower when viral inoculum was increase to 100 TCID50/ml; viral RNA decreased 48 h after infection, reaching a 250-fold difference at 72 h. Fucoidan powder partially inhibited SARS-CoV-2 infection since no CPE was observed in 62.5% of trated cultures in DMEM, but the antiviral activity was increased to 100% of protection when DMSO was used as solvent. All the algae samples showed high antiviral activity against SARS-CoV-2 with a SI above of 18. These results suggest that all three algae samples are potential therapeutic candidates for the treatment of COVID-19.

Mecanismos de evasión tumoral a la respuesta inmune / Mechanisms of tumor evasion to the immune response

El desarrollo del cáncer se determina por la capacidad proliferativa de las células tumorales y por presentar facultades invasoras y de metastatizar a tejidos distantes. La compleja relación de la patología con el sistema inmunitario facilita la evolución de la enfermedad, por lo que mediante esta bidireccionalidad, la célula cancerígena tiene la capacidad de escapar de la regulación del huésped, evadiendo la respuesta inmune antitumoral, mediante mecanismos intrínsecos y extrínsecos. El objetivo de este manuscrito es describir a cabalidad y de una forma actualizada dichos mecanismos, con la finalidad de generar un impacto tangible y mayor conocimiento en la comunidad médico-científica sobre la génesis de posibles nuevos diagnósticos y tratamientos específicos que busquen disminuir las estadísticas de tan letal enfermedad. Para la realización de este trabajo, se hizo uso de las plataformas y bases de datos de PubMed, Google Académico, Scielo y Elsevier, durante un período de dos meses, así como de libros especializados en inmunología e inmunopatología, y artículos publicados en los últimos cinco años. Esta revisión narrativa permite incentivar la investigación de rutas de comunicación intercelulares que puedan cumplir en un futuro, quizás no muy lejano, con este propósito

Cancer's development is determined by the proliferative capacity of tumor cells and by presenting invasive abilities and to metastasize to distant tissues. The complex relationship of this pathology with the immune system facilitates its natural evolution; thus, this bidirectionality allows cancer cells to escape from the host's regulation, evading antitumoral immune responses, through intrinsic and extrinsic mechanisms. The aim of this manuscript is to describe exhaustively, and in the most updated way possible, said mechanisms, with the objective of generating a tangible impact and more awareness the medical-scientific community, regarding the genesis of possible new and more specific diagnostic and treatment options that diminish this lethal disease's statistics. The information used to write this article was obtained from medical digital archives, including PubMed, Google Scholar, Scielo, and Elsevier, as well as specialized books in immunology and immunopathology, and articles published in the last five years. This narrative review encourages the investigation of intercellular communication routes that may be fulfilled, in the non-too distant future, for this purpose

Reporte de caso: Quiste neuroentérico intradural/extramedular en paciente joven / Case report: Intradural/extramedullary neurenteric cyst in a young patient

Introducción: Los quistes neuroentéricos son lesiones congénitas, benignas, solitarias e infrecuentes del eje espinal, compuestas de tejido endodérmico heterotópico, productos del cierre incompleto del tubo neural. Se presentan, principalmente, en hombres durante la primera y segunda década de vida. Se localizan mayoritariamente en el espacio intradural/extramedular, ventralmente a la médula espinal, a nivel cervical bajo o torácico superior. La sintomatología neurológica depende de la localización del quiste. El diagnóstico presuntivo se realiza con una resonancia magnética, y el definitivo con un estudio histopatológico, llevado a cabo posterior a la exéresis completa o parcial de la muestra, con abordaje posterior, en la mayoría de los casos. Caso: Se describe el caso de una paciente de 35 años, quien tiene antecedente de haber presentado a los 14 años un quiste neuroentérico intradural/extramedular, a nivel cervial bajo. Había debutado con cervicalgia irradiada a miembros superiores e inferiores, radiculopatía, pérdida de la fuerza muscular, e hiperreflexia. Se realizó en ese momento una resonancia magnética, evidenciando una lesión ocupante de espacio en C5 y C6, la cual fue intervenida quirúrgicamente a través de una laminectomía en C5-C6 con abordaje posterior. Se realizó exéresis completa de la misma. El estudio anatomopatológico reportó quiste neuroentérico intradural/extramedular, sin atipias celulares. La evolución posoperatoria de la paciente resultó satisfactoria. Conclusión: Se describe este caso clínico, resaltando su importancia, al tratarse de lesiones sumamente infrecuentes en la literatura médica, con sintomatología poco específica, pudiendo confundirse con otras patologías, y recidivar, incluso después de haberse extraído completamente

Introduction: Neuroenteric cysts are congenital, benign, solitary, and infrequent lesions of the spinal axis, composed of heterotopic endodermic tissue, resulting from an incomplete closure of the neural tube. They mainly occur in men, during the first or second decade of life. Most of these cysts are located in the intradural/extramedullary compartment, ventrally to the spinal cord, especially at the lower cervical or upper thoracic spine. The neurological symptomatology varies depending on the location of the cyst. The presumptive diagnosis is made with magnetic resonance imaging, and the definitive diagnosis is made with a histopathological assessment, which is done after a complete or partial resection of the mass, generally with a posterior approach. Case presentation: We describe the case of a 35-year-old female patient, with the medical history of presenting an intradural/extramedullary neuroenteric cyst, located at the lower cervical level, at the age of 14. She presented cervical pain irradiated to upper and lower limbs, radicular pain, loss of muscular strength, and hyperreflexia. A magnetic resonance imaging was indicated, showing a space-occupying lesion at the C5 and C6 levels, which was surgically intervened through a posterior cervical (C5-C6) laminectomy. A complete resection of this mass was performed. The histopathological assessment reported an intradural/extramedullary neuroenteric cyst, with no cellular atypia. The patient's postoperative progress and development were satisfactory. Conclusion: The objective is to describe this case, highlighting its importance, since these lesions are extremely infrequent in the medical literature, with a non-specific symptomatology, which is why they can be confused with other pathologies, and recur, even after their complete resection.

Classical description of the parameter space geometry in the Dicke and Lipkin-Meshkov-Glick models.

We study the classical analog of the quantum metric tensor and its scalar curvature for two well-known quantum physics models. First, we analyze the geometry of the parameter space for the Dicke model with the aid of the classical and quantum metrics and find that, in the thermodynamic limit, they have the same divergent behavior near the quantum phase transition, as opposed to their corresponding scalar curvatures which are not divergent there. On the contrary, under resonance conditions, both scalar curvatures exhibit a divergence at the critical point. Second, we present the classical and quantum metrics for the Lipkin-Meshkov-Glick model in the thermodynamic limit and find a perfect agreement between them. We also show that the scalar curvature is only defined on one of the system's phases and that it approaches a negative constant value. Finally, we carry out a numerical analysis for the system's finite sizes, which clearly shows the precursors of the quantum phase transition in the metric and its scalar curvature and allows their characterization as functions of the parameters and of the system's size.

Lisado plaquetario homólogo como factor estimulante de la cicatrización en la zona donante de injertos / Homologous Platelet lysate as astimulatinghealing factor for the grafts donor area

Introducción: La búsqueda de alternativas para disminuir el tiempo de cicatrización y de hospitalización constituye uno de los aspectos fundamentales de la investigación actual. Los factores de crecimiento plaquetarios son capaces de potenciar la cicatrización. Objetivo: Determinar los beneficios de la aplicación del lisado de plaquetas homólogo sobre la zona donante del injerto autólogo de piel. Método: Se realizó un estudio longitudinal prospectivo en 20 pacientes tratados en el Hospital Hermanos Ameijeiras entre agosto de 2016 y mayo de 2019, que requirieron de injerto autólogo de piel en las zonas cruentas. Se realizaron dos tomas de injerto en el mismo paciente y región anatómica; una fue tratada con lisado plaquetario (zona de intervención) y otra con tratamiento convencional (zona control). La selección de pacientes fue intencional. Para estudiar las variables cualitativas se utilizaron números absolutos y proporciones y en las cuantitativas medidas de tendencia central y dispersión. Para la comparación de los resultados se aplicó la prueba de Friedman con un nivel de significación p ≤ 0,05. Resultados: La quemadura fue la principal causa de zona cruenta (75 por ciento), el grupo de edad más afectado fue el de mayores de 55 años. El porcentaje de cicatrización fue mayor en el grupo de intervención, con un tiempo de epitelización significativamente menor (p < 0,01), y el dolor en la zona intervenida fue menor. No hubo complicaciones. Conclusiones: Los beneficios encontrados en la zona intervenida con lisado plaquetario fueron significativos con una cicatrización más rápida y menor dolor(AU)

Introduction: The search for treatment alternatives that allow reducing wound healing and hospitalization time are fundamental aspects in research nowadays. Platelet growth factors are capable of enhancing wound healing. Objective: Determine the benefits of applying homologous platelet lysate on the donor area of autologous skin graft. Methods: A prospective longitudinal-section study was conducted in 20 patients with bloody areas that required autologous skin graft at the Hospital Hermanos Ameijeiras between August 2016 and May 2019. Two graft intakes were made in the same patient and anatomical region, one of them treated with platelet lysate (intervention zone) and one with conventional treatment (control zone). Patients selection was intentional. Absolute numbers and proportions were used to study the qualitative variables, and measures of central tendency and dispersion were used in the quantitative variables. To compare de results, the Friedman test was applied, setting a level of significance p < 0,05. Results: The main cause of bloody area was burns (75 percent), the most affected age group was those over 55 years, the healing percentage was greater in the intervention group with a statistically significant shorter epithelization time (p < 0,01) and there was less pain in the intervention zone. There were no complications. Conclusions: The benefits found in the intervened area with platelet lysate were significant with faster healing and less pain(AU)

[Weight regain after bariatric surgery in diabetic patients at a university hospital in Argentina]. / Reganancia de peso tras cirugía bariátrica en pacientes diabéticos en un hospital universitario de Argentina.

Introduction: bariatric surgery has proven to be the most effective treatment for weight reduction. The weight regain is expected in any type of surgery, and within them, the roux en Y gastric by pass (GBP) appears to be the one with the lowest weight increase compared to sleeve gastrectomy (SG). Materials and Methods: it was an observational retrospective cohort study. 167 patients undergoing bariatric surgery, GBP and SG, were analyzed between 2012 and 2017. Patients older than 18 years with a diagnosis of type 2 diabetes mellitus and obesity were selected. The main variable, weight (kg), was measured longitudinally at 6 months,1 and 5 years. Results: it was detected that there was weight regain between the first and fifth postoperative year with both techniques used but it was significantly for SG. Conclusion: both types of surgeries achieved significant weight loss, however the regimen existed and was significant for the SG group.

Introducción: la cirugía bariátrica ha demostrado ser el tratamiento más eficaz para la reducción de peso. La reganancia de peso es esperable en cualquier tipo de cirugía, y dentro de ellas, el by pass gástrico en Y de Roux (BPG) aparenta ser el que presenta menor incremento de peso comparado a la gastrectomía en manga (GM). Materiales y Métodos: se trató de un estudio de cohorte retrospectivo observacional. Se analizaron 167 pacientes sometidos a cirugía bariátrica, BPG y GM, entre los años 2012 y 2017. Se seleccionaron pacientes mayores de 18 años con diagnóstico de diabetes mellitus tipo 2 y obesidad. La variable principal, el peso (kg), fue medida de forma longitudinal a los 6 meses, 1 y 5 años. Resultados: se observó que hubo reganancia de peso entre el primer y quinto año postoperatorio con ambas técnicas utilizadas pero fue significativa para la GM. Conclusiones: ambas tipos de cirugías lograron descenso significativo de peso, sin embargo la reganancia existió y fue significativa para el grupo de GM.

In silico investigation of heparanase-correlated genes in breast cancer subtypes.

OBJECTIVE: To investigate the possible genes that may be related to the mechanisms that modulate heparanase-1. METHODS: The analysis was conducted at Universidade Federal de São Paulo, on the data provided by: The Cancer Genome Atlas, University of California Santa Cruz Genome Browser, Kyoto Encyclopedia of Genes and Genomes Pathway Database, Database for Annotation, Visualization and Integrated Discovery Bioinformatics Database and the softwares cBioPortal and Ingenuity Pathway Analysis. RESULTS: Using messenger RNA expression pattern of different molecular subtypes of breast cancer, we proposed that heparinase-1 was co-related with its progression. In addition, genes that were analyzed presented co-expression with heparanase-1. The results that showed that heparanase-1 co-expressed with phosphoinositide 3-kinase adapter protein 1, sialic acid-binding immunoglobulin-like lectin 7, and leukocyte-associated immunoglobulin-like receptor 1 are directed related with immune system evasion during breast cancer progression. Furthermore, cathepsin L was co-expressed with heparanase-1 and transformed inactive heparanase-1 form into active heparanase-1, triggering extracellular matrix remodeling, which contributes to enhanced tumor-host interaction of the tumor. CONCLUSION: The signaling pathway analysis using bioinformatics tools gives supporting evidence of possible mechanisms related to breast cancer development. Evasion genes of the immune system co-expressed with heparanase-1, a enzyme related with tumor progression.

Pitiriasis rubra pilaris tratada con lámpara excímero / Pityriasis rubra pilaris treated with excimer lamp

Resumen La pitiriasis rubra pilaris, es una dermatosis inflamatoria papuloescamosa e hiperqueratósica de origen desconocido y de progresión crónica, la cual puede evolucionar incluso a eritrodermia. El presente caso trata de un paciente de 27 años portador del virus de inmunodeficiencia humana, diagnosticado con pitiriasis rubra pilaris tipo IV, inicialmente tratado con corticosteroide tópico y fototerapia, por cuatro meses. Sin embargo, presentó reactivación de las lesiones, por lo que se recurrió a la aplicación de lámpara excímero, utilizada en otras patologías dermatológicas, mas no de uso habitual en la pitiriasis rubra pilaris.

Abstract Pityriasis Rubra Pilaris is an inflammatory papulosquamous and hyperkeratic dermatosis of unknown cause and chronic progression which can envolve even into erythroderma. This case deals with a 27-year old male patient carrier of VIH who was diagnosed with PRP type IV. Initially, it was treated with topical corticosteroid and phototherapy for four months. However, it showed reactivation of the injuries; therefore, excimer lamp was employed, which is used in other dermatologic pathologies but it is not a regular treatment for PRP type IV.

In silico investigation of heparanase-correlated genes in breast cancer subtypes / Investigação in silico dos genes correlacionados à heparanase nos diferentes subtipos de câncer de mama

ABSTRACT Objective To investigate the possible genes that may be related to the mechanisms that modulate heparanase-1. Methods The analysis was conducted at Universidade Federal de São Paulo, on the data provided by: The Cancer Genome Atlas, University of California Santa Cruz Genome Browser, Kyoto Encyclopedia of Genes and Genomes Pathway Database, Database for Annotation, Visualization and Integrated Discovery Bioinformatics Database and the softwares cBioPortal and Ingenuity Pathway Analysis. Results Using messenger RNA expression pattern of different molecular subtypes of breast cancer, we proposed that heparinase-1 was co-related with its progression. In addition, genes that were analyzed presented co-expression with heparanase-1. The results that showed that heparanase-1 co-expressed with phosphoinositide 3-kinase adapter protein 1, sialic acid-binding immunoglobulin-like lectin 7, and leukocyte-associated immunoglobulin-like receptor 1 are directed related with immune system evasion during breast cancer progression. Furthermore, cathepsin L was co-expressed with heparanase-1 and transformed inactive heparanase-1 form into active heparanase-1, triggering extracellular matrix remodeling, which contributes to enhanced tumor-host interaction of the tumor. Conclusion The signaling pathway analysis using bioinformatics tools gives supporting evidence of possible mechanisms related to breast cancer development. Evasion genes of the immune system co-expressed with heparanase-1, a enzyme related with tumor progression.

RESUMO Objetivo Investigar os genes que podem estar relacionados aos mecanismos que modulam a heparanase-1. Métodos A análise foi realizada na Universidade Federal de São Paulo, utilizando dados fornecidos por: The Cancer Genome Atlas, University of California Santa Cruz Genome Browser, Kyoto Encyclopedia of Genes and Genomes Pathway Database, Database for Annotation, Visualization and Integrated Discovery Bioinformatics Database e os softwares cBioPortal e Ingenuity Pathway Analysis. Resultados Usando o perfil de expressão de RNA mensageiro de diferentes subtipos moleculares de câncer de mama, propusemos que a heparanase-1 esteve correlacionada com a progressão tumoral. Além disso, os genes analisados apresentaram coexpressão com heparanase-1. Os resultados mostraram que a heparanase-1 coexpressa com proteína adaptadora 1 da fosfoinositídeo 3-quinase, lectina 7 tipo Ig de ligação ao ácido siálico e receptor 1 do tipo imunoglobulina associado a leucócitos, estes genes estão diretamente relacionados à evasão do sistema imune durante a progressão do câncer de mama. Além disso, a catepsina L foi coexpressa com a heparanase-1 e transformou a forma inativa da heparanase-1 em heparanase-1 ativa, desencadeando o remodelamento da matriz extracelular, o que contribuiu para a interação do tumor com o ambiente tumoral. Conclusão A análise utilizando bioinformática fornece evidências de possíveis mecanismos relacionados ao desenvolvimento do câncer de mama. Genes de evasão do sistema imune foram coexpressos com a heparanase-1, uma enzima relacionada à progressão tumoral.

Pioderma gangrenoso ulceroso asociado a artritis reumatoide: reporte de caso / Ulcerative pyoderma gangrenosum associated with rheumatoid arthritis: a case report

ResumenEl pioderma gangrenoso corresponde a una dermatosis crónica inflamatoria rara, cuya etiología y patogénesis es aún incierta, aunque factores inmunológicos y disfunción neutrofílica parecen desempeñar un papel importante. Se presenta en la mayoría de los casos asociada a enfermedad sistémica no infecciosa, como artritis reumatoide, malignidad hematológica y enfermedad inflamatoria intestinal (EII). Es más común en mujeres entre la tercera y quinta década de la vida y puede presentarse como cuatro variantes clínicas distintas que conllevan a ulceración de la piel, con topografía predominante a nivel de extremidades inferiores. Su diagnóstico es meramente clínico y de exclusión y el tratamiento a menudo amerita medidas locales y sistémicas.Se describe aquí el caso clínico de una paciente femenina de 38 años con pioderma gangrenoso variante ulcerativa, asociado a artritis reumatoide, quien presentó excelente evolución clínica posterior a instaurado el tratamiento esteroideo sistémico.

AbstractPyoderma gangrenosum is a rare chronic inflammatory dermatosis of unknown etiology and pathogenesis, although immunological factors and neutrophil dysfunction are believed to play an important role. In most cases it is associated with non-infectious systemic diseases such as rheumatoid arthritis, hematologic malignancies and inflammatory bowel disease. It is more common in women with a peak incidence between the third and fifth decades of life and it may present in four distinct clinical forms, all leading to ulceration of the skin, with involvement predominantly of the lower limbs. The diagnosis is based on the clinical manifestations and exclusion of other entities. Frequently systemic and local therapy is required.The clinical case of a 38 year old woman with ulcerative pyoderma gangrenosum associated with rheumatoid arthritis who had an excellent response to treatment with systemic steroids is described.

[Mandibular osteoradionecrosis (ORN) as a side effect of head and neck cancer treatment: Factors that induce it]. / Osteoradionecrosis (ORN) mandibular como efecto colateral del tratamiento del cáncer de cabeza y cuello: factores que la inducen.

INTRODUCTION: Osteoradionecrosis of the mandible is a relatively common complication in patients with head and neck cancer undergoing radiotherapy or concomitant chemoradiotherapy, characterized by exposure of the mandibular bone either in the mouth or in the facial skin, with no improvement with conservative treatment for six months. The risk factors are radiotherapy in head and neck region, lack of dental prophylaxis before treatment and dental extraction. MATERIAL AND METHODS: Retrospective observational study analyzing incidence and etiologic factors of osteoradionecrosis in 250 patients undergoing radiotherapy or combined treatment of cervicofacial area between 2002 and 2010. RESULTS: 25 patients were included; the horizontal branch was the most affected area, followed by the anterior arch. Associated factors were: stage (T4a and T4b), tumor location (oral cavity), dental extraction pre or post-radiotherapy, and radiotherapy time (pre-or postoperative); 72% had association with tooth extraction. Only five patients had control with conservative measures, and 20 required some type of mandibulectomy, only three of them were candidates for reconstruction with fibular free flap; none received treatment in a hyperbaric chamber. CONCLUSIONS: The data suggest that osteoradionecrosis has a multifactorial origin, and prevention is the best alternative and includes pretreatment dental prophylaxis to avoid tooth extractions and close monitoring and surveillance in order to identify early osteoradionecrosis. Most patients require mandible resection as definitive treatment.

Efectos de la intervención educativa de enfermería en las prácticas de cuidados paliativos en el cuidador primario al paciente en enfermedad terminal. Lima, Perú / Effects of the educational intervention of infirmary in the practices of taken care palliative in the primary keeper to the patient in terminal illness. Lima, Perú

Determinar el efecto de la intervención educativa de enfermería en las prácticas de Cuidados Paliativos en el cuidador primario al paciente con enfermedad terminal. Material y métodos: diseño de estudio cuasi - experimental, la muestra estuvo constituida por 138 cuidadores primarios, se aplicó una guía de observación de 20 ítems en el pre test y post test, la validez fue medida a través del Análisis Factorial Exploratorio, aplicando el método muestral de Kaiser-Meyer-Olkin y la confiabilidad se evaluó según estadístico Kudder Richardson para variables dicotómicas en una muestra piloto (30 cuidadores primarios). Análisis de los datos fueron tabulados por el paquete estadístico SPSS v 20; y analizados con un nivel de significancia < 0,05. Resultados: en cuanto a las prácticas de cuidados paliativos antes y después de la intervención educativa en el cuidador primario del paciente en enfermedad terminal según la guía de observación en el pre test, un 80,4 % presenta practicas inadecuadas, en el post test un 68,1 % medianamente adecuada. En cuanto al puntaje de prácticas, antes de la intervención según guía de observación fue 6,86 puntos, mientras que después de la intervención se incrementó a 7,58 puntos, siendo la diferencia estadísticamente significativa (p=0.000). Conclusiones: la intervención educativa incrementa las prácticas en los cuidadores primarios, lo cual favorece los cuidados paliativos para brindar calidad de vida en los pacientes con enfermedad terminal...

To determine the effect of educational nursing intervention in palliative care practices in the primary caregiver to the patient with terminal illness. Material and methods: Study design quasi - experimental sample consisted of 138 primary caregivers, an observation guide of 20 items was applied in the pre test and post test, the validity was measured by exploratory factor analysis, applying the sampling method Kaiser -Meyer-Olkin and reliability was evaluated according to statistical Kudder Richardson for dichotomous variables in a pilot sample (30 primary caregivers). Analysis of the data was tabulated by SPSS v 20; and analyzed with a significance level <0.05. Results: in terms of palliative care practices before and after the educational intervention in the primary caregiver of the patient in terminal disease as the observation guide in the pretest, 80.4% have inadequate practices in the post test 68.1% suitable medium. As the score range, before the intervention by observation guide was 6.86 points, while after the intervention was increased to 7.58 points, with statistically significant difference (p = 0.000). Conclusions: educational intervention increases practices primary caregivers, which promotes palliative care to provide quality of life in patients with terminal illness...

Implementation of malaria dynamic models in municipality level early warning systems in Colombia. Part I: description of study sites.

As part of the Integrated National Adaptation Pilot project and the Integrated Surveillance and Control System, the Colombian National Institute of Health is working on the design and implementation of a Malaria Early Warning System framework, supported by seasonal climate forecasting capabilities, weather and environmental monitoring, and malaria statistical and dynamic models. In this report, we provide an overview of the local ecoepidemiologic settings where four malaria process-based mathematical models are currently being implemented at a municipal level. The description includes general characteristics, malaria situation (predominant type of infection, malaria-positive cases data, malaria incidence, and seasonality), entomologic conditions (primary and secondary vectors, mosquito densities, and feeding frequencies), climatic conditions (climatology and long-term trends), key drivers of epidemic outbreaks, and non-climatic factors (populations at risk, control campaigns, and socioeconomic conditions). Selected pilot sites exhibit different ecoepidemiologic settings that must be taken into account in the development of the integrated surveillance and control system.