Use of cytological specimens for p53 gene alteration detection in oral squamous cell carcinoma risk patients.

AIMS: Recurrence and multifocal nature are two important characteristics of oral squamous cell carcinoma. Leukoplakia is the most frequent pre-cancerous oral lesion and, in most cases, it is not possible to predict malignant capacity. The objective of this study is to identify p53 alterations in cells taken from the oral cavity of at-risk patients. MATERIALS AND METHODS: The following samples were collected from 34 patients with oral leukoplakia with and without previous carcinoma: oral rinse, a brush swabbed over the lesions and hair roots. Mutational analysis of the p53 gene was performed by single-strand conformation polymorphisms and confirmed by DNA sequencing. RESULTS: We detected 11 mutations in p53 gene in oral cytological specimens. These alterations were observed only in brush cytology samples in patients without previous carcinoma, and in both samples (rinse and brush) in patients with previous carcinoma. Three of these patients had disease recurrence. CONCLUSION: This non-invasive technique may be useful in the follow-up of at-risk patients, and introduces new possibilities to analyse molecular markers before malignant lesions are clinically apparent.

Gene promoter hypermethylation in oral rinses of leukoplakia patients--a diagnostic and/or prognostic tool?

Leukoplakia is the most frequent oral precancerous lesion and shows a variable rate of malignant transformation. We hypothesised that the detection of molecular alterations, like the promoter hypermethylation of DNA, in oral cytological samples from patients at risk of developing primary or recurrent tumours could be a valuable diagnostic and prognostic tool in the management of these lesions. Two groups of patients with differing risks of developing oral squamous cell carcinoma (OSCC) were analysed. DNA was extracted from the oral rinse of each patient. The methylation status of the p16, p14 and MGMT gene promoters was determined using a methylation-specific polymerase chain reaction (MSP). Methylation of p16 and MGMT was observed in 44 and 56% of the oral samples, respectively. Only 12% of the cases showed p14 methylation. DNA hypermethylation was more frequent in patients with previous OSCC. DNA promoter hypermethylation is frequent during early oral carcinogenesis and even more so in the later stages. MSP using oral rinses is a non-invasive and highly sensitive technique which could be used to monitor patients with precancerous and cancerous oral lesions.

[Tobacco dependence in primary care: the opinion of professionals in the Guadalajara Health Area]. / Tabaquismo en atención primaria: la opinión de los profesionales en el Area de Salud de Guadalajara.

OBJECTIVE: To find the views and approach of primary care professionals in this Health Area to questions referring to restrictions on tobacco consumption, possibilities of intervention and resources devoted to monitoring tobacco dependency. DESIGN: A crossover study using an anonymous self-administered questionnaire with closed replies. SETTING: Primary care professionals from the Guadalajara Health Area. PARTICIPANTS: Medical, nursing and other professional staff (361 people), with an 86.1% reply rate. MEASUREMENTS AND MAIN RESULTS: 90.7% thought it was a good idea that tobacco consumption was legally regulated, although only 54.3% of non-smokers and 49.7% of doctors were in favour of extending the law. 37.5% of doctors and 19.5% of nurses (at the expense above all of non-smokers) were in favour of prioritizing care for non-smokers. Over 85% considered useful or very useful the introduction of methods to combat dependency in Health Centres and among health staff. CONCLUSIONS: There is a broad consensus on restricting tobacco consumption in determined places and applying methods in primary care to facilitate giving up tobacco. A critical attitude to the state on its tobacco policy was noted.

[Characteristics of tobacco use among the primary health care personnel in Guadalajara]. / Características del tabaquismo en el personal de Atención Primaria del Area Sanitaria de Guadalajara.

BACKGROUND: Tobaccoism is one of the most important social and health problems that exists. Given the role of Health Profesionals as educators and their example within the community, this particular group of people are vital in preventing and controlling tobaccoism. The purpose of this study was to identify the number and type of smokers working as professional health personnel in the Guadalajara Primary Medical Care Services, as well as their attitudes and knowledge in relation to the problem. METHODS: A descriptive cross-sectional study was carried out by means of a survey of all Guadalajara Primary Medical Care Personnel (doctors, nurses and other professionals). Data was compiled on social and demographic factors as well as the use of tobacco and awareness, attitudes and opinions: results were then analysed according to age, sex, occupation, working environment and degree of addiction. RESULTS: The rate of response was 86.1%. 38.2% claimed to be smokers (34.9% men and 41.2% women). Single male doctors living in urban areas showed the lowest rate of tobaccism. The majority of smokers did so at work, however not in front of patients, 63.2% had tried to give up smoking. The main cause of failure was attributed to lack of willpower (45.9%). 79.7% of ex-smokers had given up the habit after diagnosis of a health problem or illness. With respect to awareness and attitude, it was the medical profession and not tobaccoism itself that provided the most effective information and created less permissiveness in relation to the habit. Over 90% are in favour of initiating anti-smoking programs in Health Departments. CONCLUSIONS: A significant number of smokers in the sector was recorded, however attitudes towards the problem were positive.