Defunciones por mieloma múltiple en Chile entre 2018-2022 por sexo, edad, temporalidad y región nacional / Deaths from multiple myeloma in Chile between 2018-2022 by sex, age, temporality, and national region

Introducción: Chile es el país con la mayor tasa de mortalidad por mieloma múltiple (MM) en Latinoamérica, sin embargo, no existen estudios actualizados que describan esto. El objetivo de este estudio es describir las defunciones por MM según año, sexo, grupo etario y región en Chile, en el periodo 2018-2022. Metodología: Estudio ecológico de las defunciones por MM en el periodo 2018-2022 según año, sexo, grupo etario y región (n=2433). Se calculó el número de defunciones y las tasas de mortalidad por causa específica. Datos obtenidos del Departamento de Estadísticas e Información de Salud. No se requirió comité de ética. Resultados: El promedio de la tasa de mortalidad por año fue de 2.51 por 100.000 habitantes en el periodo estudiado, y fue menor a este valor en 2020 y 2021. El sexo masculino obtuvo un 52.2% del total de las defunciones. Las personas de 80-89 años obtuvieron la mayor tasa de mortalidad (27.57 por 100.000 habitantes). La región con mayor tasa de mortalidad es la de Ñuble (3.45 por 100.000 habitantes). Discusión: La disminución en la tasa de mortalidad para MM en los años 2020-2021 podría deberse al COVID-19. Las tasas entre sexos son similares, pese a que las estadísticas internacionales indican mayor prevalencia en hombres. Los grupos etarios más afectados son los de mayor edad, pues es factor de riesgo para MM. Las regiones con mayor tasa de mortalidad son las del centro-sur, aunque es difícil establecer causalidad. Las investigaciones respecto a este tema en Chile son escasas, este trabajo podría ser útil para futuras investigaciones.

Introduction: Chile is the country with the highest mortality rate from multiple myeloma (MM) in Latin America, however, there are no updated studies that describe this. The objective of this study is to describe the functions by MM according to year, sex, age group and region in Chile, in the period 2018-2022. Methodology: Ecological study of the functions by MM in the period 2018-2022 according to year, sex, age group and region (n=2433). The number of deaths and cause-specific mortality rates were calculated. Data obtained from the Department of Health Statistics and Information. No ethics committee was required. Results: The average mortality rate per year was 2.51 per 100,000 inhabitants in the period studied, and it was lower than this value in 2020 and 2021. The male sex obtained 52.2% of all deaths. People aged 80-89 years had the highest mortality rate (27.57 per 100,000 inhabitants). The region with the highest mortality rate is Ñuble (3.45 per 100,000 inhabitants). Discussion: The decrease in the mortality rate for MM in the years 2020-2021 could be due to COVID-19. The rates between sexes are similar, despite the fact that international statistics indicate a higher prevalence in men. The most affected age groups are the older ones, as it is a risk factor for MM. The regions with the highest mortality rate are those of the center-south, although it is difficult to establish causality. Research on this topic in Chile is scarce, this work could be useful for future research.

A soybean-based diet modulates cadmium-induced vascular apoptosis.

Cadmium (Cd) exposure has been associated with an increased risk of cardiovascular diseases. The diet is a modifiable source of protecting or damaging factors that may affect this risk. Herein we tested the hypothesis that a soybean-based diet (SBD) protects the vascular wall of the aorta against Cd-induced pro-inflammatory and pro-apoptotic effects. To test this hypothesis, we fed male Wistar rats for 60 days with a casein-based diet (CBD) or an SBD. These animals were also exposed to tap-water without (CBD-Co/SBD-Co) or with 15(CBD-15Cd/SBD-15Cd) or 100 (CBD-100Cd/SBD-100Cd) ppm of Cd. Inflammatory parameters (mRNAs and/or proteins) were measured in thoracic aorta tissue. These included inducible and endothelial nitric oxide synthases, cyclooxygenase-2, intracellular-adhesion molecule-1, and vascular cell-adhesion molecule-1. As pro-apoptotic parameters, we measured Bax and Bcl-2 mRNA/protein, as well as TUNEL positive cells in the aorta tissue. Compared to CBD-Co, inflammatory and apoptosis markers increased in the aorta with the concentration of Cd in the drinking water. These effects were not observed in either SBD-15Cd or SBD-100Cd, which were similar to CBD-Co. Cd content in serum and in aortas from animals fed CBD-Co/SBD-15Cd or CBD-Co/SBD-100Cd were similar suggesting that, if any, the effect of SBD is not due to changes in Cd bioaccumulation, but due to secondary effects linked to the composition of the dietary soybean flour. Our findings are consistent with a protective effect of an SBD against Cd-induced inflammation and apoptosis in the thoracic aorta in a rat model.

Clinical characteristics and management of iron overload in 631 patients with chronic transfusion dependency: results from a multicentre, observational study.

BACKGROUND: Long-term red blood cell transfusion therapy results in iron overload. Consensus documents have been developed for several transfusion-dependent groups of patients to provide clinicians with guidance on the monitoring and treatment of this transfusion complication. The objective of this study was to describe the clinical characteristics and current standard of care for patients with transfusion dependency in Spain. MATERIAL AND METHODS: This observational, multicentre study was conducted from November 2008 to December 2009 in 41 Spanish hospitals and day-care centres. Patients who received their first transfusion after January 2007, and who had received at least 10 units of packed red blood cells at the time of inclusion were eligible for the study. RESULTS: We collected data from 631 patients with a mean age of 65±17 years. Haematological disease (84% of patients) was the most frequent underlying disorder. Patients had received a mean of 30±26 red blood cell units from diagnosis until inclusion in the study, and a mean of 18±18 red blood cell units in the previous year. Ferritin levels were available before and after starting the study for 116 (18%) and 412 (65%) patients, respectively. Mean ferritin level at study inclusion was 1,570 ng/mL, and 58% of patients had a ferritin level of at least 1,000 ng/mL. In spite of this, only 89 (14%) patients were receiving chelation therapy. DISCUSSION: The management of patients with transfusion dependency could be improved by using ferritin levels to diagnose iron overload and guide the timely start of chelation therapy.

Protective effect of soybeans as protein source in the diet against cadmium-aorta redox and morphological alteration.

We investigated the effects of cadmium exposition on thoracic aorta redox status and morphology, and the putative protective effect of soybeans in the diet. Male Wistar rats were separated into 6 groups: 3 fed with a diet containing casein and 3 containing soybeans, as protein source. Within each protein group, one was given tap water (control) and the other two tap water containing 15 and 100 ppm of Cd(2+), respectively, for two months. In rats fed with casein diet, 15 ppm of Cd induced an increase of thiobarbituric acid-reactive substances (TBARS), and of the catalase (CAT) and glutathione peroxidase (GPx) activities, which were even higher with 100 ppm of Cd(2+), in aorta. Also, 100 ppm Cd(2+) exposure increased superoxide dismutase (CuZnSOD) activity; CAT, GPX, SOD, Nrf2 and metallothioneine II mRNA expressions and CAT, GPx and NOX-2 protein levels, compared with control. Aorta endothelial and cytoplasmic alterations were observed. However, with the soybeans diet, 15 and 100 ppm of Cd(2+) did not modify TBARS levels; CAT, GPX and Nrf2 mRNA expressions; CAT, GPx and NOX-2 protein; and the aorta morphology, compared with control. The soybean diet attenuates the redox changes and protects against morphological alterations induced, in a dose-dependent way, by Cd in aorta.

Cadmium-induced oxidative stress and histological damage in the myocardium. Effects of a soy-based diet.

Cd exposure has been associated to an augmented risk for cardiovascular disease. We investigated the effects of 15 and 100 ppm of Cd on redox status as well as histological changes in the rat heart and the putative protective effect of a soy-based diet. Male Wistar rats were separated into 6 groups and treated during 60 days as follows: groups (1), (2) and (3) were fed a casein-based diet; groups (4), (5) and (6), a soy-based diet; (1) and (4) were given tap water; (2) and (5) tap water containing 15 ppm of Cd²âº; and (3) and (6) tap water containing 100 ppm of Cd²âº. Serum lipid peroxides increased and PON-1 activity decreased in group (3). Lipoperoxidation also increased in the heart of all intoxicated groups; however protein oxidation only augmented in (3) and reduced glutathione levels diminished in (2) and (3). Catalase activity increased in groups (3) and (6) while superoxide dismutase activity increased only in (6). Glutathione peroxidase activity decreased in groups (3) and (6). Nrf2 expression was higher in groups (3) and (6), and MTI expression augmented in (3). Histological examination of the heart tissue showed the development of hypertrophic and fusion of cardiomyocytes along with foci of myocardial fiber necrosis. The transmission electron microscopy analysis showed profound ultra-structural damages. No protection against tissue degeneration was observed in animals fed the soy-based diet. Our findings indicate that even though the intake of a soy-based diet is capable of ameliorating Cd induced oxidative stress, it failed in preventing cardiac damage.

Implication of vitamin A deficiency on vascular injury related to inflammation and oxidative stress. Effects on the ultrastructure of rat aorta.

BACKGROUND: Vitamin A deficiency induces activation of NF-kB and impairs activities of antioxidant enzymes in aorta. AIM OF THE STUDY: We study the effect of vitamin A deficiency on the aorta histoarchitecture and the possibly contribution of its prooxidant and inflammatory effects to artery alterations. METHODS: Twenty-one-day-old Wistar male rats were fed during 3 months with vitamin A-deficient diet (-A, n = 8) or the same diet containing 8 mg of retinol palmitate/kg of diet (+A, control, n = 8). In aortas, thiobarbituric reactive substances and reduced glutathione levels were measured by spectrophotometry. Expressions of TNF-alpha, NOX-2, VCAM-1, and TGF-beta1 were assessed by RT-PCR and Western Blot. The morphology of aorta was examined by light and transmission electron microscopy. RESULTS: In -A rats, high levels of TBARS in serum and aorta and low levels of GSH in aorta were found. An increased expression of TNF-alpha, NOX-2, VCAM-1, and TGF-beta1 in aorta from -A rats was observed. Examination of the intimal layer by light microscopy indicated the presence of an irregular surface in -A aortas. TEM studies showed large vacuoles and multivesicular bodies along the endothelium and also multivesicular bodies in the subendothelial space of aortas from -A rats. Furthermore, the histological appearance of internal elastic lamina was different from control. Small vesicles in the medial layer were observed in aortas from vitamin A-deficient rats. CONCLUSIONS: Vitamin A deficiency produces histoarchitectural alterations in aorta, which can be associated, at least in part, to the oxidative stress and inflammation induced by vitamin A deficiency.

Yondelis® (ET-743, Trabectedin) sensitizes cancer cell lines to CD95-mediated cell death: new molecular insight into the mechanism of action.

Trabectedin, a naturally occurring substance isolated from the Caribbean marine invertebrate Ecteinascidia turbinata, is the active compound of the antitumor drug Yondelis®. The mechanism of action of Trabectedin has been attributed to interactions with the minor groove of the DNA double helix, thereby affecting transcription of different genes involved in DNA repair and thus facilitating lethal DNA strand breaks. Nevertheless, the existence of other clinically important molecular mechanisms has not yet been fully explored. In this paper we demonstrate how Yondelis®, apart from activating the caspase-8-dependent cascade of apoptosis, sensitizes cancer cells to Fas-mediated cell death at achievable concentrations similar to those found in the plasma of patients. In addition we show that the facilitated apoptosis activated through the Fas death receptor, is associated with a significant increase of membrane Fas/FasL, as well as the modulation of accessory proteins regulating this route, such as FLIP (L) or Akt. Thus, our results propose that the sensitization of the death receptor pathway is an essential mechanism amplifying the cytotoxic properties of Yondelis® that could explain the hepatotoxicity observed in patients treated with this drug. Finally, we also show how the use of dexamethasone as a prophylactic agent that protects against hepatotoxicity induced by Yondelis® may also inhibit some of the cytotoxic properties described in this work. The study of this important mechanism of action should set up the basis for reassessing clinical therapy with Yondelis® in order to improve antitumor treatment outcome.