Propiedades psicométricas de la Escala Atenas de Insomnio en población salvadoreña / Psychometric Properties of the Athens Insomnia Scale in Salvadoran Population

Antecedentes: El insomnio puede tener un efecto negativo en el funcionamiento diario y se asocia fuertemente con síntomas de depresión y ansiedad, especialmente en mujeres. En El Salvador no existen escalas con adecuadas propiedades psicométricas para su medición. En este contexto, la Escala Atenas de Insomnio (AIS) es una opción viable para medir esta sintomatología, dada su breve extensión, sólida fundamentación teórica y pertinencia en otros países. Objetivo: Analizar las propiedades psicométricas de la Escala Atenas de Insomnio en población salvadoreña, en su versión completa (AIS-8) y abreviada (AIS-5). Método: Participaron 1479 adultos salvadoreños de los 14 departamentos del país (edad media = 33.3 años, DE = 11.7), seleccionados a través de un muestreo no probabilístico. Se indagó evidencia de confiabilidad, validez basada en estructura interna y validez convergente. Resultados: Ambas escalas mostraron adecuada consistencia interna, validez basada en estructura interna a través de una estructura unifactorial, invarianza entre sexos y validez convergente con escalas de depresión, ansiedad y estrés. Conclusiones: Ambas versiones poseen adecuadas propiedades psicométricas. Covarianzas compartidas y desajustes parciales sugieren que es necesario analizar su adecuación cultural. A pesar de ello, existe suficiente evidencia que sustenta su utilidad para evaluar síntomas de insomnio no orgánico en población salvadoreña. Palabras clave: insomnio; salud mental; población salvadoreña; propiedades psicométricas; análisis factorial.

Background: Insomnia can harm daily functioning and is strongly associated with depression and anxiety symptoms, especially in women. El Salvador has no scales with adequate psychometric properties for their measurement. In this context, the Athens Insomnia Scale (AIS) is a viable option to measure this symptomatology, given its short length of time, solid theoretical foundation, and relevance in other countries. Objective: To analyze the psychometric properties of AIS in the Salvadoran population, in its complete (AIS-8) and abbreviated (AIS-5) versions. Method: The study consisted of 1479 Salvadoran adults from the 14 departments of the country (mean age = 33.3 years, SD = 11.7) who were screened through a non-probability sampling design. Evidence of reliability, validity based on internal structure, and convergent validity were examined. Results: Both scales showed adequate internal consistency, validity based on internal structure through a one-factor structure, invariance between sexes, and convergent validity with depression, anxiety, and stress scales. Conclusions: Both versions have adequate psychometric properties. Shared covariances and partial mismatch indexes suggest the need to analyze its cultural adequacy. Despite this, there is sufficient evidence to support its usefulness in evaluating symptoms of non-organic insomnia in the Salvadoran population. Keywords: insomnia; mental health; Salvadoran population; psychometric properties; factor analysis.

Overexpression of p73 as a tissue marker for high-risk gastritis.

PURPOSE: Histologic assessment of high-risk gastritis for the development of gastric cancer is not well defined. The identification of tissue markers together with the integration of histologic features will be required for this assessment. EXPERIMENTAL DESIGN: Matched tumor/nontumor adjacent mucosa (NTAM) of 91 early gastric cancer and 148 chronic gastritis cases were evaluated for histologic characteristics (atrophy, intestinal metaplasia, chronic inflammation, polymorphonuclear infiltration, and Helicobacter pylori) by the Sydney System. Atrophy risk assessment was also evaluated by the Operative Link on Gastritis Assessment (OLGA) staging system. Eight tissue markers (BRCA1, HSP90, STAT1, FHIT, EGFR, p73, p53, p16INK4a) and EBV were also evaluated by tissue microarray/immunohistochemistry/in situ hybridization platform. Data were analyzed by contingency tables (2 x 2) using Fisher's exact two-tailed test (P < 0.001) and integrated by Significance Analysis of Microarrays (SAM) and clustering analysis. RESULTS: Histologically, NTAM have severe intestinal metaplasia/chronic inflammation and severe atrophy assessed by Sydney and OLGA staging systems. H. pylori infection was similar in both groups, and EBV was found only in 5.5% of the tumor samples. Overexpression of p73 was higher in NTAM (50.5%) than in chronic gastritis (10.8%; P < 0.0001). Integration of histologic features and tissue markers showed that overexpression of p73, severe atrophy, and OLGA stage 4 were the most relevant features in NTAM. Clustering analysis correctly assigned NTAM and control cases (P < 0.0001). CONCLUSIONS: Overexpression of p73 should be considered for the assessment of high-risk chronic gastritis. SAM allows the integration of histology and tissue markers for this assessment.

The effectiveness of extended lymph node dissection for gastric cancer performed in Costa Rica under the supervision of a Japanese surgeon: a comparison with surgical results in Japan.

OBJECTIVE: In 1996, the Gastric Cancer Detection Center in Costa Rica (CR) initiated extended lymph node (D2) dissection for gastric cancer patients. We present an analysis of the surgical results compared with those in Japan. BACKGROUND: D2 dissection for gastric cancer is a standard surgical procedure in Japan, whereas it is still controversial in the West because of its poor survival benefit and high morbidity and mortality. METHODS: Between January 1996 and March 2000, 199 gastric cancer patients in Costa Rica underwent gastrectomy with D2 dissection (CR group). A Japanese surgeon performed or assisted on every gastrectomy with Costa Rican surgeons. During the same period, 497 gastric cancer patients underwent D2 dissection at Tokyo Women's Medical University (TWMU), Tokyo, Japan (TWMU group). RESULTS: The operative morbidity was 39.0% in the CR group and 27.0% in the TWMU group (P < .05). The 30-day postoperative mortality in the CR group and the TWMU group was 5% and 0.2%, respectively (P < .05). The 5-year survival rate in the CR group and the TWMU group was 98.0% and 99.3% in stage IA, 88.6% and 94.4% in stage IB, 77.8% and 76.9% in stage II, 60.1% and 66.4% in stage IIIA, 27.2% and 47.2% in stage IIIB, and 39.7% and 27.6% in stage VI, respectively (not significant in any stage). The overall 5-year survival rate in the CR group and the TWMU group was 72.5% and 69.7%, respectively (not significant). CONCLUSIONS: D2 dissection performed at the same level of quality as in Japan consequently produced the same long-term survival in Costa Rica as in Japan.

Serum pepsinogen levels, Helicobacter pylori CagA Status, and cytokine gene polymorphisms associated with gastric premalignant lesions in Costa Rica.

The detection of gastric premalignant lesions, atrophic gastritis, corpus atrophic gastritis, and intestinal metaplasia, using several potential markers was examined in Costa Rica. Depending on the lesion investigated, from a total of 223 dyspeptic patients, 58 (26.0%), 31 (13.9%), or 23 (10.3%) were histologically diagnosed with atrophic gastritis, corpus atrophic gastritis, or intestinal metaplasia, respectively. Sera were used for the measurement of pepsinogen (PG) and Helicobacter pylori CagA antibody (CagA-ab) levels by ELISA, and human genomic DNAs were used for the genotyping of interleukin (IL)-1beta (-511 and +3954), IL-10 (-1082 and -592), and IL-1RN intron 2 by PCR and RFLP. Multivariate analysis was done adjusting for sex, age, and H. pylori seropositivity. Low PG levels (L-PG; PG I < or = 70 microg/L + PG I/II < or = 3), very low PG levels (VL-PG; PG I < or = 30 microg/L + PG I/II < or = 2), and CagA-ab were individually associated with all premalignant lesions whereas IL-1beta +3954T-carrier and IL-1RN homozygous 2 allele were associated with intestinal metaplasia. VL-PG, for corpus atrophic gastritis detection, was the single marker with the highest combination of test characteristics, sensitivity (77.4%), specificity (80.7%), positive predictive value (39.3%), negative predictive value (95.7%), and seropositivity rate (27.4%), expected to improve after periodic measurements. Combined examinations of VL-PG and CagA-ab improved the specificity (92.7%) and positive predictive value (62.2%), with similar sensitivity (74.2%) and negative predictive value (95.7%). In conclusion, corpus atrophic gastritis detection with periodic measurements of serum PG, alone or in combination with CagA-ab status, to identify high gastric cancer risk, seems to be the method best suited for mass screening in Costa Rica.

Diversity of Helicobacter pylori cagA and vacA genes in Costa Rica: its relationship with atrophic gastritis and gastric cancer.

BACKGROUND: Associations between Helicobacter pylori gene diversity and gastric cancer have not been reported on in Costa Rica, despite its being one of the countries with the highest gastric cancer incidence and mortality rates in the world. The aim of this study was to determine the prevalence of H. pylori cagA and vacA genes and investigate whether it could be correlated with atrophic gastritis (AG) and gastric cancer (GC) in Costa Rica. MATERIALS AND METHODS: Genomic DNAs from isolates of 104 patients classified into two groups: non-atrophic gastritis group (n = 68) and atrophic gastritis group (n = 36), were subjected to PCR-based genotyping of cagA and vacA genes and their correlation with clinical outcome was investigated. Total DNA extractions from gastric tissues of 25 H. pylori-infected gastric cancer patients were utilized for comparative purposes. RESULTS: The presence of cagA (75.3%), vacA s1b (75.3%), and vacA m1 (74.2%) was detected, and colonization by strains with different vacA genotypes in the same stomach was found in 9.7% of the patients. Age- and sex-adjusted vacA s1b and vacA m1 were associated with GC while only vacA m1 was significantly associated with AG. A tendency for association between cagA and vacA s1b, and AG was reported. CONCLUSIONS: The prevalence status of the cagA and vacA (s1/m1) genes in Costa Rica seems to fall between that found in European/North American and East Asian countries, and both cagA and vacA seem to have clinical relevance in this country.

Helicobacter pylori CagA status associated with gastric cancer incidence rate variability in Costa Rican regions.

BACKGROUND: We evaluated several risk factors for gastric cancer in Costa Rican regions having contrasting gastric cancer incidence rates, despite the small dimensions of the country. METHODS: A total of 180 dyspeptic patients were classified into two groups according to the gastric cancer incidence (GCI) rate in their Costa Rican region: group A, with a high GCI rate (n = 91) and group B, with a low GCI rate (n = 89). Helicobacter pylori infection was detected by rapid urease test, Gram staining, and histological observation. Antral and corpus specimens were obtained to assess the grade of inflammation, topography of gastritis, gastric atrophy, and intestinal metaplasia by histological examination. Serum CagA antibody was measured by an antigen-specific enzyme-linked immunosorbent assay. RESULTS: There was no significant difference in H. pylori prevalence between groups A (73%) and B (63%); however, serum CagA antibody was more frequently detected in group A (79%) than in group B (54%) [P = 0.02; odds ratio (OR), 2.68]. Among patients under 60 years of age, serum CagA antibody was even more frequently detected in group A (81%) than in group B (49%) (P < 0.01; OR, 4.50). The prevalence of corpus-predominant gastritis, atrophic gastritis, and moderate/severe grades of neutrophilic infiltration was higher in serum CagA antibody-positive patients than in CagA antibody-negative patients (P = 0.003, 0.04, and 0.002, respectively). CONCLUSIONS: Infection with H. pylori possessing the cagA gene is associated with the development of severe gastric damage such as gastric atrophy, leading to gastric cancer, and probably influences the differences in GCI between Costa Rican regions.

[Clinical and molecular features of cardial gastric cancer associated to Epstein Barr virus]. / Características clínico-moleculares del cáncer gástrico cardial asociado al virus Epstein Barr.

BACKGROUND: Mortality caused by cardial gastric cancer in Chile, is increasing. Previously we demonstrated an association between Epstein Barr virus and this specific location of gastric cancer. AIM: To perform a clinical and molecular characterization of cardial gastric cancer associated to Epstein Barr virus. MATERIAL AND METHODS: Epstein Barr virus was identified in 93 cardial gastric tumors, by in situ hybridization. Clinical and pathological features, survival and expression of p53 and c-erbB2 were compared between tumors with or without the presence of the virus. RESULTS: Twenty two (23.6%) tumors expressed Epstein Barr virus. No difference in sex or age of patients with tumors positive or negative for the virus was observed. Epstein Barr positive tumors had a tendency to have a higher frequency of Bormann III endoscopic appearance and a lower frequency of p53 accumulation (p=0.06). Five years survival was 67% and 42% of tumors positive and negative for the presence of the virus, respectively (p=0.57). CONCLUSIONS: Our results, although not significant, show a tendency towards unique characteristics of cardial gastric tumors associated to Epstein Barr.

Asociación del polimorfismo del codon 72 del gen p53 con el riesgo de cáncer gástrico en una población de alto riesgo de Costa Rica / Association of the p53 codon 72 polymorphism to gastric cancer risk in a hight risk population of Costa Rica

El cáncer gástrico es la segunda causa de muerte por cáncer en el mundo. Varios factores han sido asociados con el riesgo de llegar a desarrollarlo, entre ellos la predisposición genética. El gen p53 presenta un polimorfismo en el codón 72, el cual ha sido asociado con un mayor riesgo de desarrollar varios tipos de cáncer entre ellos el gástrico. El objetivo de este estudio fue determinar la asociación del polimorfismo localizado en el codón 72 del gen p53 con el riesgo de cáncer gástrico y lesiones gástricas leves en una población de alto riesgo de Costa Rica. El análisis del polimorfismo se llevó a cabo mediante PCR-RFLP, en una muestra de 58 pacientes de cáncer gástrico, 99 personas controles y 41 individuos clasificados como grupos I y II de acuerdo con la clasificación histológica japonesa. No se determinó asociación del polimorfismo del codón 72 de p53 con el riesgo de cáncer gástrico, ni de lesiones gástricas leves en la muestra estudiada. Con base en este estudio y otros que han investigado el polimorfismo del codón 72 del gen p53, no está claro el papel que podría estar jugando dicho polimorfismo en el desarrollo de cáncer gástrico. Mutaciones de novo en el gen p53 producidas durante el desarrollo neoplásico de la enfermedad podrían tener un mayor efecto que polimorfismos de línea germinal de este mismo gen. Existen otros genes polimórficos que también se han asociado con el riesgo de desarrollar cáncer gástrico

Gastric cancer is the second most common cancer associated death cause worldwide. Several factors have been associated with higher risk to develop gastric cancer, among them genetic predisposition. The p53 gene has a polymorphism located at codon 72, which has been associated with higher risk of several types of cancer, including gastric cancer. The aim of this study was to determine the association of p53, codon 72 polymorphism, with the risk of gastric cancer and pre-malignant lesions in a high-risk population from Costa Rica. The genotyping was carried out by PCR-RFLP in 58 gastric cancer patients, 99 controls and 41 individuals classified as group I or II, according to the Japanese histological classification. No association was found for p53, codon 72 polymorphism with neither the risk of gastric cancer nor the risk of less severe gastric lesions in the studied population. Based on this study and taking into account other studies carried out with p53, codon 72 polymorphism, the role of this polymorphism in the development of gastric cancer remains unclear. De novo mutations on p53 gene produced during neoplasic development of this disease might play a greater role than germinal polymorphisms of the gene. Other polymorphic genes have been associated with higher risk to develop gastric cancer

Formation of extracellular glutamate from glutamine: exclusion of pyroglutamate as an intermediate.

A 4.6-fold increase in interstitial glutamate was observed following the reverse microdialysis of 5 mM glutamine into the rat hippocampus. Two possible mechanisms of glutamine hydrolysis were examined: (a) an enzymatic glutaminase activity and (b) a non-enzymatic mechanism. Injection of 14C-glutamine at the site of microdialysis followed by microdialysis with artificial cerebral spinal fluid allowed isolation of 14C-glutamine (63%), 14C-glutamate (14%), and a compound tentatively identified as pyroglutamate (22%). In this study, we determined if non-enzymatic pyroglutamate formation from glutamine contributed to the synthesis of glutamate. Pyroglutamate is in chemical equilibrium with glutamate, although under physiological conditions, the chemical equilibrium is strongly in the direction of pyroglutamate. In vitro stability studies indicated that 14C-glutamine and 14C-pyroglutamate are not subject to significant non-enzymatic breakdown at pH 6.5-7.5 at 37 degrees C for up to 8 h. Reverse microdialysis with 1 mM pyroglutamate did not increase interstitial glutamate levels. Following injection of 14C-pyroglutamate and microdialysis, radioactivity was recovered in 14C-pyroglutamate (88%) and 14C-glutamine (11%). Less than 1% of the radioactivity was recovered as glutamate. Our data do not support a role of pyroglutamate as an intermediate in the formation of extracellular glutamate following the infusion of glutamine. However, it confirms that pyroglutamate, a known constituent in brain, is actively metabolized in brain cells and contributes to glutamine in the interstitial space.

[Association of the p53 codon 72 polymorphism to gastric cancer risk in a hight risk population of Costa Rica]. / Asociación del polimorfismo del codon 72 del gen p53 con el riesgo de cáncer gástrico en una población de alto riesgo de Costa Rica.

Gastric cancer is the second most common cancer associated death cause worldwide. Several factors have been associated with higher risk to develop gastric cancer, among them genetic predisposition. The p53 gene has a polymorphism located at codon 72. which has been associated with higher risk of several types of cancer, including gastric cancer. The aim of this study was to determine the association of p53, codon 72 polymorphism. with the risk of gastric cancer and pre-malignant lesions in a high-risk population from Costa Rica. The genotyping was carried out by PCR-RFLP in 58 gastric cancer patients, 99 controls and 41 individuals classified as group I or II. according to the Japanese histological classification. No association was found for p53. codon 72 polymorphism with neither the risk of gastric cancer nor the risk of less severe gastric lesions in the studied population. Based on this study and taking into account other studies carried out with p53, codon 72 polymorphism. the role of this polymorphismn in the development of gastric cancer remains unclear. De novo mutations on p53 gene produced during neoplasic development of this disease might play a greater role than germinal polymorphisms of the gene. Other polymorphic genes have been associated with higher risk to develop gastric cancer.

Pepsinógenos séricos para detectar cáncer gástrico en Costa Rica / Serum pepsinogen in screening for gastric cancer in Costa Rica

Las concentraciones de pepsinógenos (PG) I y II en suero, reflejan el estado funcional y morfológico de la mucosa gástrica. En este estudio se determinaron los puntos de corte óptimos de los niveles séricos de PGI, PGII y de la razón PGI/PGII, para identificar a las personas con alto riesgo de cáncer gástrico en una población de alto riesgo en Costa Rica. La población en estudio estaba formada por 338 personas sin cáncer gástrico y por 20 pacientes con cáncer gástrico. Los niveles de PGI y el valor de PGI/PGII fueron significativamente más bajos en las personas con cáncer gástrico que en los controles. Los puntos de corte óptimos para la detección de cáncer gástrico fueron de PGI 2,5. Usando estos puntos de corte la sensibilidad y especificidad fueron de 90 y 64 por ciento. Las concentraciones bajas de PGI y valores bajos de PGI/PGII indican alto riesgo de presentar un cáncer gástrico. El tamizaje por medio de pepsinógenos es simple y relativamente barato, sin embargo el beneficio real de esta prueba debe determinarse en el impacto sobre las tasas de mortalidad por cáncer gástrico (AU)

Pepsinógenos séricos para detectar cáncer gástrico en Costa Rica / Serum pepsinogen in screening for gastric cancer in Costa Rica

Las concentraciones de pepsinógenos (PG) I y II en suero, reflejan el estado funcional y morfológico de la mucosa gástrica. En este estudio se determinaron los puntos de corte óptimos de los niveles séricos de PGI, PGII y de la razón PGI/PGII, para identificar a las personas con alto riesgo de cáncer gástrico en una población de alto riesgo en Costa Rica. La población en estudio estaba formada por 338 personas sin cáncer gástrico y por 20 pacientes con cáncer gástrico. Los niveles de PGI y el valor de PGI/PGII fueron significativamente más bajos en las personas con cáncer gástrico que en los controles. Los puntos de corte óptimos para la detección de cáncer gástrico fueron de PGI ¾ 2,5. Usando estos puntos de corte la sensibilidad y especificidad fueron de 90 y 64 por ciento. Las concentraciones bajas de PGI y valores bajos de PGI/PGII indican alto riesgo de presentar un cáncer gástrico. El tamizaje por medio de pepsinógenos es simple y relativamente barato, sin embargo el beneficio real de esta prueba debe determinarse en el impacto sobre las tasas de mortalidad por cáncer gástrico

Neonatal Candida glabrata sepsis: clinical and laboratory features compared with other Candida species.

BACKGROUND: Recent studies have shown a rise in Candida glabrata infections among immunocompromised adults. In published case series of neonatal candidemia, however, the species glabrata is uncommon. We conducted a retrospective chart review to examine the epidemiology, clinical presentation and outcome of neonatal infection with C. glabrata compared with other species of Candida. METHODS: Neonatal and microbiology databases of two affiliated hospitals were searched for all cases of candidemia in neonatal intensive care unit patients with suspected sepsis from 1991 through 1998. RESULTS: Of 58 cases of Candida sepsis, 9 (15%) were caused by C. glabrata (CG), 41 (71%) by C. albicans (CA) and 8 (14%) by C. parapsilosis (CP). There was no change in the proportion of candidemia caused by glabrata species in the years studied. Although there was a significantly higher proportion of CG cases at 1 hospital (29% vs. 6%, P = 0.01), there was no case clustering to suggest direct nosocomial spread. Compared with other Candida species, CG occurred in infants of higher gestational age (CG 29.7 weeks, CA 26.6 weeks, CP 27.3 weeks) and birth weight (CG 1442 g, CA 931 g, CP 965 g). Patients with CG sepsis were more likely to be receiving broad spectrum antibiotics at the time of diagnosis (CG 67%, CA 38%, CP 38%), were less likely to present with apnea and had less severe thrombocytopenia. Of 9 patients with CG sepsis, 1 had meningitis, 1 had necrotizing enterocolitis and 3 had candiduria. CONCLUSION: C. glabrata is a significant nosocomial pathogen in the neonate.

Identificación histológica de Helicobacter pylori por los métodos de tinción de Warthins-Stary y Giménez en biopsias gástricas / Histological identification of Helicobacter pylori for methods of Warthin-Starry and Gimenez in gastric biopsies

En el presente estudio se comparan sensibilidad, especificidad y valores predictivos positivos y negativos de dos métodos de tinción : Warthin-Starry y Giménez, utilizando como referencia la técnica de cultivo para el diagnóstico de Helicobacter pylori, en biopsias gástricas. De los 49 pacientes estudiados, el 71.4 por ciento fueron positivos por la técnica de cultivo y el 69.4 por ciento por ambas tinciones. Para las tinciones de Warthin-Starry y Giménez se obtuvo una sensibilidad y especificidad de 97 por ciento y 85.7 por ciento y de 97.7 por ciento y 78.6 por ciento respectivamente. Los valores predictivos positivos y negativos para los dos tinciones fueron de alrededor de un 90 por ciento. Aún cuando el cultivo no es el método más sensible de diagnosticar la infección por H. pylori permanece como el más específico. Ambs tinciones demostraron correlación con el cultivo bacteriano para el diagnóstico de H. pylori.

Práctica sexual de adolescentes escolares: variables individuales / Sexual practice among school adolescents: individual variations

Se estudian factores propios del adolescente escolar, determinantes de práctica sexual precoz. La investigación se realizó en dos colegios del área oriente de Santiago, a través de una encuesta anónima a un total de 609 alumnos de enseñanza media. El sexo, fuentes de enseñanza en reproducción y sexualidad, nivel de conocimientos en sexualidad y la percepción de la educación sexual recibida, aparecen como variables relacionadas con experiencia coital en la población estudiada