Longer time to testosterone recovery impacts favorably on outcomes for prostate cancer following androgen deprivation and radiotherapy.

PURPOSE: To evaluate the impact of sustained hypogonadism after androgen deprivation therapy (ADT) associated with radiotherapy in prostate cancer (PCa) patients with biochemical relapse-free survival (bRFS). METHODS: A retrospective cohort analysis of 213 consecutive PCa patients referred for radiotherapy plus ADT was carried out. Follow-up times including time to testosterone recovery (TTR) and bRFS were calculated from the end of ADT. Univariate and multivariate Cox regression analyses predicting bRFS were used. The optimal cutoffs for TTR and duration of ADT were determined using the maximally selected rank statistics (MSRS). RESULTS: After a median follow-up of 104 months, 18 patients relapsed among those who had recovered testosterone levels and 9 among those who did not. Median ADT duration was 36 months. The optimal cutoff for TTR was determined using MSRS. TTR >48 months was significantly associated with better bRFS (logrank, p < 0.0027). Five-year bRFS was 100% for >48 months vs. 85% for <48 months. TTR was the only significant variable for bRFS in multivariate Cox analysis. CONCLUSION: Our data show an association between longer TTR and bRFS values among PCa patients treated with ADT.

Seroprevalence of SARS-CoV-2 IgM and IgG antibodies in an asymptomatic population in Sergipe, Brazil.

OBJECTIVE: To estimate the prevalence of SARS-CoV-2 antibodies in an asymptomatic population in the state of Sergipe, Brazil.
. METHODS: This cross-sectional study with stratified sampling (sex and age) included serological immunofluorescent tests for IgM and IgG on samples from 3 046 asymptomatic individuals. Sample collection was performed in wet-markets of the 10 most populous cities of Sergipe, Brazil. Exclusion criteria included symptomatic individuals and health workers. The presence of comorbidities was registered.
. RESULTS: Of the 3 046 participants, 1 577 (51.8%) were female and 1 469 (48.2%) were male; the mean age was 39.76 (SD 16.83) years old. 2 921 tests were considered valid for IgM and 2 635 for IgG. Of the valid samples, 347 (11.9% [CI 10.7%-13.1%]) tested positive for IgM and 218 (8.3% [CI 7.2%-9.4%]) tested positive for IgG. Women over 40 had the highest prevalence for IgM (group C, p=0.006; group D p=0.04). The capital Aracaju displayed the highest prevalence for both antibodies; 83 (26.3% [CI 21.6%-31.6%]) tested positive for IgM and 35 (14.6% [CI 10.4%-19.7%]) for IgG. The most prevalent comorbidities were hypertension (64/123 individuals) and diabetes (29/123).
. CONCLUSIONS: A high prevalence of SARS-CoV-2 antibodies was found among asymptomatic persons in Sergipe. Women over 40 showed the highest rates. The capital, Aracaju, displayed the highest seroprevalence. Surveys like this one are important to understand how the virus spreads and to help authorities to plan measures to control it. Repeated serologic testing are required to track the progress of the epidemic.

OBJETIVO: estimar la prevalencia de anticuerpos dirigidos contra el SARS-CoV-2 en una población asintomática del estado de Sergipe, Brasil. MÉTODOS: estudio transversal con muestreo estratificado (por sexo y edad) que incluyó pruebas serológicas de inmunofluorescencia para IgM e IgG en muestras de 3 046 individuos asintomáticos. La recolección de muestras se realizó en los mercados húmedos de las 10 ciudades más pobladas de Sergipe, Brasil. Se excluyó a los individuos sintomáticos y a los trabajadores de la salud. Se registró la presencia de comorbilidades. RESULTADOS: De los 3 046 participantes, 1 577 (51,8%) eran mujeres y 1 469 (48,2%) varones; la edad promedio fue de 39,76 (SD 16,83) años. Se consideraron válidas 2 921 pruebas para la IgM y 2 635 para la IgG. De las muestras válidas, 347 (11,9% [CI 10,7%-13,1%]) resultaron positivas para IgM y 218 (8,3% [CI 7,2%-9,4%]) para IgG. Las mujeres mayores de 40 años tuvieron la mayor prevalencia de IgM (grupo C, p=0,006; grupo D, p=0,04). Aracaju, la capital del estado, mostró la mayor prevalencia para ambos anticuerpos; 83 (26,3% [CI 21,6%-31,6%]) resultaron positivas para IgM y 35 (14,6% [CI 10,4%-19,7%]) para IgG. Las comorbilidades más frecuentes fueron la hipertensión (64/123 individuos) y la diabetes (29/123). CONCLUSIONES: Se encontró una alta prevalencia de anticuerpos contra el SARS-CoV-2 en personas asintomáticas en Sergipe. Las mujeres mayores de 40 años mostraron las tasas más altas. La capital, Aracaju, mostró la mayor seroprevalencia. Las encuestas como esta son importantes para comprender cómo se propaga el virus y para ayudar a las autoridades a planificar medidas de control. Se requieren pruebas serológicas repetidas para dar seguimento al progreso de la epidemia.

Safety, long-term outcomes and predictors of recurrence after first-line combined endoepicardial ventricular tachycardia substrate ablation in arrhythmogenic cardiomyopathy. Impact of arrhythmic substrate distribution pattern. A prospective multicentre study.

BACKGROUND: First-line endoepicardial ventricular tachycardia (VT) ablation has been proposed for patients with arrhythmogenic cardiomyopathy (AC). This study reports procedural safety, outcomes, and predictors of recurrence. METHODS AND RESULTS: Forty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA). Arrhythmogenic substrate area (ASA) was defined as the area containing electrograms with delayed components. Implantable cardioverter defibrillator interrogations were evaluated for VT recurrence. Epicardial LVA was larger in all cases (102.5 ± 78.6 vs. 19.3 ± 24.4 cm2; P< 0.001). Consistent with an epicardium-to-endocardium arrhythmogenic substrate progression pattern, epicardial ASA (epi-ASA) was negatively correlated with bipolar endocardial LVA (r = -0.368; P= 0.035) and with endocardial bipolar/unipolar-LVA (Bi/Uni-LVA) ratio (r= -0.38; P= 0.037). A Bi/Uni-LVA ratio >0.23 predicted an epi-ASA ≤10 cm2 (100% sensitivity, 84% specificity). Patients showing an epi-ASA < 10 cm2 required less epicardial (8.4 ± 5.8 vs. 25.3 ± 16; P= 0.045) and more endocardial (16.5 ± 8.6 vs. 7.5 ± 8.2; P= 0.047) radiofrequency applications. One patient with epi-ASA < 10 cm2 died of cardiac tamponade after epicardial puncture. Acute success (no VT inducibility after procedure) was achieved in 36 patients (90%). After 32.2 ± 21.8 months, 11 (26.8%) patients had VT recurrences. Left-dominant AC was associated with an increased risk of recurrence (HR = 3.41 [1.1-11.2], P= 0.044; log-rank P= 0.021). CONCLUSION: First-line endoepicardial VT substrate ablation achieves good long-term results in AC. Left-dominant AC is associated with an increased risk of recurrence. The Bi/Uni-LVA ratio identifies patients with limited epicardial arrhythmogenic substrate in whom the indication of epicardial approach should be more cautiously assessed.

Comparison of New Tau PET-Tracer Candidates With [18F]T808 and [18F]T807.

Early clinical results of two tau tracers, [(18)F]T808 and [(18)F]T807, have recently been reported. In the present study, the biodistribution, radiometabolite quantification, and competition-binding studies were performed in order to acquire comparative preclinical data as well as to establish the value of T808 and T807 as benchmark compounds for assessment of binding affinities of eight new/other tau tracers. Biodistribution studies in mice showed high brain uptake and fast washout.In vivoradiometabolite analysis using high-performance liquid chromatography showed the presence of polar radiometabolites in plasma and brain. No specific binding of [(18)F]T808 was found in transgenic mice expressing mutant human P301L tau. In semiquantitative autoradiography studies on human Alzheimer disease slices, we observed more than 50% tau selective blocking of [(18)F]T808 in the presence of 1 µmol/L of the novel ligands. This study provides a straightforward comparison of the binding affinity and selectivity for tau of the reported radiolabeled tracers BF-158, BF-170, THK5105, lansoprazole, astemizole, and novel tau positron emission tomography ligands against T807 and T808. Therefore, these data are helpful to identify structural requirements for selective interaction with tau and to compare the performance of new highly selective and specific radiolabeled tau tracers.

Effect of rectal enemas on rectal dosimetric parameters during high-dose-rate vaginal cuff brachytherapy: A prospective trial.

PURPOSE: To evaluate the effects of rectal enemas on rectal doses during postoperative high-dose-rate (HDR) vaginal cuff brachytherapy (VCB). PATIENTS AND METHODS: This prospective trial included 59 patients. Two rectal cleansing enemas were self-administered before the second fraction, and fraction 1 was considered the basal status. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Statistical analyses used paired and unpaired t-tests. RESULTS: Despite a significant 15 % reduction in mean rectal volume (44.07 vs. 52.15 cc, p = 0.0018), 35.6 % of patients had larger rectums after rectal enemas. No significant rectal enema-related DVH differences were observed compared to the basal data. Although not statistically significant, rectal cleansing-associated increases in mean rectal DVH values were observed: D0.1 cc: 6.6 vs. 7.21 Gy; D1 cc: 5.35 vs. 5.52 Gy; D2 cc: 4.67 vs. 4.72 Gy, before and after rectal cleaning, respectively (where Dx cc is the dose to the most exposed x cm(3)). No differences were observed in DVH parameters according to rectal volume increase or decrease after the enema. Patients whose rectal volume increased also had significantly larger DVH parameters, except for D5 %, D25 %, and D50 %. In contrast, in patients whose rectal volume decreased, significance was only seen for D25 % and D50 % (Dx % dose covering x % of the volume). In the latter patients, nonsignificant reductions in D2 cc, D5 cc and V5 Gy (volume receiving at least 5 Gy) were observed. CONCLUSION: The current rectal enemas protocol was ineffective in significantly modifying rectal DVH parameters for HDR-VCB.

P38 MAPK and Radiotherapy: Foes or Friends?

Over the last 30 years, the study of the cellular response to ionizing radiation (IR) has increased exponentially. Among the various signaling pathways affected by IR, p38 MAPK has been shown to be activated both in vitro and in vivo, with involvement in key processes triggered by IR-mediated genotoxic insult, such as the cell cycle, apoptosis or senescence. However, we do not yet have a definitive clue about the role of p38 MAPK in terms of radioresistance/sensitivity and its potential use to improve current radiotherapy. In this review, we summarize the current knowledge on this family of MAPKs in response to IR as well as in different aspects related to radiotherapy, such as their role in the control of REDOX, fibrosis, and in the radiosensitizing effect of several compounds.

Sentiment Analysis on Twitter: Role of Healthcare Professionals in the Global Conversation during the AstraZeneca Vaccine Suspension.

The vaccines against COVID-19 arrived in Spain at the end of 2020 along with vaccination campaigns which were not free of controversy. The debate was fueled by the adverse effects following the administration of the AstraZeneca-Oxford (AZ) vaccine in some European countries, eventually leading to its temporary suspension as a precautionary measure. In the present study, we analyze the healthcare professionals' conversations, sentiment, polarity, and intensity on social media during two periods in 2021: the one closest to the suspension of the AZ vaccine and the same time frame 30 days later. We also analyzed whether there were differences between Spain and the rest of the world. Results: The negative sentiment ratio was higher (U = 87; p = 0.048) in Spain in March (Med = 0.396), as well as the daily intensity (U = 86; p = 0.044; Med = 0.440). The opposite happened with polarity (U = 86; p = 0.044), which was higher in the rest of the world (Med = -0.264). Conclusions: There was a general increase in messages and interactions between March and April. In Spain, there was a higher incidence of negative messages and intensity compared to the rest of the world during the March period that disappeared in April. Finally, it was found that the dissemination of messages linked to negative emotions towards vaccines against COVID-19 from healthcare professionals contributed to a negative approach to primary prevention campaigns in the middle of the pandemic.

Chronic stress as a mediator of the relationship between socioeconomic status and pharmacological adherence in hypertensive patients / [El estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico de pacientes hipertensos].

Introduction: High blood pressure is a public health problem worldwide. In Colombia, its prevalence is 25% with a high mortality rate. The psychosocial factors affecting pharmacological adherence among patients have not been sufficiently studied and despite international evidence on their impact, in Colombia, there is a paucity of research on the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence. Objective: To examine the role of chronic stress in the relationship between socioeconomic status and pharmacological adherence in hypertensive patients aged 45 to 70 years old in three Colombian cities between 2015 and 2016. Materials and methods: We conducted a cross-sectional study in a population of hypertensive patients. Data for this study came from the first wave of longitudinal study aimed at examining social factors associated with the control of hypertension in Bogotá, Medellín, and Quibdó. Patients with hypertension were selected randomly from a sample of those participating in the hypertension control program De todo corazón. For the statistical analysis of the data, we used factorial analysis and multivariate regressions. Results: We found a positive association between socioeconomic status and the degree of pharmacological adherence and a negative one with chronic stress. Besides, evidence was found that stress has a negative association with the degree of adherence. Conclusions: The results suggest that stress is not a likely mediator between socioeconomic status and the pharmacological adherence of hypertensive patients in Colombia. Additional studies are required to confirm these relationships with a larger sample.

Introducción. La hipertensión arterial sistémica es un problema de salud pública en el mundo. En Colombia, su prevalencia es del 25 % y la mortalidad es alta. Los factores psicosociales que afectan el cumplimiento del tratamiento farmacológico no han sido estudiados suficientemente. En otros países, se ha estudiado el papel del estrés crónico en la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo. Objetivo. Examinar el papel del estrés crónico como mediador de la relación entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico, en pacientes hipertensos de 45 a 70 años en el 2015 y el 2016. Materiales y métodos. Se hizo un estudio transversal de una población de pacientes hipertensos. Los datos provienen de la muestra seleccionada para el programa "De todo corazón" en Bogotá, Medellín y Quibdó. El análisis estadístico de los datos se hizo mediante análisis factorial y regresiones multivariadas. Resultados. Los resultados confirmaron una asociación positiva entre la posición socioeconómica y el grado de cumplimiento del tratamiento farmacológico, y una relación negativa entre la primera y el estrés crónico. Además, se evidenció que el estrés tiene una asociación negativa con el grado de cumplimiento. Conclusiones. Los resultados sugieren que el estrés no es un mediador entre la posición socioeconómica y el cumplimiento del tratamiento farmacológico antihipertensivo en Colombia. Se requieren estudios adicionales para confirmar estas relaciones con una muestra más amplia.

Transportability of Conclusions From Confined Field Trials: A Case Study Using the Virus Resistant Transgenic Bean Developed in Brazil.

The conceptual framework for Data Transportability, builds on the premise that well-designed studies conducted for the environmental and food/feed risk assessment of transgenic crops may be transportable across geographies. Beyond individual data, provided that certain criteria are met, the general conclusions of comparative assessments of a transgenic crop with its conventional counterpart would also be transportable. In spite of this, many regulatory agencies still require in-country field trials to complete risk assessments of transgenic crops. A sub-team from ILSI Argentina's (International Life Sciences Institute, Argentina. www.ilsi.org.ar) Biotechnology Working Group tested the applicability of the transportability concept to the case of the golden mosaic virus-resistant transgenic bean, developed by EMBRAPA (EMBRAPA: Brazilian Agricultural Research Corporation). To this end, regulatory confined field trials (CFTs) carried out in Brazil to gather agro-phenotypic and compositional data were analyzed. The transportability of the conclusions of these studies to the bean cropping areas in Argentina was assessed as a conceptual exercise (with no intention to conclude on the biosafety of the common bean event). Comparative studies included the transgenic bean and its conventional parental line and were run in different agroecological environments so that any relevant differences could be observed. The main criteria to enable transportability were set by the sub-team and found to be met by the CFTs carried out in Brazil to inform a potential risk evaluation for Argentina.

The relationships between correct helmet use, enforcement presence, and mortality in a Latin-America city: The case study of Bogotá, Colombia.

OBJECTIVE: In Bogotá, Colombia, motorcyclists represent a concern as the proportion of motorcycle users between 2013 and 2018 has increased from 18% to 35%. Despite available risk reduction strategies, the fatality rates are also growing, notably in young adults (15-29 years old). This study aims at identifying correct helmet use patterns and its relationship with official records of injuries and casualties in the city over time. METHODS: Between 2015 and 2018, semiannual observational studies of motorcycle users in six randomly selected sites in Bogotá were conducted. Data was collected and analyzed on the number of occupants per vehicle (driver and passengers), gender, approximate age, type of helmet, and whether it was correctly used (strapped) or not. Bivariate and multivariate analyses were performed to identify the determinants of correct helmet use. Additionally, a spatial analysis was conducted to estimate the relationship between motorcycle's casualties and correct use of the helmet (full-face helmet use) prevalence. RESULTS: A total of 77,932 motorcycles were observed, showing a high prevalence of helmet use (99% for drivers and passengers), but only 88% use it correctly (89% drivers and 82% passengers). The presence of enforcement (camera or police personnel) increases the correct use of the helmet, especially in principal roads. Female, adults, and single riders are more likely to correctly wear the helmet. Finally, there is a relationship between the concentration of the fatalities and the incorrect helmet use in 80% of the observational sites. CONCLUSIONS: Incorrect helmet use has been found by the study to be related to higher mortality among motorcycle occupants in Bogotá. Our data shows that enforcement increases correct helmet use with the potential to reduce deaths among motorcycle occupants.

Evaluación de la experiencia de telemedicina en consulta de Cirugía de cabeza y cuello en un centro de referencia en Manizales / Evaluation of telemedicine experience in head and neck surgery consultation in a referral center in Manizales

Introducción. La infección por COVID-19 afectó drásticamente la atención en salud a nivel mundial, generando retos para la atención primaria. En orden de mitigar y manejar el contagio, la telemedicina se convirtió en una modalidad emergente y efectiva en varias especialidades médicas, incluida la cirugía de cabeza y cuello. Métodos. Estudio de corte transversal con análisis retrospectivo de pacientes atendidos en la consulta virtual durante 18 meses. Se estimaron frecuencias absolutas y relativas, y bivariado con regresión logística binaria. Se incluyeron las variables de diagnóstico primario, poder resolutivo de la consulta, necesidad de cita presencial, plataforma y dificultades de la misma. Resultados. Se incluyeron 2485 pacientes provenientes de 11 departamentos. La patología tiroidea fue la más frecuente (62,9 %), seguida de la aerodigestiva (10,9 %). La consulta fue eficiente en el 99 % de los casos, con una capacidad resolutiva del 96,4 %. El 1,4 % tuvo dificultades en la plataforma y el 8,3 % de los pacientes requirió cita presencial. Cuando hubo dificultad para la revisión de exámenes o una inadecuada inspección funcional, fue 30 veces más probable no poder resolver eficientemente la consulta. Conclusión. La telemedicina provee una alternativa eficiente de atención en cirugía de cabeza y cuello, especialmente en los controles de patología tiroidea, evitando desplazamientos innecesarios. En el tracto aerodigestivo, donde el examen físico es primordial, su utilidad está limitada a la posibilidad de realizar un examen endoscópico posterior que permita una adecuada estadificación y facilite la valoración presencial.

Introduction. The COVID-19 infection drastically affected health care worldwide, creating challenges for primary care. In order to mitigate and manage infection, telemedicine has become an emerging and effective modality in several medical specialties, including head and neck surgery. Methods. Retrospective cross-sectional analysis of patients seen in virtual consultation over 18 months. Absolute and relative frequencies were estimated, univariate analysis was done with chi-square, and bivariate analysis with binary logistic regression. Variables such as primary diagnosis, the resolution power of the consultation, the need for an in-person appointment, the platform, and its difficulties were included. Results. 2485 patients from 11 departments were included. Thyroid pathology was the most frequent (62.9%), followed by aerodigestive tract pathology (10.8%). The consultation was efficient in 99% of cases, with a resolution capacity of 96.4%. 1.4% had difficulties on the platform and 8.3% of patients required an in-person. When there was difficulty in reviewing exams or an inadequate functional inspection, it was 30 times more likely to not be able to efficiently be resolved. Conclusion. Telemedicine provides an efficient alternative for care in head and neck surgery, especially in thyroid pathology controls, avoiding unnecessary travel. In the aerodigestive tract, where the physical examination is essential, its usefulness is limited to the possibility of performing a subsequent endoscopic examination that allows adequate staging and facilitates in-person assessment.

Evaluación de la agudeza diagnóstica de la Ecografía Translaríngea Transcutánea (ETLTC) en la valoración de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides / Evaluation of the diagnostic acuity of the Transcutaneous Translaryngeal Ultrasound (TCTLUS) in the assessment of the vocal cords mobility in thyroid and parathyroid surgery

Introducción. La evaluación de la movilidad de las cuerdas vocales en cirugía de tiroides y paratiroides hace parte de la adecuada valoración integral. Aunque la laringoscopia directa es prueba de referencia, su uso real no es rutinario por lo que se propone la ecografía translaríngea como alternativa de evaluación. Métodos. Estudio prospectivo de evaluación de una prueba diagnóstica de la movilidad de las cuerdas vocales pre y posoperatoria, comparando la ecografía translaríngea con la video laringoscopia, en pacientes con cirugía de tiroides y paratiroides, de febrero 1° a noviembre 30 de 2022. Se describieron las variables usando frecuencias absolutas y relativas. En el análisis univariado se calcularon Chi cuadrado y T de Student y en el bivariado, regresión logística binaria. La agudeza diagnóstica se determinó con sensibilidad, especificidad y valores predictivos; se consideró la significancia estadística con p < 0,05. Resultados. Se incluyeron 267 pacientes, 219 mujeres y 48 hombres; 196 pacientes (73,4%) tenían malignidad. Se encontró en el preoperatorio, sensibilidad 100 %, especificidad 99,6 %, VPP 83,3 %, VPN 100 %, odds de probabilidad positiva 83 % y Odds de probabilidad negativa 0,004 %. En el posoperatorio, sensibilidad 82,8 %, especificidad 99,2 %, VPP 92,3 % VPN 97,9 %, odds de probabilidad positiva 92 % y odds de probabilidad negativa 0,2 %. Conclusiones. La ecografía translaríngea en nuestro medio tiene alta agudeza diagnóstica. Podría ser usada en el abordaje inicial de la evaluación de la movilidad de las cuerdas vocales y reemplazar la laringoscopia directa, dejando ésta para cuando la visualización ecográfica no sea adecuada, o en casos de afectación o sospecha de invasión, para su confirmación.

Introduction. The evaluation of the mobility of the vocal cords in thyroid and parathyroid surgery is part of the adequate comprehensive assessment. Altough, direct laryngoscopy is the gold standard, its real use is not routine, so translaryngeal ultrasound approach is proposed as an alternative. Methods. A prospective diagnostic test study was carried out to evaluate the translaryngeal ultrasound compared with video laryngoscopy in visualizing vocal mobility in patients with thyroid and parathyroid surgery from February 1 to November 30, 2022. Patients were described using absolute and relative frequencies. Univariate statistical analysis with Chi-square and Student's t tests. T. Bivariate analysis using binary logistic regression. Diagnostic acuity was calculated with sensitivity, specificity, PPV, NPV. Statistical significance with p< 0.05, 95% confidence interval. Results. 267 patients undergoing thyroid or parathyroid surgery were included, 219 women and 48 men. Malignant: thyroid neoplasm 196 patients (73.4%). The findings were for the preoperative period, 100% sensitivity, 99.6% specificity, PPV 83.33%, NPV 100%, 83% positive probability odds, and 0.004% negative probability odds. For the postoperative period, 82.8% sensitivity, 99.2% specificity, 92.3% PPV, 97.9% NPV, 92% positive probability odds, and 0.2% negative probability odds were found.Conclusions. Translaryngeal ultrasound in our series has high diagnostic acuity. It could be used as the initial approach to evaluate vocal mobility and might replace direct laryngoscopy, leaving it when its visualization is not adequate or in cases of involvement or suspected invasion for confirmation.

Oropharyngeal Squamous Cell Carcinoma: Human Papilloma Virus Coinfection with Streptococcus anginosus.

INTRODUCTION: Human papilloma virus (HPV) and oral bacteria capable of acetaldehyde production from ethanol, such as Streptococcus anginosus, Prevotella melaninogenica, and Fusobacterium naviforme are among oropharyngeal squamous cell carcinoma (OSCC) infectious risk factors. OBJECTIVE: Determine associations with HPV and S. anginosus, P. melaninogenica, and F. naviforme in patients with and without OSCC. METHODS: Presence of HPV and HPV-16 was determined in 26 patients with OSCC and 26 without OSCC by conventional PCR and simultaneous presence of S. anginosus, P. melaninogenica, and F. naviforme quantification through q-PCR. Statistical analysis was carried out using Pearson's X² and Student's-t test. RESULTS: Patients with OSCC had HPV and HPV-16 frequencies of 84% and 61.5%, respectively, in contrast for patients without OSCC frequencies were 34.6 and 30.7%. P. melaninogenica, and F. naviforme microorganisms were not present in any participant in this study. S. anginosus frequency in patients with OSC was 38.4% and in patients without OSCC was 30.7%. Patients with OSCC had S. anginosus + HPV co-infection at a 38.4% frequency and S. anginosus + HPV-16 at a 23.1% frequency. For individuals without OSCC S. anginosus + HPV co-infection was 3.8% and S. anginosus + HPV-16 3.8%. A greater frequency of S. anginosus + HPV co-infection and S. anginosus + HPV-16 was observed in patients with OSCC in comparison with individuals without OSCC, suggesting the importance of detecting HPV/HPV-16 and S. anginosus simultaneously in individuals at risk of developing OSCC.

Determinants of demand for antenatal care in Colombia.

In recent years, interest on researching on antenatal care issues and other health promotion and prevention interventions has increased. However, even though there is a growing interest in publishing about antenatal care use, evidence concerning which, and how socioeconomic conditions influence whether a pregnant woman demands or not antenatal consultations on the assumption that the theoretical access to this service has not entry barriers, is still limited. In order to generate this evidence, a two-stage analysis was performed with data gathered on the Demographic and Health Survey (DHS) carried out by Profamilia in Colombia during 2005. The first stage was run as a logistic regression model showing the marginal effects on the probability of attending the first visit and an ordinary least squares model was performed for the second stage accounting for the absences to antenatal consultations once at least one visit was carried out. It was found that mothers living in the Pacific Ocean region as well as young mothers seem to have a lower probability of attending the first visit but these factors are not related to the number of absences to antenatal consultation once the first visit has been achieved. The effect of health insurance was surprising because of the differing effects that the health insurers showed. Some familiar and personal conditions such as willingness to have the last children and number of previous children, demonstrated to be important in the determination of demand. The effect of mother's educational attainment was proved as important whereas the father's educational achievement was not. This paper provides some elements for policy making in order to increase the demand inducement of antenatal care, as well as stimulating research on demand for specific issues on health.

Does postoperative irradiation improve survival in early-stage endometrial cancer?

Endometrial cancer is the most common gynecological cancer in developed countries. Postoperative irradiation has been shown to lower locoregional relapses among high-intermediate risk endometrial cancer patients. In addition, vaginal cuff brachytherapy has demonstrated similar control to external beam radiotherapy but with lower toxicity. Although randomized trials have failed to translate that into better overall survival, reports from large databases, such as the National Cancer Database and the Surveillance, Epidemiology, and End Results database, have shown evidence of a statistical relationship between postoperative irradiation and survival in the intermediate- and high-risk groups. This review will address the risk groups that have led the therapeutic decisions and then we will review the clinical results accordingly. Special attention will be paid to the survival results based on the data presented through an analysis of the large databases that suggest a possible survival benefit.

Vaginal cuff brachytherapy in endometrial cancer - a technically easy treatment?

Endometrial cancer (EC) is one of the most common gynecological cancers among women in the developed countries. Vaginal cuff is the main location of relapses after a curative surgical procedure and postoperative radiation therapy have proven to diminish it. Nevertheless, these results have not translated into better survival results. The preeminent place of vaginal cuff brachytherapy (VCB) in the postoperative treatment of high- to intermediate-risk EC was given by the PORTEC-2 trial, which demonstrated a similar reduction in relapses with VCB than with external beam radiotherapy (EBRT), but VCB induced less late toxicity. As a result of this trial, the use of VCB has increased in clinical practice at the expense of EBRT. A majority of the clinical reviews of VCB usually address the risk categories and patient selection but pay little attention to technical aspects of the VCB procedure. Our review aimed to address both aspects. First of all, we described the risk groups, which guide patient selection for VCB in clinical practice. Then, we depicted several technical aspects that might influence dose deposition and toxicity. Bladder distension and rectal distension as well as applicator position or patient position are some of those variables that we reviewed.

The usefulness of fleet rectal enemas on high-dose-rate intracavitary cervical cancer brachytherapy. A prospective trial.

PURPOSE: To evaluate the effects of rectal enemas on rectal doses during radical high-dose-rate (HDR) intracavitary cervical brachytherapy (BT). MATERIAL AND METHODS: Twenty patients suffering from cervical cancer and treated with external beam radiotherapy and HDR-BT were included in a prospective trial. The first brachytherapy fraction was considered the basal status, and patients were instructed to self-administer two rectal cleansing enemas before the second fraction. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Brachytherapy was carried out with a Fletcher or Utrecht applicator. RESULTS: No significant rectal volume differences were observed between fractions with or without rectal enemas (without, 52.64 ± 15.92 cc; with, 53.16 ± 19.28 cc). There was a significant correlation between both rectal volumes (r = 0.722, p = 0.001). No significant differences were observed in analyzed DVH parameters (median values: ΔD0.1cc, 4.17 vs. 3.61 Gy; ΔD1cc, 3.23 vs. 2.87 Gy; ΔD2cc, 2.9 vs. 2.54 Gy; ΔD5cc, 2.35 vs. 2.05 Gy, for no enema and enema fraction, respectively). No significant rectal volume differences nor DVH parameter differences were observed according the applicator type. CONCLUSIONS: Our rectal enemas protocol prior to HDR-BT was ineffective in significantly modifying rectal DVH parameters. No differences were observed according to the type of applicator used.

Hipercolesterolemia familiar descripción de un caso en una familia de Armenia - Quindío (Colombia)

Introducción: La Hipercolesterolemia familiar (HF) es una enfermedad genética de carácter autosómico dominante, poco frecuente, generada por la mutación en el cromosoma 19. Es la primera causa de enfermedad cardiovascular prematura. Las mutaciones patogénicas que generan la HF se relacionan con el receptor de LDL (LDLr), la apolipoproteina B-100 (Apo- B100) y la proteína convertasa subtilisina / kexina tipo 9 (PCSK9), que produce elevación del colesterol y alteración de la vía del LDLr en el 80 % de los casos diagnosticados de HF (5). Presentamos un reporte de caso de cuatro pacientes que pertenecen a la misma familia, quienes presentan mutaciones patogénicas de diferente compromiso a nivel cardiovascular y sistémico que ha afectado de manera negativa su cotidianidad. El objetivo de este trabajo es realizar una correlación del hipercolesterolemia familiar de tipo genético a partir de la literatura, con respecto a la serie de casos presentada, y evaluar el impacto que este genera en los servicios de salud, en la vida del paciente y su familia. Discusión: El reporte de caso que presentamos se fundamenta en la sospecha de HF según los criterios de Holanda. En estos pacientes se reconoce mutación del gen LDLr que se relaciona con HF. Sin embargo, no ha sido ampliamente estudiada. Chmara realizó en Polonia por primera vez un estudio en el que reportó la variante ac 11G>T. En Colombia, el estudio de López encontró tres mutaciones, identificadas como variante a c.11G > A, n c.416A > G y c.1187G > A (8). Conclusión: La HF en nuestro medio es poco frecuente y con gran impacto social, en la mayoría de los casos genera síntomas clínicos y aumento del riesgo cardiovascular desde una edad temprana. Es importante resaltar el diagnóstico oportuno y el conocimiento por parte del personal de salud para generar una calidad de vida adecuada a los pacientes y evitar que aumente el riesgo cardiovascular.

Introduction: Familial hypercholesterolemia (FH) is a rare autosomal dominant genetic disease caused by a chromosome 19 mutation. It is the main cause of premature cardiovascular disease. Pathogenic mutations which cause FH are related to the LDL receptor (LDLr), B-100 apolipoprotein (Apo-B100) and type 9 subtilisin/kexin convertase protein (PCSK9), causing blood cholesterol increase and impairment of the LDLr pathway in up to 80% of patients diagnosed with FH. We present the case of 4 patients belonging to the same family and who present pathogenic mutations leading to diverse kinds of cardiovascular and systemic disease. Discussion: The case report we are presenting is based on the suspicion of FH according to the dutch criteria. These patients had the LDLr gene mutation related to FH. However, this mutation has not been thoroughly studied. The ac 11G>T variant was reported for the first time in Poland by Chmara. In Colombia, Lopez found 3 mutations identified as variant a c.11G > A, variant n c.416A > G and variant c.1187G > A. Conclusion: FH is rare in Colombia. Early diagnosis and healthcare worker awareness must be highlighted to improve the quality of life and decrease the cardiovascular risk of patients.

Localización intraoperatoria de las recurrencias en cáncer de tiroides mediante la inyección de azul de metileno guiada por ecografía / Intraoperative localization of recurrences in thyroid cancer by ultrasound-guided injection of methylene blue

Introducción. La cirugía para extirpación de metástasis en un cuello previamente intervenido afronta un reto para lograr una resección exitosa. El presente estudio pretende demostrar la utilidad de la técnica de inyección de azul de metileno, guiada por ecografía, para la localización intraoperatoria de lesiones recurrentes en cáncer de tiroides, para facilitar su resección. Métodos. Se realizó un estudio observacional, descriptivo y retrospectivo, en pacientes reintervenidos por recurrencia de carcinoma diferenciado de tiroides, durante un periodo de dos años y medio. Se utilizó la inyección intratumoral de azul de metileno guiada por ecografía para su identificación intraoperatoria de recurrencia. Se hizo análisis de variables demográficas y clínicas. Resultados. Este estudio incluyó 10 procedimientos en 9 pacientes, 77,8 % mujeres, con una media de edad de 54 años. Todos tenían un nivel de tiroglobulina detectable y elevado antes de la intervención; posteriormente, el 89 %presentó un descenso y el 33 % una adecuada respuesta bioquímica. La técnica agregó 10 minutos al tiempo quirúrgico. En el 100 % se identificaron de manera intraoperatoria los ganglios marcados; el promedio de ganglios resecados fue de 12, de los cuales, 6 fueron positivos, todos con carcinoma papilar de tiroides. Esta técnica se consideró de gran utilidad y de bajo costo en todos los casos. Discusión. Esta técnica se muestra como una estrategia efectiva para la identificación intraoperatoria de las recurrencias corregionales en carcinoma de tiroides, permitiendo una disección ganglionar exitosa, disminuyendo complicaciones, tiempo quirúrgico y, especialmente, costos frente a otras intervenciones

Introduction. The approach of a previously operated neck for metastasis resection faces a challenge to achieve a successful resection. The present study aims to demonstrate the usefulness of the ultrasound-guided injection of methylene blue technique for the intraoperative localization of recurrent lesions in thyroid cancer to facilitate their resection. Methods. An observational, descriptive and retrospective study was conducted in patients reoperated for recurrences of differentiated thyroid carcinoma over a period of two and a half years, using ultrasound-guided intratumoral injection of methylene blue for its intraoperative identification. An analysis of demographic and clinical variables was carried out and its advantages over other methods were identified. Results. This study included 10 procedures in nine patients, 77.8% women and 22.2% men, with a mean age of 54 years. All had a detectable and elevated thyroglobulin level before the intervention, 89% had a decrease in its level and 33% had an adequate biochemical response. The technique added 10 minutes to the surgical time. All marked lymph nodes were identified intraoperatively. The average number of lymph nodes resected was 12, of which six were positive, all with papillary thyroid carcinoma. It was considered of great utility and low cost in all cases. Discussion. This technique shows to be an effective strategy for the intraoperative identification of locoregional recurrences in thyroid carcinoma, allowing a successful lymph node dissection, reducing complications, surgical time and especially costs compared to other interventions

Analysing the integration of MR images acquired in a non-radiotherapy treatment position into the radiotherapy workflow using deformable and rigid registration.

AIM: Our aim was to analyse the feasibility of integrating an MRI acquired in a non-radiotherapy set-up into the prostate cancer radiotherapy workflow. MATERIAL AND METHODS: The MRIs of 15 prostate cancer patients, acquired with a flat table-top (MRI-flat), and with a curved tabletop (MRI-curve) were analysed. MRIs were rigidly (RIR) and non-rigidly registered (DIR) with CT images. The prostate and rectum were contoured in each image set and translated to the CT, and IMRT plans were computed taking into account structural changes after RIR and DIR (P-flatRIR, P-curveRIR and P-curveDIR). In addition the P-curveDIR was overlaid with RIR structures. Spatial overlap parameters and dose-volume histogram metrics were generated. RESULTS: No significant differences were observed among P-flatRIR and P-curveRIR or P-flatRIR and P-curveDIR. Median gamma-values: P-curveRIR, 95.3%; P-curveDIR, 96%, translated-P-curveDIR, 95%. DVH metrics for translated-P-curveDIR were: Dmin, 64.5Gy; Dmean, 70.06Gy; V95%, 100%. No statistically significant differences were found in the dosimetric MRI-flatDIR values. CONCLUSIONS: The dosimetric reproduction of treatment position image following image registration of non-radiotherapy set-up images suggests that it is feasible to integrate these images into the radiotherapy workflow.