Putative Biomarkers of Response to Treatment in Breast Cancer Patients: A Pilot Assay.

Identifying tumor biomarkers associated with clinical behavior in breast cancer patients may allow higher accuracy in the selection of treatment. Different types of cells were determined in the primary tumors of stage I, II, and III of breast cancer patients, who were assigned to one of the two groups: (1) disease-free or (2) relapsed/progressed, at 5 years after primary treatment. We studied 32 tumor samples. CD4+ lymphocytes and CD44+CD24-/low cells (cancer stem cells) showed a significant association with clinical outcome at 5 years of primary treatment, while CD8+, Foxp3+, CD34+, and myeloid-derived suppressor cells did not show any association. Coincident with the results of individual analysis, we identified CD4+ cells and CD44+CD24-/low cells as good predictors of long-term clinical outcome in a logistic regression.

Quality of life in patients with metastatic breast cancer treated with metronomic chemotherapy.

AIM: The objective of the study was to detect changes in quality of life (QoL) in metastatic breast cancer patients treated with metronomic chemotherapy with daily low doses of cyclophosphamide and celecoxib. MATERIAL & METHODS: Patients included in a Phase II trial, treated with metronomic cyclophosphamide and celecoxib were included in the QoL study. Assessment of QoL was carried out every 2 months by the Functional Assessment of Cancer Therapy Breast (FACT-B) questionnaire, Brief Pain Inventory and Eastern Cooperative Oncologic Group scale. Data were analyzed at three time points: baseline (BL); middle of treatment (MT); and end of treatment (ET). RESULTS: A total of 20 patients were included. All patients were heavily pretreated. Treatment showed a good and safe therapeutic profile. With FACT-B questionnaire, no significant differences were observed during the response period (BL-MT). However, a significant increase was observed in the Emotional well-being and Additional concerns axes, when the last time point was included in the analysis (BL-MT-ET). A significant decrease in the proportion of patients with pain was found when comparing BL with ET (p = 0.046). The assessment with Eastern Cooperative Oncologic Group scale showed that 26.7% (4/15) of the patients improved their functional status and 40% (6/15) showed no changes, while 33.3% (5/10) worsened it. CONCLUSION: Patients treated metronomically for several months did not worsen their QoL. A high proportion of patients showed improvement or no changes and there were less patients with pain at the end of the treatment.

Dietary intake and nutritional status of patients with Chagas disease.

Chagas disease is a parasitic infection that affects 17 million people in Latin America. The real influence of nutritional status and food intake effect over the course of the disease to chronic Chagas Cardiomyopathy is still unknown. Furthermore, some cardiovascular risk factors might influence the evolution of the disease. A cross-sectional study of a sample of patients with Chagas disease attending the Cardiology Section of the Hospital Centenario of Rosario was carried out in order to characterize their food intake and nutritional status. Data on the general characteristics of the sample was collected; anthropometric measurements were performed and food consumption was investigated using a food frequency questionnaire and a n photographic atlas. One hundred and thirteen patients were enrolled; 70% of men and 90% of women were overweight or obese. In addition 78.9% of women and 27% of men presented a waist-hip ratio according to cardiovascular risk. When analyzing macronutrient intake, it was observed that lipid intake recommendations were exceeded. When the food intake groups were analyzed separately, it was found that men consume more lean beef, cold cuts, pork and alcoholic drinks, while women eat more whole dairy products and sugary drinks. This patients´ urban sample with Chagas disease, he presents a nutritional profile similar to that of the general population, and the food consumption is influenced by life in big cities.

[Food consumption patterns and risk of gallstone disease (GD): Case and Control Study in Rosario Argentina.] / Patrones de consumo alimentario y riesgo de enfermedad colelitiásica (EC): Estudio de Casos y Controles en Rosario Argentina.

Introduction: Nutritional exposure is considered the main environmental influence that contributes to gallstone disease (GD). Aim: The aim of this study was to determine food intakes patters and estimate risk of GD. Methods: A nested case-control study was carried out within the framework of a previous screening study conducted on a representative sample in Rosario, Argentina. Participants underwent a personal interview. Average amount of each food intake and quantity nutrients were estimated applying a food-frequency questionnaire. Food consumption patterns were identified by principal component analysis, and logistic regression analysis was used to estimate risks. Results: The sample was conformed by 51 cases and 69 controls. Two dietary patterns were identified. Cases were characterised by the unhealthy intake pattern (high intakes of animal fats, sugar, cereals, grains, cold cuts, processed meats, chicken with skin, fat beef and low intake of red vegetables and yellows, cabbages, fruits and fish). Conclusion: Controls were characterised by the healthy intake pattern (high intake of skinless chicken, nuts, lean beef, vitamin A and C rich fruits, and low consumption of chicken with skin, green leaves vegetables and sprouts). The unhealthy pattern showed an increased risk of developing GD while healthy patter behaved as a protective factor.

Introducción: La exposición nutricional se considera la principal exposición ambiental que contribuye a la formación de cálculos biliares. Objetivo: El objetivo de este trabajo fue determinar el patrón de consumo alimentario de casos y controles de EC y estimar el riesgo de desarrollar la enfermedad según los distintos patrones constituidos. Métodos: Se llevó a cabo un estudio analítico retrospectivo transversal de casos y controles, anidado a un estudio de prevalencia realizado en Rosario. Todos los participantes fueron entrevistados personalmente. El consumo de alimentos se consignó a través de un cuestionario semi-cuantitativo de frecuencia de consumo. Para determinar patrones de consumo alimentario se realizó un análisis de componentes principales, y análisis de regresión logística múltiple para evaluar riesgos. Resultados: La muestra quedó conformada por 51 casos y 69 controles. Se determinaron dos componentes que permitían diferenciar los casos de los controles, a través de las cuales se establecieron 2 patrones de consumo. Los casos se caracterizaron por un consumo determinado por el Patrón Poco saludable (altas ingestas de grasas animales, azúcar, cereales, granos, fiambres y embutidos) y los controles por el consumo del patrón Saludable (altas ingestas de pollo sin piel, frutas secas, carne vacuna magra, frutas, lácteos enteros). El patrón Poco saludable, aumentó el riesgo de desarrollar EC mientras que el patrón Saludable, se comportó como protector. Conclusión principal: Los patrones constituidos diferencian los casos de los controles, y la ingesta propia de los casos se correlaciona con un perfil de consumo que caracteriza a las culturas occidentales modernas y urbanas.

Safety and therapeutic effect of metronomic chemotherapy with cyclophosphamide and celecoxib in advanced breast cancer patients.

Metronomic chemotherapy (MCT), the chronic administration, at regular intervals, of low doses of chemotherapeutic drugs without extended rest periods, allows chronic treatment with therapeutic efficacy and low toxicity. Our preclinical results suggested that combined MCT with cyclophosphamide and celecoxib could inhibit breast cancer growth. The aim of this study was to determine the toxicity, safety and efficacy of oral MCT with cyclophosphamide 50 mg per orem daily and celecoxib 400 mg (200 mg per orem two-times a day) in advanced breast cancer patients. During the first stage of the study, the therapeutic response consisted of prolonged stable disease for ≥24 weeks in six out of 15 (40%) patients with a median duration of 37.5 weeks and a partial response in one out of 15 (response rate: 6.7%) patients lasting 6 weeks. The overall clinical benefit rate was 46.7%. The median time to progression was 14 weeks. Progression-free survival at 24 weeks was 40% and the 1-year overall survival rate was 46.7%. The adverse events were mild (gastric, grade 1; and hematologic, grade 1 or 2). No grade 3 or 4 toxicities were associated with the treatment. Evaluation of patients' quality of life showed no changes during the response period. MCT with cyclophosphamide plus celecoxib is safe and shows a therapeutic effect in advanced breast cancer patients.

Factors associated with mortality among hospitalized patients with COVID-19 disease treated with convalescent plasma.

The use of convalescent plasma (CP) for hospitalized patients with SARS-CoV-2 infection might be a useful option in certain settings. Soon after the outbreak of COVID-19, the National Ministry of Health of Argentina recommended the use of CP transfusion for hospitalized patients with COVID-19 disease. Between 1 June and 3 October 2020, 480 patients, excluding those on invasive mechanical ventilation (IMV), received at least one CP infusion in the province of Santa Fe. We aimed to find factors associated with mortality among this cohort of patients. The median age was 60 years (interquartile range: 49-69 years) and 320 (66.7%) were males. Most of these patients (93.75%) received a single CP infusion, 82.1% and 95.6% before day 4 and day 7 of hospitalization, respectively. Anti-SARS-CoV-2 titers were determined in the CP units administered using Elecsys Anti-SARS-CoV-2 S assay. At 28 days of follow-up, 250 patients were discharged (52.1%), 131 (27.3%) remained hospitalized without and 16 (3.3%) with oxygen requirement, 27 (5.6%) were on IMV, and 56 (11.7%) had died. In the multivariate logistic regression analysis, the factors significantly associated with 28-day mortality were (i) requirement of IMV, (ii) the administration of CP after the third day of hospitalization, (iii) age, and (iv) number of comorbidities. The qualitative and quantitative analyses of antibodies against SARS-CoV-2 in the infused CP were not associated with mortality. Our findings may imply a seemingly favorable effect of CP administration among patients with severe COVID-19 disease when infused sooner after hospitalization.IMPORTANCEThe use of convalescent plasma (CP) could be an option for patients with severe COVID-19, especially in poor-resource countries where direct antiviral drugs are not commercially available. Currently, the U.S. Food and Drug Administration limits the CP administration for outpatients and inpatients with COVID-19 who are immunocompromised and only if high levels of anti-SARS-CoV-2 antibodies are confirmed in the CP unit. Although most of the randomized clinical trials failed to show a clear-cut benefit of CP in hospitalized patients with severe COVID-19, other studies have shown that if given early in the course of the disease, it might be a useful therapeutic option. In this retrospective study, we demonstrated that early treatment (within 3 days of hospitalization) was significantly associated with reduced 28-day mortality compared with those patients treated beyond day 3. The results from our study add up to the scientific evidence on the use of CP as a relatively safe, cheap, and possibly effective therapy in certain patients suffering from severe SARS-CoV-2 infection.

The long-term antibody response after SARS-CoV-2 prime-boost vaccination in healthy individuals. The positive influence of extended between-dose intervals and heterologous schedule.

Introduction: Anti-COVID vaccination in Argentina was carried out using different protocols and variations in periods between administrations, as well as combinations of different vaccine platforms. Considering the relevance of the antibody response in viral infections, we analyzed anti-S antibodies in healthy people at different points of time following the Sputnik immunization procedure. Methods: We attended the vaccination centers in the city of Rosario, which had shorter versus longer intervals between both doses. A total of (1021) adults with no COVID-compatible symptoms (throughout the study period) were grouped according to the gap between both vaccine doses: 21 (Group A, n=528), 30 (Group B, n=147), and 70 days (Group C, n=82), as well as an additional group of individuals with heterologous vaccination (Sputnik/Moderna, separated by a 107-day interval, group D, n=264). Results and conclusions: While there were no between-group differences in baseline levels of specific antibodies, data collected several weeks after administering the second dose showed that group D had the highest amounts of specific antibodies, followed by values recorded in Groups C, B, and A. The same pattern of group differences was seen when measuring anti-S antibodies at 21 or 180 days after the first and second doses, respectively. Delayed between-dose intervals coexisted with higher antibody titers. This happened even more when using a prime-boost heterologous schedule.

[Food intake pattern in a sample of adults with gallbladder disease (GD)]. / Patrón de consumo alimentario en una muestra de adultos con Enfermedad Colelitiasica (EC).

In Rosario, Argentina, a 20,5% prevalence rate of Gallbladder Disease (GD) was found in a random sample of adults. The aim of this study was to determine the food consumption pattern of subjects with GD nested in that sample for further comparison with the Recommended Dietary Allowances (RDA). Forty-four subjects were interviewed about the food consumption during the five years before their diagnosis, by applying a semi-quantitative food frequency questionnaire (FFQ) and a photographic atlas of standardized portions. Age, body mass index (BMI), all consumed nutrients, and total energy intake (kilocalories) were reported as Mean +/- standard deviation. Comparisons according to sex (18 males and 26 females) revealed no significant differences in the variables under analysis. Age and BMI in the overall sample were as follows 63.8 +/- 13.8 years and 28.2 +/- 5.8, respectively. Mean daily consumption of nutrients was as follows: Carbohydrates 295.3 +/- 96.9 g, Protein 131.6 +/- 36.8 g, Fat 128.9 +/- 43 g, Saturated fatty acids 41.9 +/- 18,6 g, Polyunsaturated fatty acids 13.8 +/- 8.7 g, Cholesterol 455.4 +/- 186.8 mg, Sodium 2730 +/- 1552.1 mg, Potassium 2912.8 +/- 1001.4 mg, Calcium 719.3 +/- 403.3 mg, Iron 16 +/- 4.6 mg, Phosphorus 801.6 +/- 320.3 mg, Vitamin A 3121.7 +/- 1811.9 mcg, Vitamin B1 0.80 +/- 0.30 mg, Vitamin B2 1.9 +/- 0.8 mg, Vitamin C 157.6 +/- 114.1 mg, Niacin 6.9 +/- 2.7 mg, Fiber 5.3 +/- 12 g, Coffee 70.7 +/- 104.3 cc (total energy intake 2941 +/- 791.1 Kcal). Subjects with GD have a history of higher intake of fat, saturated fatty acids and cholesterol with consumption of carbohydrates, calcium, niacin and fiber below the recommended quantities.

Micrometric measurement of the density of stained odontoblast processes.

UNLABELLED: The embryological, structural and functional unit of the dentine-pulp complex shares the odontoblast, located in the border of the dentine pulp, with basal nuclei and organelles. The odontoblast process emerges from its apical pole. It is formed by microtubules, microfilaments and vesicles covered by membranes penetrating the dentinal tubules, isolated from the inter-tubular matrix, along the extent of the dentine. The objective of this study was to evaluate the efficacy of three staining techniques: hematoxylin-eosin, periodic acid-Schiff and Schmorl, by staining the process, from beginning to end, and compare the results with the erosion technique. Thirty human teeth were employed in the trial; after their extraction the pulp was fixated, the pieces demineralized in nitric acid at 8%, the collagen filaments eliminated with Type II Collagenase, the tissue was stained, and the measurements were made. The portions with no pulp were prepared with the erosion technique. RESULTS: Comparing the best results obtained by staining with the values obtained with the erosion technique, the former showed lower values. CONCLUSION: Staining techniques show lower density of the staining processes compared with the dentinal tubules in the erosion technique.

Knowledge, adherence and perceptions about colorectal cancer screening in primary and secondary school teachers in Carcarañá / [Conocimiento, adherencia y percepciones acerca del tamizaje del cáncer colorrectal en docentes de escuelas primarias y secundarias de Carcarañá]

Introduction: This study describes the knowledge and perceptions regarding colorectal cancer screening (CRC) in a population of teachers from primary and secondary schools in Carcarañá, Santa Fe. The proportion of participants who underwent the screening is described, as well as the facilitating factors and barriers that could affect test adherence. Methods: An observational, descriptive and cross-sectional study was carried out through a self-administered survey of the population of teachers aged 50 or over from all primary and secondary schools in the city. Results: 96 teachers, 87 women (90.6%) and 9 men (9.4%) were surveyed. Average age: 53.2 ± 2.5 years. 66.7% knew about CRC screening. However, only 13.5% knew the recommended time to start performing these tests. 28.1% had adhered to some of the screening tests. 94.8% agreed that CRC has a greater chance of cure if it is discovered early, and 92.7% reported that screening is part of good health care. . Conclusion: The positive perception regarding screening is not consistent with adherence to screening. Lack of knowledge, lack of information and medical indication are the most important barriers to adherence. The main facilitating factor was the existence of a family history of CRC. New research that addresses this issue would be necessary in order to develop strategies aimed at modifying these barriers and reducing mortality from this neoplasm

Introducción: Este estudio describe los conocimientos y percepciones respecto del tamizaje del cáncer colorrectal (CCR) en una población de  docentes de escuelas primarias y secundarias de Carcarañá, Santa Fe. Se describe la proporción de participantes que se sometió a la realización del mismo, así como los factores facilitadores y las barreras que podrían afectar la adherencia a las pruebas. Métodos: Se realizó una estudio observacional, descriptivo y transversal mediante una encuesta autoadministrada a la población de docentes de 50 años o más de todas las escuelas primarias y secundarias de la ciudad. Resultados: Se encuestaron 96 docentes, 87 mujeres (90,6%) y  9 hombres (9,4%). Edad promedio: 53,2 ± 2,5 años. El 66,7% tenía conocimiento acerca de la existencia del tamizaje de CCR. Sin embargo, sólo el 13,5% conocía cuál era el momento recomendado para iniciar la realización dichas pruebas. El 28,1% había adherido a alguna de las pruebas de tamizaje. El 94,8% acordó que el CCR tiene mayor posibilidad de curación si se descubre de manera temprana y el 92,7% refirió que el tamizaje es parte del buen cuidado de salud. Conclusión: La percepción positiva respecto del tamizaje no se condice con la adherencia al mismo. El desconocimiento, la falta de información y de indicación médica constituyen las barreras más importantes a la adherencia. El principal factor facilitador fue la existencia de antecedentes familiares de CCR. Serían necesarias nuevas investigaciones que aborden esta temática con el fin de elaborar estrategias dirigidas a modificar dichas barreras y disminuir la mortalidad por esta neoplasia.

[Colorectal cancer: epidemiologic characteristics in a hospital center of Rosario, Argentina]. / Cáncer colorrectal: características epidemiológicas en un centro endoscópico hospitalario de Rosario, Argentina.

OBJECTIVE: To obtain clinical and epidemiological information that could be relevant for the purpose of screening and diagnostic strategies in colorectal cancer (CRC). PATIENTS AND METHODS: A retrospective, descriptive, observational study was performed during a three year-period at the Hospital Provincial del Centenario in Rosario, Argentina. A population of symptomatic patients referred for colonoscopic examination was evaluated after the histopathologic diagnosis of colorectal adenocarcinoma was made. A total of 1.543 colonoscopies was evaluated. Relevant information was retrieved from clinical records, and endoscopic, pathologic and tomography examinations. RESULTS: Eighty six cases of CRC were diagnosed, with an incidence rate of CRC in the study population of 5.6%. Eighty six percent of patients were older than 50 years. Seventy five percent of tumors were located in the sigmoid colon and rectum. Synchronic lesions were found in 5.8% of tumor cases. Type 2 stenotic lesions were preferentially found in the left colon, whereas the site of most type 1 lesions was within the right colon. Most tumors (89.70%) were moderately well-differentiated adenocarcinomas. The most frequent site of metastases was the liver (64%). CONCLUSIONS: In this population of symptomatic patients, 75% of colorectal tumors were found in the sigmoid colon and rectum, with 5.8% of cases showing a second, synchronous tumor. More than 80% of neoplastic lesions occurred in patients aged 50 or older and almost 90% were moderately well-differentiated adenocarcinomas. These data suggest guidelines for a proper strategy to prevent CRC.

[Cost-effectiveness analysis of different imaging for the diagnosis of acute pulmonary embolism]. / Análisis coste-efectividad de distintos métodos de diagnóstico por imagen del tromboembolismo pulmonar agudo.

BACKGROUND: The optimal diagnostic test for detecting acute pulmonary embolism (APE) is still under discussion. The ventilation /perfusion scanning has been the preferred examination for several decades, but with the development of new tests the diagnostic possibilities have increased. It is necessary to evaluate them from the cost-effectiveness perspective. The goal of this study was to evaluate several methods of imaging diagnosis so as to determine the most cost-effective for detecting APE. METHODS: Cost-effectiveness (CE) analysis using a decision tree to model various diagnostic test (V/Q lung scan, spiral CT, angiography by MDCT, MRI and conventional arteriography). Sensitivity and specificity values, and positive and negative predictive values of diagnostic tests were calculated. Expected outcome: "new APE case detected." The direct costs were evaluated in eurosos (euros), including the secondary complications of diagnostic methods. To assess the robustness of the findings, a one way sensitivity analysis was performed. RESULTS: The most cost-effective diagnostic test was angiography by MDCT. No diagnostic test were eliminated by extended dominance. The crude rate of CE for MDCT was 486 euros per case of APE detected. The marginal cost between spiral CT and V / Q lung scan was euros 103 for 8 cases of APE detected additionally, while the marginal cost between MDCT and spiral CT was 229 euros to detect an additional case of APE. CONCLUSIONS: The most cost-effective diagnostic test was the MDCT; this finding showed to be robust in relationship to sensitivity, specificity and costs changes. However, the incremental C-E analysis showed that MDCT was capable to detect only one additional case of APE than spiral CT, with an incremental cost of 229 euros. When peripheral branches are affected, high negative predictive value of the MDCT justify its conduct.

[Study about skin cancer screening in comparison with breast and cervix cancer screening in a female sample from Concordia, Argentina.] / Estudio acerca del conocimiento, actitudes y prácticas del cribado de cáncer de piel, mama y cérvix en una muestra de mujeres en Concordia, Argentina.

Introduction: The aim of this study was to describe the knowledge, practices and attitudes regarding the screening of skin cancer, compared to the breast and cervix cancer. Methods. An observational, cross-sectional study using structured questionnaires was carried out among women in the city of Concordia, Entre Ríos. The sample consisted of 90 mothers or tutors from low (G1, n=32), middle (G2, n=29) and high (G3, n=29) socioeconomic status elementary schools students. Results. Mean age were 37,9±6,6, 38,0±6,9 and 43,1±5,6 years, respectively. The annual skin exam has been performed by dermatologist in 30.0% (G1), 30.8% (G2) and 51.7% (G3) of these women. The annual gynecological exam has been done by 46.4% (G1), 60.7% (G2) and 86.2% (G3). The existence of the skin cancer prevention campaign was known in 35,7%, 16% and 10,7% in G1, G2 and G3 respectively, but only 3,7% of G2, 3,7% of G3 and no women in G1 had ever participated in a campaign. Major conclusion. These data indicate the need to achieve effective strategies that allow improving the adherence of women to prevention campaigns, especially those for skin cancer prevention, where there is less participation when compared with breast and cervical cancer screening. Methods: An observational, cross-sectional study using structured questionnaires was carried out among women in the city of Concordia, Entre Ríos. The sample consisted of 90 mothers or tutors from low (G1, n=32), middle (G2, n=29) and high (G3, n=29) socioeconomic status elementary schools students. Results. Mean age were 37,9±6,6, 38,0±6,9 and 43,1±5,6 years, respectively. The annual skin exam has been performed by dermatologist in 30.0% (G1), 30.8% (G2) and 51.7% (G3) of these women. The annual gynecological exam has been done by 46.4% (G1), 60.7% (G2) and 86.2% (G3). The existence of the skin cancer prevention campaign was known in 35,7%, 16% and 10,7% in G1, G2 and G3 respectively, but only 3,7% of G2, 3,7% of G3 and no women in G1 had ever participated in a campaign. Major conclusion. These data indicate the need to achieve effective strategies that allow improving the adherence of women to prevention campaigns, especially those for skin cancer prevention, where there is less participation when compared with breast and cervical cancer screening. Results: Mean age were 37,9±6,6, 38,0±6,9 and 43,1±5,6 years, respectively. The annual skin exam has been performed by dermatologist in 30.0% (G1), 30.8% (G2) and 51.7% (G3) of these women. The annual gynecological exam has been done by 46.4% (G1), 60.7% (G2) and 86.2% (G3). The existence of the skin cancer prevention campaign was known in 35,7%, 16% and 10,7% in G1, G2 and G3 respectively, but only 3,7% of G2, 3,7% of G3 and no women in G1 had ever participated in a campaign. Major conclusion. These data indicate the need to achieve effective strategies that allow improving the adherence of women to prevention campaigns, especially those for skin cancer prevention, where there is less participation when compared with breast and cervical cancer screening. Major conclusion: These data indicate the need to achieve effective strategies that allow improving the adherence of women to prevention campaigns, especially those for skin cancer prevention, where there is less participation when compared with breast and cervical cancer screening.

Introducción: En este estudio se describen los conocimientos, prácticas y actitudes en relación al cribado de cáncer de mama, cérvix y piel en una muestra de madres o tutoras de alumnos de sexto grado de establecimientos de educación primaria de la ciudad de Concordia, Entre Ríos. Métodos. Durante el año 2016 se realizó un estudio observacional, descriptivo, transversal, mediante entrevistas y encuestas estructuradas a 90 mujeres mayores de 18 años, madres o tutoras de alumnos de tres escuelas de la ciudad de Concordia correspondientes a diferentes niveles socioeconómicos (bajo: G1, n=32), medio (G2, n=29) y alto (G3, n=29). Resultados. La edad promedio fue 37,9±6,6; 38±6,9 y 43,1±5,6 años, respectivamente. Las proporciones de mujeres que se realizaron controles periódicos de mama, cérvix y piel por médicos especialistas fueron mayores en el grupo de madres pertenecientes al nivel socioeconómico alto. El 35,7%, 16% y 10,7% de las mujeres del G1, G2 y G3 respectivamente, conocían las campañas de prevención de cáncer cutáneo; pero sólo participó en alguna de ellas el 3,7% del G2, 3,7% del G3 y ninguna del G1. Conclusión principal. Estos datos nos indican la necesidad de lograr estrategias que permitan mejorar la adhesión de las mujeres a las campañas de prevención. Métodos: Durante el año 2016 se realizó un estudio observacional, descriptivo, transversal, mediante entrevistas y encuestas estructuradas a 90 mujeres mayores de 18 años, madres o tutoras de alumnos de tres escuelas de la ciudad de Concordia correspondientes a diferentes niveles socioeconómicos (bajo: G1, n=32), medio (G2, n=29) y alto (G3, n=29). Resultados. La edad promedio fue 37,9±6,6; 38±6,9 y 43,1±5,6 años, respectivamente. Las proporciones de mujeres que se realizaron controles periódicos de mama, cérvix y piel por médicos especialistas fueron mayores en el grupo de madres pertenecientes al nivel socioeconómico alto. El 35,7%, 16% y 10,7% de las mujeres del G1, G2 y G3 respectivamente, conocían las campañas de prevención de cáncer cutáneo; pero sólo participó en alguna de ellas el 3,7% del G2, 3,7% del G3 y ninguna del G1. Conclusión principal. Estos datos nos indican la necesidad de lograr estrategias que permitan mejorar la adhesión de las mujeres a las campañas de prevención. Resultados: La edad promedio fue 37,9±6,6; 38±6,9 y 43,1±5,6 años, respectivamente. Las proporciones de mujeres que se realizaron controles periódicos de mama, cérvix y piel por médicos especialistas fueron mayores en el grupo de madres pertenecientes al nivel socioeconómico alto. El 35,7%, 16% y 10,7% de las mujeres del G1, G2 y G3 respectivamente, conocían las campañas de prevención de cáncer cutáneo; pero sólo participó en alguna de ellas el 3,7% del G2, 3,7% del G3 y ninguna del G1. Conclusión principal: Estos datos nos indican la necesidad de lograr estrategias que permitan mejorar la adhesión de las mujeres a las campañas de prevención.

Sentinel Lymph Node Biopsy in Patients With Thick Primary Cutaneous Melanoma.

BACKGROUND: The clinical value of sentinel lymph node biopsy (SLNB) in patients with thick melanoma is uncertain. The purpose of this study was to investigate the correlations between survival and lymph node status in thick melanomas. METHODS: Of a total of 736 melanoma patients registered between 2000 and 2016, 50 presented with thick melanomas (≥ 4.0 mm) without distant metastatic disease. All patients were examined with a whole-body magnetic resonance imaging, or computed tomography, and positron emission tomography-computed tomography depending on the incorporation of the new technology in our medical institutions. They were studied according to the following procedure: 1) preoperative determination of regional lymph node along with the estimation and localization of sentinel lymph node (SLN) (dynamic isotope lymphography); 2) intraoperative localization and SLNB (lymphatic mapping); and 3) histopathology. Patient and tumor features were collected. RESULTS: Mean follow-up was 40 months, and 37% had a follow-up ≥ 5 years. A positive SLN was identified in 28 patients (56%). No significant difference in melanoma-specific overall survival was observed in terms of the primary tumor site. Hazard ratios (HRs) were statistically significant for SLNB-positive group and mitotic rate (MR) > 3 mm2, but not for presence of ulceration. Mortality risk in the SLN-positive group was almost fourfold greater than that in the SLN-negative group at any time of follow-up. CONCLUSIONS: SLN status, along with MR, can provide valuable prognostic information in patients with thick primary cutaneous melanoma.

[Association between hip fractures and risk factors for osteoporosis. Multivariate analysis]. / Factores de riesgo para osteoporosis y fracturas de cadera. Análisis multivariado.

In this observational, case-control study, 376 inpatients were evaluated in order to determine the association of risk factors (RF) and hip fracture; 151 patients had osteoporotic hip fracture (cases); the remaining were controls. Data were obtained from medical charts, and through a standardized questionnaire about RF. Mean age of the sample (+/- SD) was 80.6 +/- 8.1 years, without statistically significant difference between cases and controls; the female:male ratio was 3:1 in both groups. Fractured women were older than men (82.5 +/- 8.1 vs. 79.7 +/- 7.2 years, respectively; p < 0.01). Physical activity, intake of alcohol and tobacco, and sun exposure were low in all patients. Falls among cases happened predominantly at home (p < 0.001). Among female cases, time spent in household duties was a RF (p = 0.007), which was absent in males. In multivariate analysis, the following RF were significantly more frequent: Cognitive impairment (p = 0.001), and previous falls (p < 0.0001); whereas the following protective factors were significantly different from controls: Calcium intake during youth (p < 0.0001), current calcium intake (p < 0.0001), and mechanical aid for walking (p < 0.0001). Evaluation of RF and protective factors may contribute to diminish the probability of hip fracture, through a modification of personal habits, and measures to prevent falls among elderly adults. Present information can help to develop local and national population-based strategies to diminish the burden of hip fractures for the health system.

Cardiovascular risk factors in chronic Chagas' disease are associated with a different profile of putative heart-pathogenic antibodies.

Given that cardiovascular risk factors (CRF), such as smoking, alcoholism and hypertension, may contribute to the development of heart lesions, chronically Trypanosoma cruzi-infected individuals were studied to explore the relationship between the presence of such CRF, cardiomyopathy and antibodies that have been proposed to play a pathogenetic role in Chagas' disease. The targets of these antibodies were T. cruzi antigens such as cruzipain (Cz), a P ribosomal antigen (P2), and a component of myelin sheaths also present in T. cruzi (sulphatide). Individuals were classified into four groups on the basis of specific serology and presence of CRF: subjects with T. cruzi infection and CRF; those with positive serology and no CRF; seronegatives with CRF; and seronegatives without CRF, were analysed. Seronegatives or seropositives with CRF showed a greater occurrence of heart involvement (chest X-ray and/or electrocardiogram abnormalities). Seropositives with CRF displayed significantly higher levels of antisulphatide antibodies than the three remaining groups and higher levels of antibodies against Cz and P2 compared to the seropositives without CRF. Increased amounts of anti-P2 and antisulphatide antibodies were also found in seropositives with marked heart involvement. The presence of CRF is associated with a different profile of antibody responses and degree of cardiac effects.

Metastatic breast cancer patients treated with low-dose metronomic chemotherapy with cyclophosphamide and celecoxib: clinical outcomes and biomarkers of response.

BACKGROUND: Preclinical results showing therapeutic effect and low toxicity of metronomic chemotherapy with cyclophosphamide (Cy) + celecoxib (Cel) for mammary tumors encouraged its translation to the clinic for treating advanced breast cancer patients (ABCP). PATIENTS AND METHODS: A single-arm, mono-institutional, non-randomized, phase II, two-step clinical trial (approved by Bioethics Committee and Argentine Regulatory Authority) was designed. Patients received Cy (50 mg po.d) + Cel (200 mg p.o.bid). Patient eligibility criteria included: ABCP who progressed to anthracyclines, taxanes and capecitabine, ≤4 chemotherapy schemes, with good performance status. Several pro- and anti-angiogenic molecules and cells were determined as biomarkers. Informed consent was signed by all patients. Primary endpoint was clinical benefit (CB). RESULTS: Twenty patients were enrolled. Main clinical outcomes were prolonged disease stabilization and partial remission in 10/20 and 1/20 patients, respectively. CB was 55 %, and time to progression (TTP) was 21.1 weeks. Median TTP in patients who achieved CB was 35.6 weeks, and mean overall survival was 44.20 weeks. There were no grade 3/4 toxicities associated with treatment. Circulating endothelial cells (CECs) increased at the time of progression in patients who showed CB (P = 0.014). Baseline CECs and circulating endothelial progenitor cells showed marginal associations with TTP. Serum VEGF decreased (P = 0.050), sVEGFR-2 increased (P = 0.005) and VEGF/sVEGFR-2 ratio decreased during treatment (P = 0.041); baseline VEGF and VEGF/sVEGFR-2 were associated with TTP (P = 0.035 and P = 0.030, respectively), while sVEGFR-2 did not. CONCLUSIONS: Treatment was effective, showing low toxicity profile and excellent tolerability. The combination had anti-angiogenic effect. Increased levels of CEC could be useful for detecting progression. Baseline VEGF and VEGF/sVEGFR-2 values could be useful as early predictors of response. TRIAL REGISTRATION: ANMAT#4596/09.

Construction of two instruments for the presumptive detection of post-menopausal women with low spinal bone mass by means of clinical risk factors.

The objective of this investigation was the design of two instruments based on clinical risk factors for the presumptive detection of post-menopausal women with spinal BMD<2.5 S.D. below average (LBMD). We investigated the association of 20 risk factors (RF) with LBMD in a series of 131 women. According to current densitometric criteria, subjects were classified as normals (N=33); osteopenics (N=53) and osteoporotics (N=45). Normals and osteopenics were taken as a single group because only 'nulliparity' and 'personal fractures' exhibited significant differences between these groups. A logistic regression attempting to identify which factors were associated with osteopenia showed a poor fit (pseudo R(2)=0.289). Univariate unconditional logistic regression analysis was used to calculate odd ratios (ORs) and their 95% CI for all RF. Those with associated P-values <0.100 were included in a multivariate logistic regression analysis to obtain the odds ratios (OR) adjusted by the effects of the others. The variables with not significant beta coefficients were eliminated, producing a reduced model. BMI (<25 kg/m(2)), calcium intake (<1.2g/day), menopause (>10 years), and the simultaneous occurrence of kyphosis and personal fractures showed significant association with low bone mass at the lumbar spine and their effect was additive. Fitting of the data to the model was assessed with the Hosmer-Lemeshow test (P=0.926) The area under the ROC curve is 0.833 (95% CI=0.757-0.909). The following equation calculates the probability of having low spinal bone mass: The sensitivity, specificity and area under the ROC curve were defined. The point of maximum specificity and sensitivity derived from the ROC curve, has a probability of 0.409. With such a cut-off point, the equation has a sensitivity of 73%, specificity 79%, positive predictive value 65% and negative predictive value 85%. The second instrument associates very low lumbar bone mass with the number of risk factors accumulated per patient. At baseline, all subjects had four RFs: they were, women, white, post-menopausal, and with no previous exposure to estrogens. With six additional RFs the presumptive diagnosis of LBMD has a specificity of 99%, positive predicting value 94% and false positives 6.5%. The area under the curve in a ROC graph was 0.826 (95% CI=0.747-0.914). Comparing present instruments with others in the literature, it is concluded that each population require its own algorithm for the presumptive detection of subjects with low bone mass. The algorithm should be reassessed periodically if the characteristics of the population or its social-economic conditions change.

Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina.

OBJECTIVE: Our aim was to ascertain the effect of an infection control program, using education and performance feedback on intensive care units, for intravascular device (IVD)-associated bloodstream infection (BSI). METHODS: Within 4 level III, adult, intensive care units in Argentina, all admitted, adult patients with a central vascular catheter in place for at least 24 hours were included. This was a prospective before-and-after trial in which rates of IVD-associated BSI determined during a period of active surveillance without education or performance feedback (phase 1) were compared after sequential implementation of an infection control program using education (phase 2) and performance feedback (phase 3). RESULTS: A total of 1219 IVD days were accumulated in phase 1; 586 during phase 2; and 4140 during phase 3. Compliance with central vascular catheter--site care improved significantly from baseline during the study period. Overall rates of IVD-associated BSI were lowered significantly from baseline after sequential implementation of education and performance feedback (11.10 vs 46.63 BSI/1000 IVD days; relative risk=0.25; 95% confidence interval=0.17-0.36; P<.0001). Rates of IVD-associated BSI decreased significantly after implementation of an educational program (phase 1 to phase 2) (relative risk 0.37; confidence interval 0.19-0.73; P=.0026) and further reductions were seen after implementation of a performance feedback program (phase 2 to phase 3), although the reduction did not reach statistical significance (9.9 vs 17.06 BSI/1000 IVD days; relative risk 0.58; confidence interval 0.29-1.18; P=.11). Additional analysis of the data using chi2 for trends demonstrated that sequential implementation of an education and performance feedback program resulted in a significant trend toward reduced rates of IVD-associated BSI (P<.001). CONCLUSION: Implementation of an infection control program, using education and performance feedback, resulted in significant reductions in rates of IVD-associated BSI.

[Mortality rate trends for breast cancer in Rosario, Argentina. Association with socioeconomic factors]. / Evolución de las tasas de mortalidad por cáncer de mama en Rosario, Argentina. Asociación con factores socioeconómicos.

This report is based on data from death certificates of all women whose cause of death was breast cancer, residents in Rosario City, during two 5-year-periods: 1977-81 and 1988-92, in order to know these rates evolution. Deaths, which were allocated to the last residence of the decedents, were aggregated into the 22 census areas of the city. Age-standardized mortality rates (SMR) by area were correlated with socioeconomic variables. The SMR for the whole city was not different in the two studied periods: 38%000 and 36%000, respectively. However, while small changes were found in the high socioeconomic areas, important increments were found in the poorest ones, mainly in postmenopausal women. Consequently, geographic correlations also changed between the two studied periods. While in the first period negative correlations were found with variables considered as socioenvironmental pointers, such as fertility and infant mortality rates, these associations were positive in the last one.