Fibroblast phenylalanine concentration as a surrogate biomarker of cellular number.

Metabolomics studies in human dermal fibroblasts can elucidate the biological mechanisms associated with some diseases, but several methodological issues that increase variability have been identified. We aimed to quantify the amino acid levels in cultured fibroblasts and to apply different sample-based normalization approaches. Forty-four skin biopsies from control subjects were collected. Amino acids were measured in fibroblasts supernatants by UPLC-MS/MS. Statistical supervised and unsupervised studies were used. Spearman's test showed that phenylalanine displayed the second highest correlation with the remaining amino acids (mean r = 0.8), whereas the total protein concentration from the cell pellet showed a mean of r = 0.67. The lowest percentage of variation was obtained when amino acids were normalized by phenylalanine values, with a mean of 42% vs 57% when normalized by total protein values. When amino acid levels were normalized by phenylalanine, Principal Component Analysis and clustering analyses identified different fibroblasts groups. In conclusion, phenylalanine may be a suitable biomarker to estimate cellular content in cultured fibroblasts.

Sun protection behaviour in organ transplant recipients and non-transplant patients attending a dermatology outpatient clinic in Sweden: A questionnaire survey.

BACKGROUND/PURPOSE: Organ transplant recipients (OTRs) are at high risk of developing skin cancer and are therefore advised to protect their skin against ultraviolet radiation from the sun. Specialized OTR clinics with dermatological follow-up may improve sun habits among OTRs. In this study, we compared self-reported sun exposure and sun protection behaviour between OTRs and non-transplant patients (non-TPs) and between OTRs with and without special dermatological follow-up. METHODS: Patients from Sahlgrenska University Hospital, Gothenburg, Sweden, completed a sun exposure questionnaire. Between 2011 and 2015, 282 OTRs transplanted in the period 1976-2014 and 414 non-TPs were recruited among dermatological outpatients. Participants were stratified into five groups by their status as OTRs or non-TPs and by attendance to dermatological follow-up. RESULTS: More non-TPs than OTRs reported one or more sunburns in the past year, 46% vs. 20%, P < .0001). More OTRs with than OTRs without dermatological follow-up reported frequent use of sunscreens (63% vs 44%, P = .006). More OTRs with follow-up used one or more sun protection measure such as covering clothes, than other OTRs (54% vs 34%, P = .016). CONCLUSION: In this study, OTRs reported less sun exposure than non-TPs. Specialized dermatological follow-up seems to improve sun protection behaviour among OTRs. We suggest that specialized OTR clinics should be more broadly implemented.

Degree of differentiation of cutaneous squamous cell carcinoma: a comparison between a Swedish cohort of organ transplant recipients and immunocompetent patients.

BACKGROUND: Organ transplant recipients (OTRs) have a very high risk of developing cutaneous squamous cell carcinoma (cSCC). Immunosuppressed OTRs may have a higher proportion of poorly differentiated cSCC than non-OTRs. OBJECTIVES: The aim of this study was to investigate the degree of differentiation of cSCCs in OTRs compared with immunocompetent individuals. PATIENTS/METHODS: Data from the Swedish Cancer Registry were crosschecked with data from the Transplant registry of the Transplant Institute at Sahlgrenska University Hospital in Gothenburg, Sweden. All OTRs with a diagnosis of cSCC, basosquamous carcinoma, and/or cSCC in situ established at the Department of Dermatology, Sahlgrenska University Hospital, during 2002-2015 were included. The control group consisted of non-OTRs with the same diagnoses during the same time period. RESULTS: During 2002-2015, 82 OTRs diagnosed with 515 tumors and 883 non-OTRs with 1,247 tumors were included. OTRs developed 0.47 tumors/year vs 0.10 tumors/year for non-OTRs, but no significant differences were observed in the degree of tumor differentiation of invasive cSCCs between OTRs and non-OTRs (P = 0.4). The distribution of poorly, moderately, and well-differentiated invasive cSCCs among OTRs and non-OTRs were 8.5% vs 12.5%, 22.1% vs 29.9%, and 69.4% vs 57.6%, respectively. CONCLUSIONS: OTRs do not develop a higher proportion of poorly differentiated cSCCs than non-OTRs.

Repercusión social en la persona con traumatismo craneoencefálico / Social repercussion in the person with traumatic brain injury

Resumen

Introducción: el enfoque social de una lesión cerebral por traumatismo craneoencefálico, de primera instancia, tiene que ver con la adquisición de una discapacidad que tendrá un impacto importante sobre la función social de quién lo padece.

Desarrollo: incluye los aspectos de percepción y manejo del trauma craneoencefálico, el cual se manifiesta por deterioro físico o funcional con daño neuropsicológico, la presencia de lesiones primarias y lesiones secundarias denominadas insultos extra neurológicos interfieren en la atención, la memoria, las funciones frontales, la emoción y la conducta. La valoración neuropsicológica posterior al traumatismo craneoencefálico se enfoca al deterioro intelectual, la movilidad voluntaria y el nivel de conciencia.

Conclusiones: el entorno social de las personas con traumatismo craneoencefálico, de acuerdo con la magnitud de la lesión, pueden presentar reacciones antisociales, por lo tanto la intervención de un profesional neuroeducador es la mejor alternativa para mejorar las respuestas conductuales, cognitivas y de aprendizaje.

Abstract

Introduction: The social approach to a brain injury due to traumatic brain injury, first instance has to do with the acquisition of a disability, which will have a significant impact on the social function of who has it.

Development: Includes aspects of perception and management of cranioencephalic trauma, which is manifested by physical or functional impairment with neuropsychological damage, presence of primary lesions and secondary lesions called extra neurological insults interfere with attention, memory, frontal functions, emotion and behavior. The neuropsychological assessment after traumatic brain injury focuses on intellectual deterioration, voluntary mobility and level of consciousnes.

Conclusions: The social environment of people with traumatic brain injury, according to the magnitude of the injury, may present antisocial reactions; therefore the intervention of a neuroeducator is the best alternative to improve the behavioral, cognitive and learning responses.

Multiple Primary Melanomas: A Common Occurrence in Western Sweden.

Patients diagnosed with a single primary cutaneous melanoma are at increased risk of developing multiple primary melanomas. The aim of this study is to describe the epidemiology of multiple primary melanomas (invasive and in situ) in Western Sweden. Data from the Swedish Melanoma Registry from 1990 to 2013 revealed that 898 patients (7.4%) developed 2,037 multiple primary lesions and 11,254 patients developed single lesions. The proportion of subsequent lesions that were melanoma in situ was 47%, compared with 26% of first melanomas (p < 0.0001).The median and mean time to diagnosis of a subsequent melanoma was 38 and 58 months (95% confidence interval (CI), 53-62 months). In total, 49% of subsequent melanomas were detected within 3 years. Patients and physicians should be aware of the high proportion of multiple primary melanomas in Western Sweden, especially during the first years of follow-up.

Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway.

Incidence rates for cutaneous malignant melanoma are increasing worldwide. Estimates of the future number of melanoma cases are important for strategic planning of the care pathway. The aim of this study was to use system dynamics modelling to evaluate the long-term effects of changes in incidence, population growth and preventive interventions. Historical data on invasive melanoma cases in Western Sweden from 1990 to 2006 were obtained. Using computer simulation software, a model estimating the accumulated number of melanoma cases for 2014 to 2023 was developed. Five future scenarios were designed: stable incidence, business-as-usual, 25% reduced patient's delay, 50% reduced doctor's delay, and a combination of the last two, called improved overall secondary prevention. After 10 years, improved overall secondary prevention would have resulted in a 42% decrease in melanomas > 4 mm and a 10% increase in melanomas ≤ 1 mm, compared with business-as-usual. System dynamics is a valuable tool, which can help policymakers choose the preventive interventions with the greatest impact.

Epidemiology of injuries in the Spanish national futsal male team: a five-season retrospective study.

BACKGROUND: Futsal started being played in 1930 and the number of futsal players has increased all over the world ever since. Nonetheless, despite the fact that Spain is one of the most relevant national teams worldwide, information on the incidence of injuries and their anthropometric characteristics is sparse in this country. AIM: To analyse medical assistance provided to players in their prematch concentration camps with the Spanish national team over five seasons, from 2010-2011 to 2014-2015, and also to collect data regarding anthropometric characteristics. MATERIALS AND METHODS: This is a retrospective and detailed study of injuries players suffered over these five seasons. All variables were registered on an Excel spreadsheet and later analysed statistically. RESULTS: 411 injuries were studied in total. The dominant somatotype was mesomorph and the injured pivots were both the most endomorphic and the most mesomorphic. The most injured body structure was the hamstring muscles, occurring due to training and intrinsic mechanisms, where fatigue was the most frequent diagnosis. Only a few complementary examinations were carried out and prematch withdrawal was rare. DISCUSSION: The skinfold test total sum was lower than that of the Spanish 11-a-side players or than that in the lower category futsal Spanish players. In various research studies analysing exclusively injuries occurring in matches, the most frequent injury is ligament injury by extrinsic mechanism. The body mass index was not a useful parameter when assessing players' appropriate weight. Most injuries occurred in training sessions, mostly by intrinsic mechanism; the highest percentage of traumatic injuries occurred in official matches.

Oral and lip cancer in solid organ transplant patients--a cohort study from a Swedish Transplant Centre.

OBJECTIVES: Previous large studies have shown that solid organ transplant (SOT) patients have an increased risk of developing malignancies. Few studies have compared the prognosis for SOT patients who develop cancer with that of non-transplanted cancer patients. In this study we have investigated the increased risk of oral and lip cancer in SOT patients and also compared the relative survival between SOT patients and non-SOT patients with oral and lip cancer. PATIENTS AND METHODS: From the patient registers at the Transplant Institute at Sahlgrenska University Hospital, records of 4604 SOT patients from 1965 to 2010 were collected. These patient records were linked to the nationwide Swedish Cancer Register and compared to those of the normal population regarding the risk of developing oral and lip cancer, and also to non-SOT patients with lip and oral cancer. A Poisson regression model was used to compare the relative survival between SOT and non-SOT patients with oral and lip cancer. RESULTS: We observed 17 oral cancers (expected 2.69) and 34 lip cancers (expected 0.78) in the cohort. The standardized incidence ratio (SIR) for oral cancer was 6.32 (95% CI, 3.7-10.1) and 43.7 (95% CI, 30.3-61.1) for lip cancer. Relative five-year survival for lip cancer was lower for SOT patients compared to non-SOT patients (p<0.001). CONCLUSION: This study shows that SOT patients have a higher risk of developing both oral and lip cancer, and in addition, that SOT patients with lip cancer have a worse prognosis.

Patients' experiences of pain and pain relief during photodynamic therapy on actinic keratoses: an interview study.

Photodynamic therapy (PDT) is a well-known, effective method for treating extensive areas of multiple actinic keratoses in the face and scalp. The main side-effect of PDT is the pain experienced during treatment. The objective of this study was to explore and describe patients' experiences of PDT. The study used individual interviews, and analysis was carried out using phenomenography. The patients had all been treated with PDT for actinic keratoses on the face and scalp, and experienced PDT with and without nerve blocks. The results are presented in 3 themes and 10 categories. Most patients reported that the nerve blocks given prior to PDT altered their experience of pain. Alternative options are needed to reduce pain during PDT based on patients' needs and body site. This study adds a patient perspective highlight-ing patients' own voices as a qualitative complement to statistical analysis using the visual analogue scale.

Incidence of cutaneous melanoma in Western Sweden, 1970-2007.

The aim of this study was to describe the increasing incidence of cutaneous malignant melanoma (CMM) in Western Sweden during the period 1970-2007. A secondary aim was to show a geographical variation in incidence between coastal and inland areas, considering the effects of the local average duration of sunshine, and the sun exposure-related behavior in the populations. The Swedish Cancer Registry provided data on invasive melanomas during 1970-2007. Meteorological maps showed the annual average duration of sunshine during 1961-1990. A survey from 2007 with 2871 participants, carried out by the National Board of Health and Welfare, provided data on self-reported sun exposure. During the period studied, the age-standardized incidence for men in Western Sweden more than quadrupled to 31.1/100 000 inhabitants, whereas it tripled for women to 27.1/100 000. Coastal areas, including Gothenburg city, had a high average duration of sunshine (1701-1900 h of sun/year), whereas inland areas had lower average duration of sunshine (≤1700 h). The incidence of CMM was higher in coastal areas and in Gothenburg city, compared with inland areas. This may be linked to ultraviolet radiation, a consequence of the higher average duration of sunshine. The sun exposure survey showed additional factors, which possibly led to the increased incidence, for example high sun exposure on holidays abroad. The alarming increase in the incidence of CMM in Western Sweden, during the period 1970-2007, shows the need for additional primary preventive measures, for example sun protection programs targeted at populations in this area.

Predictors of pain associated with photodynamic therapy: a retrospective study of 658 treatments.

Pain is the most common side-effect of photodynamic therapy (PDT). Our main objective was to identify pain predictors in PDT. In total, we performed 658 treatments on 377 patients at our department during 2004. Larger sized treatment areas were the strongest pain predictor, and actinic keratoses were more painful to treat than basal cell carcinomas and Bowen's disease. The most sensitive areas to treat were the face and scalp. Gender and age did not influence pain. Although treatment outcome was not our primary objective, 62% of 95 superficial basal cell carcinomas that were followed for 3 years showed complete clearance. Also, perforation of nodular basal cell carcinomas did not lead to better clinical results. In conclusion, the size of the treatment area, the diagnosis and the lesion location influence pain during PDT. Nevertheless, there is a large variance in visual analogue scale assessment within each group, thereby limiting the ability to predict pain.

Percutaneous absorption with emphasis on sunscreens.

Sunscreens are widely used products. When recreationally used they are applied to large areas of the skin repeatedly. In moisturizers and foundation it is common to find sun protective ingredients, in these cases the product is usually applied to smaller areas but often done daily. Active ingredients in sunscreens can be absorbed by the skin. Percutaneous absorption is an important factor to take into consideration. There are several methods to measure the percutaneous absorption, both in vivo and/or in vitro. This paper will give an overview of the different methods.

Solid-phase extraction and reverse-phase HPLC: application to study the urinary excretion pattern of benzophenone-3 and its metabolite 2,4-dihydroxybenzophenone in human urine.

BACKGROUND: Benzophenone-3 (BZ-3) is a common ultraviolet (UV) absorbing compound in sunscreens. It is the most bioavailable species of all UV-absorbing compounds after topical application and can be found in plasma and urine. OBJECTIVES: The aim of this study was to develop a reverse-phase high performance liquid chromatography (HPLC) method for determining the amounts BZ-3 and its metabolite 2,4-dihydroxybenzophenone (DHB) in human urine. The method had to be suitable for handling a large number of samples. It also had to be rapid and simple, but still sensitive, accurate and reproducible. The assay was applied to study the urinary excretion pattern after repeated whole-body applications of a commercial sunscreen, containing 4% BZ-3, to 25 healthy volunteers. METHODS: Each sample was analyzed with regard to both conjugated/non-conjugated BZ-3 and conjugated/non-conjugated DHB, since both BZ-3 and DHB are extensively conjugated in the body. Solid-phase extraction (SPE) with C8 columns was followed by reverse-phase HPLC. For separation a Genesis C18 column was used with an acethonitrile-water mobile phase and the UV-detector was set at 287 nm. RESULTS: The assay was linear r(2) > 0.99, with detection limits for BZ-3 and DHB of 0.01 micromol L(-1) and 0.16 micromol L(-1) respectively. Relative standard deviation (RSD) was less than 10% for BZ-3 and less than 13% for DHB. The excretion pattern varied among the human volunteers; we discerned different patterns among the individuals. CONCLUSIONS: The reverse-phase HPLC assay and extraction procedures developed are suitable for use when a large number of samples need to be analyzed and the method fulfilled our objectives. The differences in excretion pattern may be due to differences in enzyme activity but further studies, especially about genetic polymorphism, need to be performed to verify this finding.

Photostability of commercial sunscreens upon sun exposure and irradiation by ultraviolet lamps.

BACKGROUND: Sunscreens are being widely used to reduce exposure to harmful ultraviolet (UV) radiation. The fact that some sunscreens are photounstable has been known for many years. Since the UV-absorbing ingredients of sunscreens may be photounstable, especially in the long wavelength region, it is of great interest to determine their degradation during exposure to UV radiation. Our aim was to investigate the photostability of seven commercial sunscreen products after natural UV exposure (UVnat) and artificial UV exposure (UVart). METHODS: Seven commercial sunscreens were studied with absorption spectroscopy. Sunscreen product, 0.5 mg/cm2, was placed between plates of silica. The area under the curve (AUC) in the spectrum was calculated for UVA (320-400 nm), UVA1 (340-400 nm), UVA2 (320-340 nm) and UVB (290-320 nm) before (AUCbefore) and after (AUCafter) UVart (980 kJ/m2 UVA and 12 kJ/m2 of UVB) and before and after UVnat. If theAUC Index (AUCI), defined as AUCI = AUCafter/AUCbefore, was > 0.80, the sunscreen was considered photostable. RESULTS: Three sunscreens were unstable after 90 min of UVnat; in the UVA range the AUCI was between 0.41 and 0.76. In the UVB range one of these sunscreens was unstable with an AUCI of 0.75 after 90 min. Three sunscreens were photostable after 120 min of UVnat; in the UVA range the AUCI was between 0.85 and 0.99 and in the UVB range between 0.92 and 1.0. One sunscreen showed in the UVA range an AUCI of 0.87 after UVnat but an AUCI of 0.72 after UVart. Five of the sunscreens were stable in the UVB region. CONCLUSION: The present study shows that several sunscreens are photounstable in the UVA range after UVnat and UVart. There is a need for a standardized method to measure photostability, and the photostability should be marked on the sunscreen product.

Caracterización de la evolución del estado nutricional de pacientes con cáncer de mama en tratamiento quimioterapéutico / Characterization of the evolution of the nutricional condition of patient with breast cancer on chemotherapy

Introducción: El cáncer de mama es común en las mujeres y es tratado regularmente con quimioterapia. Se ha afirmado que este tratamiento afecta el estado nutricional porque produce sintomatología gastrointestinal y modifica el consumo de alimentos. Objetivos: Caracterizar las alteraciones nutricionales en mujeres con cáncer de mama tratadas con adriamicina y ciclofosfamida(AC). Materiales y métodos: Se realizó un estudio longitudinal prospectivo con veinticinco pacientes durante tres ciclos continuos de quimioterapia. El consumo de alimentos y los indicadores antropométricos de estado nutricional se midieron antes del tratamiento y al iniciar cada ciclo y los síntomas gastrointestinales se evaluaron semanalmente. Resultados: Durante la quimioterapia se disminuyó el consumo de carnes, postres y productos de pandería, se redujeron el tamaño de la porción y la frecuencia del consumo de queso, frutas y arroz. El 40 porciento de las mujeres se encontraron eutróficas y otro 40 porciento en sobrepeso, antes de y duarante el tratamiento. Los síntomas gastrointestinales más frecuentes fueron xerostomía (61 porciento= y náuseas (55 porciento). el 56 porciento de las pacientes presentaron cambios en el olfato y el 47 porciento en el gusto. Los alimnetos más rechazados fueron carne de res, pescado, leche y yogurt. Se encontró asociación estadísticamente significativa entre las alteraciones del olfato y el gusto y la aversión a los alimentos, pero no entre aversiones y disminución del consumo de alimentos. Conclusiones: El tratamiento a corto plazo con adriamicina y ciclofosfamida no produjo modificación en el peso corporal durante la qumioterapia y, a pesar de los efectos gastrointestinales, el conumo de alimentos no se afectó de manera importante

Estrategia de fortalecimiento de la planeación local en salud, implementada por la Secretaría Distrital de Salud en las localidades entre enero de 2001 y agosto de 2002 / Strategy for strengthening local health planning, implemented by the District Health Secretariat in the localities between January 2001 and August 2002

Este documento recoge la experiencia de evaluación y sistematización de los resultados de la Estrategia de fortalecimiento de la planeación local en salud, realizada entre enero de 2001 y el 30 de agosto del 2002, en las veinte localidades del Distrito Capital, con el fin de brindar a la Secretaría Distrital de Salud, a las empresas sociales del Estado y a los integrantes de los mecanismos de participación social, información concreta, real y focalizada para la toma de decisiones en la consecución de recursos y en el seguimiento de los planes de desarrollo local 2002-2004

Respiratory syncytial virus prophylaxis: cost-effective analysis in Argentina.

INTRODUCTION: Respiratory syncytial virus is a major cause of bronchiolitis during the first year of life. Preterm infants and patients with bronchopulmonary dysplasia (BPD) have a higher risk of hospitalization. The objective of this study was to assess the risk of hospitalization and to evaluate the cost effectiveness of palivizumab use in our at risk population. METHODS: The study design was based on the hypothetical use of palivizumab in a cohort of patients. The cost effectiveness analysis included costs of palivizumab, the drug prescription and hospitalization. The effectiveness measure was the hospitalization rate decrease according to the result of the IMpact study: a 55% reduction in the need for hospitalization attributable to RSV. The years 1998 and 1999 were analyzed. Evaluable patients had follow-up at the High Risk Clinic and fulfilled the American Academy of Pediatrics criteria for palivizumab prophylaxis. RESULTS: Forty-two patients, 24 with BPD and 18 preterm infants without BPD, were evaluated. Ten patients required hospitalization because of respiratory syncytial virus; one of them died. Hospitalization cost was $184,777. The total palivizumab administration cost would have been $185,064. With a 55% decrease of hospitalization rate, the cost per hospitalization averted would have been $15,358, and the number needed to treat would have been 7.9. A sensitivity analysis showed that the cost per hospitalization averted could range between $2,171 and $48,630 according to the hospitalization rate. CONCLUSIONS: Because new effective but expensive treatments like palivizumab are available, this cost effective analysis can be an important tool in decisions about resource distribution.

Sensibilidade e especifidade do diagnóstico clínico, sorológico e tomográfico da encefalite por Toxoplasma gondii na síndrome da imodeficiência adquirida (SIDA) / The sensivity and specifity of the clinical , serological and tomographic diagnosis of Toxoplasma gondii encephalitis in the acquired immunodeficiency syndrome (AIDS)

A encefalite por Toxoplasma gondii (ET) é a principal causa de massa no sistema nervoso central (SNC) em pacientes com a síndrome da imunodeficiência adquirida (SIDA). Com o objetivo de determinar a prevalência dessa afecçäo e da presença de anticorpos específicos no soro e no líquor, bem como a sensibilidade (S) e a especificidade (E) da tomografia computadorizada (TC), dos achados clínicos e dos testes específicos foram revisados todos os prontuários de 516 pacientes com SIDA, internados no HCPA entre maio/85 e dezembro/91. A prevalência através de TC foi de 13 por cento (diagnóstico preseuntivo). A pesquisa de anticorpos específicos para toxoplasmose por imunofluorescência indireta no sangue (SS) foi positiva em 65 por cento e no líquor (SL) em 49 por cento dos pacientes em que foi realizada. Necrópsias de 125 pacientes foram revisadas encontrando-se uma prevalência de ET em 27 (22 por cento) casos, em que o diagnóstico foi considerado definitivo. A sensibilidade da TC foi de 65 por cento e a especificidade de 82 por cento. A SS apresenta S de 95 por cento e E de 30 por cento, enquanto a SL apresentou uma S de 77 por cento e E de 56 por cento. Os seguintes achados clínicos foram pesquisados: febre (S=92 por cento; E=56 por cento); sinais neurológicos focais (S=59 por cento; E=82 por cento) e cefaléia (S=41 por cento; E=69 por cento. Concluímos que é alta a prevalência da ET na SIDA e que a TC e a pesquisa de anticorpos específicos no soro e no líquor, devido à alta especificidade da primeira e a alta sensibilidade da segunda, constituem-se em métodos adequados para o diagnóstico da ET, sendo discutível a necessidade de realizar biópsia cerebral nesses casos