Ultrahypofractionation in postoperative radiotherapy for breast cancer: A single-institution retrospective cohort series.

BACKGROUND: The 'FAST-forward', study published in April 2020, demonstrated the effectiveness of an extremely hypofractionated radiotherapy schedule, delivering the total radiation dose in five sessions over the course of 1 week. We share our department's experience regarding patients treated with this regimen in real-world clinical settings, detailing outcomes related to short-term toxicity and efficacy. METHODS: A descriptive observational study was conducted on 160 patients diagnosed with breast cancer. Between July 2020 and December 2021, patients underwent conservative surgery followed by a regimen of 26 Gy administered in five daily fractions. RESULTS: The median age was 64 years (range: 43-83), with 82 patients (51.3%) treated for left-sided breast cancer, 77 patients (48.1%) for right-sided breast cancer, and 1 instance (0.6%) of bilateral breast cancer. Of these, 66 patients had pT1c (41.3%), 70.6% were infiltrative ductal carcinomas, and 11.3% were ductal carcinoma in situ. Most tumours exhibited intermediate grade (41.9%), were hormone receptor positive (81.3%), had low Ki-67 (Ki-67 < 20%; 51.9%) and were Her 2 negative (85%). The majority of surgical margins were negative (99.4%). Among the patients, 72.5% received hormonotherapy, and 23.8% received chemotherapy. Additionally, 26 patients (16.3%) received an additional tumour boost following whole breast irradiation (WHBI) of 10 Gy administered in five sessions of 2 Gy over a week. The median planning target volume (PTV) was 899 cm3 (range: 110-2509 cm3). Early toxicity was primarily grade I radiodermatitis, affecting 117 patients (73.1%). During a median follow-up of 15 months (range: 3.9-28.77), only one patient experienced a local relapse, which required mastectomy. CONCLUSIONS: The implementation of this highly hypofractionated regimen in early-stage breast cancer appears feasible and demonstrates minimal early toxicity. However, a more extended follow-up duration would be required to evaluate long-term toxicity and efficacy accurately.

Cutaneous polyarteritis nodosa: An atypical simulator. Report of 3 cases and a narrative review of the literature

Objectives: To report the clinical manifestations and therapeutic schemes established in three patients with cutaneous polyarteritis nodosa, as well as to describe the pathophysiology, clinical features, diagnostic criteria, and therapeutic options. Methods: A literature review was performed using Google scholar and PubMed and MeSH terms. There was no limit on the publication date or language for the selection of the articles. Results: Cutaneous polyarteritis nodosa is an uncommon small and medium-sized vessel vasculitis, and is rarely reported in Colombia. Although its pathophysiology is unknown, it is considered to be mediated by the deposition of immunocomplexes in the walls of blood vessels. It can be triggered by infectious agents and be associated with autoimmune diseases. The cutaneous manifestations mainly include subcutaneous painful nodules, livedo reticularis, and ulcers. Myalgia, arthralgia, peripheral neuropathy, and fever can also be present. It represents a diagnostic challenge. Treatment is not standardized and is guided according to the severity. Conclusions: Cutaneous polyarteritis nodosa is a rare entity, with a wide variety of cutaneous manifestations. There is still no specific diagnostic test. Its diagnosis represents a challenge for the dermatologist, and requires multidisciplinary management, in which the rheumatologist plays a fundamental role.

Objetivos: Reportar las diferentes manifestaciones clínicas y los esquemas terapéuticos instaurados en 3 pacientes con poliarteritis nudosa cutánea. Así mismo, describir la fisiopatología, el cuadro clínico, los criterios diagnósticos y las opciones terapéuticas. Métodos: Se realizó una búsqueda de la literatura en Google Académico y PubMed utilizando términos MeSH. En la selección de la bibliografía, la búsqueda no se limitó por fecha de publicación ni por idioma, debido al escaso número de reportes. Resultados: La poliarteritis nudosa cutánea es una vasculitis de pequeño y mediano vaso, infrecuente, poco reportada en Colombia. Su fisiopatología no es del todo conocida, se considera mediada por el depósito de inmunocomplejos en las paredes de vasos sanguíneos; puede ser desencadenada por agentes infecciosos y asociarse con enfermedades autoinmunes. Las manifestaciones cutáneas incluyen principalmente nódulos subcutáneos dolorosos, livedo reticular y úlceras. A nivel extracutáneo podrían encontrarse mialgias, artralgias, neuropatía periférica y fiebre. El diagnóstico representa un desafío. El tratamiento no está estandarizado y es guiado según la severidad de la patología. Conclusión: La poliarteritis nudosa cutánea es una entidad poco frecuente, con una amplia variedad de manifestaciones cutáneas. Hasta el momento, no contamos con una prueba diagnóstica específica. Su diagnóstico representa un reto para el dermatólogo y requiere un manejo multidisciplinario, en el cual el reumatólogo desempeña un papel fundamental.

Importance of dose in palliative treatment for incurable head and neck cancer with radiotherapy.

PURPOSE: To identify predictors of palliation for head and neck cancer treated with the "Hypo Trial" hypofractionated radiation therapy regimen in a clinical setting. DESIGN/METHOD: We retrospectively assessed 106 consecutive patients with incurable cancer, treated between January 2008 and December 2018. Regimen used was 30-36Gy in 5-6 biweekly fractions of 6Gy. RESULTS: The prescription dose was 30Gy in 57 (53.8%) patients and 36Gy in 49 (46.2%) patients. 89.6% patients completed the prescribed treatment. With a median follow-up of 6.92 months, 79.2% of the patients experienced clinical palliation. Palliation was correlated with the radiation therapy dose (P = 0.05). Median overall and progression-free survival (OS, PFS) were 7 and 4.63 months, respectively. Achieving palliation was associated to OS (P = 0.01). CONCLUSIONS: This short palliative hypofractionated scheme resulted in a high rate of palliation, with excellent compliance and acceptable toxicity. Our results show that radiation dose is a predictive factor for palliation.

[Results of the neonatal screening on Western Andalusia after a decade of experience.] / Resultados del cribado neonatal de Andalucía Occidental tras una década de experiencia.

OBJECTIVE: The main justification of this study was to describe our experience in neonatal screening and to define the prevalence of the diseases included in the neonatal screening program in Andalusia, among which are congenital hypothyroidism, expanded screening (aminoacidopathies, mitochondrial beta-oxidation defects and organic acidurias), cystic fibrosis, and screening for sickle cell anemia. METHODS: The study was carried out in the Metabolopathies Unit of the Virgen del Rocío Hospital in Seville with samples of newborns from Western Andalusia (Cádiz, Córdoba, Huelva and Seville) and autonomous city of Ceuta. A total of 435,141 newborns were studied (from the period from April 1st 2009 to December 31st 2019) to rule out congenital hypothyroidism and expanded screening; 378,306 for cystic fibrosis from May 1st 2011 to the same date described above. Finally, sickle cell anemia screening was included, which comprised a total of 55,576 newborns from November 26th, 2018 to the same period as the previous ones. Statistical analysis was performed using IBM SPSS software (version 22, SPSS INC., USA). RESULTS: The study revealed a prevalence of 1:1565 newborns for congenital hypothyroidism, 1:1532 newborns for extended screening, 1:6.878 newborns for cystic fibrosis, and a 1:11.115 newborns for sickle cell disease. CONCLUSIONS: The neonatal screening program allows a large number of newborns to benefit from the early detection of certain serious congenital diseases. This aim improves the morbidity and mortality of those who suffer from them.

OBJETIVO: La principal justificación del trabajo fue describir nuestra experiencia en cribado neonatal y definir la prevalencia de cada una de las enfermedades incluidas en el programa de cribado neonatal de Andalucía, entre las que se encuentran el hipotiroidismo congénito, cribado ampliado expandido (aminoacidopatías, defectos de la beta-oxidación mitocondrial y acidurias orgánicas), fibrosis quística y enfermedad de células falciformes. METODOS: El estudio se realizó en la Unidad del Laboratorio de Metabolopatías del Hospital Universitario Virgen del Rocío de Sevilla con muestras de recién nacidos de Andalucía Occidental (Cádiz, Córdoba, Huelva y Sevilla) y la ciudad autónoma de Ceuta. Para descartar hipotiroidismo congénito y cribado ampliado expandido se estudiaron un total de 435.141 recién nacidos, con fecha de inicio el 1 de abril de 2009. El cribado de fibrosis quística comenzó el 1 de mayo de 2011, siendo estudiados un total de 378.306 recién nacidos. Por último, el 26 de noviembre de 2018 se incorporó el cribado de anemia de células falciformes, que comprendió un total de 55.576 recién nacidos. La fecha fin de estudio fue el 31 de diciembre de 2019 para todas las patologías descritas anteriormente. El análisis estadístico se realizó usando el software IBM SPSS (versión 22, SPSS INC., EEUU). RESULTADOS: El estudio reveló una prevalencia de 1:1.565 recién nacidos para hipotiroidismo congénito, 1:1.532 para cribado ampliado expandido, 1:6.878 para fibrosis quística y 1:11.115 recién nacidos para enfermedad de células falciformes. CONCLUSIONES: El programa de cribado neonatal permite que se beneficien gran número de recién nacidos en la detección precoz de determinadas enfermedades congénitas graves y, con ello, mejora la morbimortalidad de aquellos que las padecen.

Liquen escleroso y atrófico extragenital en hombre con cáncer de próstata: ¿manifestación cutánea paraneoplásica? / Extragenital lichen sclerosus et atrophicus in man with prostate cancer: paraneoplastic skin manifestation?

Resumen Introducción: los síndromes esclerodermiformes se definen por la presencia de esclerosis cutánea, induración y pérdida de la elasticidad de la piel. Su diagnóstico diferencial incluye casos de escleroderma localizada, dentro de los cuales se describe el liquen escleroso y atrófico que, hasta la fecha, no se ha reconocido en el escenario de síndromes cutáneos paraneoplásicos. Resultados: se presenta el caso de un paciente con adenocarcinoma de próstata avanzado, quién desarrolló lesiones compatibles con liquen escleroso y atrófico extragenital durante el curso de su enfermedad oncológica, confirmadas por histopatología. Conclusiones: Se cuestiona la naturaleza paraneoplásica de esta entidad cutánea en este contexto clínico particular

Abstract Introduction: Scleroderma syndromes are defined by the presence of skin sclerosis, induration and loss of skin elasticity. Their differential diagnosis includes cases of localized scleroderma, within which lichen sclerosus et atrophicus are described, which, to date, have not been recognized in the setting of paraneoplastic skin syndromes. Results: We present the case of a patient with advanced adenocarcinoma of the prostate, who developed cutaneous lesions compatible with extragenital lichen sclerosus et atrophicus during the course of the cancer, confirmed by histopathology. Conclusions: The paraneoplastic nature of this skin entity is questioned in this particular clinical context.

Enfoque de los factores de riesgo de la lepra con las determinantes sociales de la salud / Approach to the risk factors for leprosy based on social determinants of health

Objetivos: identificar los factores de riesgo de la lepra, según las determinantes de salud. Métodos: estudio observacional descriptivo de carácter transversal. La muestra estuvo constituida por todos los casos de lepra notificados en la provincia desde 2009 hasta mayo de 2011. Para la obtención de la información se revisaron las tarjetas de enfermedades de declaración obligatoria y las encuestas epidemiológicas. Se utilizó como medida de resumen el porcentaje. Resultados: los principales factores de riesgos que se identificaron en el elemento de la biología humana fue la infección multibacilar; en el medio ambiente, el riesgo de la convivencia con pacientes con baciloscopia positiva; en la organización de la atención de salud el fallo del sistema de salud, al prevalecer la detección espontánea de los casos; en cuanto a estilos de vida, la conducta individual de las migraciones. De forma general, en la base socioeconómica, 40,7 por ciento de los pacientes tenían bajo nivel escolar. Conclusiones: estos factores de riesgo socioeconómicos, son de importancia ya que se conoce que el Mycobacterium leprae, es un germen transmisible, que requiere condiciones especiales para manifestar su patogenicidad, condicionamientos inmunogenéticos de receptividad individual y predominantemente. Alteraciones inmunoreactivas, determinadas por factores socioeconómicos que deprimen los mecanismos de defensa a la invasión bacteriana en grupos poblacionales que viven en hacinamiento, con déficit nutricionales y alteraciones metabólicas, así como un conjunto de factores dependientes de la pobreza, propios de países subdesarrollados, y que juegan un papel determinante en la presentación de la enfermedad(AU)

Objectives: identify the risk factors for leprosy on the basis of health determinants. Methods: cross-sectional observational descriptive study. The sample consisted of all the leprosy cases reported in the province from 2009 to May 2011. Data were obtained from notifiable disease cards and epidemiological surveys. The summary measurement used was percentage. Results: the main risk factors identified were the following: in human biology, multibacillary infection; in the environment, living with positive bacilloscopy patients; in health care, failure of the health system, since spontaneous detection prevails; and in life styles, the individual behavior of migrations. From a socioeconomic point of view, 40.7 percent of patients had a low schooling level. Conclusions: these are important socioeconomic risk factors. It is a well known fact that Mycobacterium leprae is a communicable germ requiring special conditions to manifest its pathogenicity: individual immunogenic reception conditioning and most of all immunoreactive alterations determined by socioeconomic factors depressing the defense mechanisms against bacterial invasion in population groups living in crowded conditions, with nutritional deficits and metabolic alterations, as well as a number of poverty-related factors typical of underdeveloped countries, which play a decisive role in the development of the disease(AU)

Prevalencia y pronóstico de la lepra en Pinar del Río / Prevalence and prognosis of leprosy in Pinar del Rio

Introducción: la lepra es una enfermedad infecciosa crónica, granulomatosa, transmisible, poco contagiosa, causada por el bacilo Mycobacterium leprae, que afecta principalmente la piel, los nervios periféricos, la mucosa de las vías respiratorias superiores, los ojos y otras estructuras. Objetivo: estimar la prevalencia real a partir del cálculo de la prevalencia oculta y el pronóstico de la lepra en Pinar del Río para el 2013. Material y método: se realizó un estudio observacional descriptivo de carácter prospectivo, para la obtención de la información se revisaron las tarjetas de declaración obligatoria y las encuestas epidemiológicas de los casos de lepra. Se calcularon diferentes indicadores: tasa de prevalencia de lepra, la prevalencia oculta y el pronóstico de la enfermedad por el método de alisamiento exponencial. Resultados: la prevalencia de la lepra en la provincia en los últimos años tiene una tendencia al descenso, existiendo una diferencia entre la prevalencia conocida y la prevalencia real, al incrementarse esta última con la sumatoria de la prevalencia oculta que fue de 5 casos, con un pronóstico para la enfermedad para el 2013, similar al año anterior. Conclusión: el estudios reveló que aunque la lepra no constituye un problema de salud en la provincia, existen brechas en el sistema de vigilancia, que se identifican con el calculo del estimado de la prevalecía oculta que representa el número de casos de lepra, que no se diagnosticaron en la provincia en los últimos cinco años, lo que influirá en los indicadores operacionales y epidemiológicos del programa de lepra.

Introduction: leprosy is a chronic, mildly contagious granulomatous disease caused by the bacillus Mycobacterium leprae, affecting chiefly the skin, the peripheral nerves, the mucosa of the upper respiratory tracts, the eyes and other structures. Objective: to estimate the real prevalence by the calculation of the hidden prevalence and the prognosis of leprosy in Pinar del Río for the year 2013. Material and method: an observational descriptive study of prospective character was carried out; for obtaining the information, compulsory declaration cards and the epidemiological surveys of the leprosy cases were reviewed. Several indicators were calculated: leprosy prevalence rate, hidden prevalence, and the prognosis of the disease by the method of exponential smoothing. Results: in the last years, the prevalence of leprosy in P. Rio has a tendency towards decrease, existing a difference between the known prevalence and the real prevalence, on the increase of the latter to the sum of the hidden prevalence of 5 cases, with a forecast in the disease for 2013 similar to the previous year. Conclusion: the study revealed that although leprosy does not constitute a health problem in the Province, there are gaps in the surveillance system, identified after calculation of the estimate of hidden prevalence representing the number of leprosy cases, not diagnosed in the Province in the last five years, which will have an influence in the operational and epidemiological indicators of the leprosy program.

Enfoque de los factores de riesgo en lepra: un enfoque a partir de las determinantes sociales de la salud / Focus of the risk factors in leprosy: a focus starting from some social health determinants

Introducción: la lepra es una enfermedad infecciosa crónica, granulomatosa, transmisible aunque poco contagiosa, causada por el bacilo Mycobacterium leprae, que afecta principalmente la piel, los nervios periféricos, la mucosa de las vías respiratorias superiores, los ojos y otras estructuras. Objetivo: identificar los factores de riesgo de la lepra, enfocado según las determinantes de salud, en las que se estudiarán la biología humana, condiciones y estilos de vida, medio ambiente, organización de los servicios de salud, y la base socioeconómica. Materiales y métodos: estudio observacional descriptivo de carácter transversal, el universo del estudio estuvo constituido por los 27 casos de lepra notificados en la provincia de Pinar del Río, Cuba, de enero del 2009 hasta mayo del 2011. Para la obtención de la información se revisaron las tarjetas de declaración obligatoria y las encuestas epidemiológicas. Se utilizó como medida de resumen las frecuencias absolutas y el porcentaje. Resultados: los principales factores de riesgo que se identificaron fueron: en el elemento de la biología humana, la infección multibacilar; en el medio ambiente, el riesgo de la convivencia con pacientes con baciloscopía positiva; en la organización de la atención de salud, detección espontánea de los casos de lepra; en cuanto a los estilos de vida, la conducta individual de las migraciones, y de forma general en la base socioeconómica el 40,7% de los pacientes tenían bajo nivel escolar..

Introduction: leprosy is a chronic, infectious, granulomatous, transferable disease, although is not very contagious, caused by bacillus Mycobacterium leprae that affects the skin, the outlying nerves, the mucous membrane of the breathing superior roads, the eyes and other structures. Objective: to identify the risk factors of the leprosy focused in health determinants, in those that study the human biology, condition and lifestyles, environment, organization of the leprosy focused and the socioeconomic base. Materials and methods: observational descriptive study of traverse character, the universe of the study was constituted by the 27 cases of leprosy notified in the county of Pinal del Río, Cuba, from January of 2009 to May of 2011. To obtain the information the cards of mandatory declaration and the epidemic surveys were revised. It was used as summary measure the absolute frequencies and the percentage. Results: the main risk factors identified were: in the element of the human biology, the multibacilar infection; in the environment, the risk of the coexistence with a patient with positive baciloscopy test; in the organization of the health attention, spontaneous detection of the leprosy cases; as for the lifestyles, the individual behavior of the migrations, and in a general way in the socioeconomic base 40.7% of the patients had low school level..

Virulence factors of Trypanosoma cruzi: who is who?

The aim of this review is to gather the current knowledge of Trypanosoma cruzi's virulence factors described to date in an integrative way, relating these with the parasite's life cycle and trying to elucidate their importance in each process. Several aspects relevant for the parasite's survival, such as invasion, resistance to oxidative damage, escape from the phagolysosomal vacuole and differentiation, among others, will be discussed. However, there is still a lot to learn about what virulence really means in T. cruzi and which parasite molecules are absolutely required to make T. cruzi one of the most successful pathogens to invade, survive and persist in a mammalian host.

Características clínicas epidemiológicas de los cooperantes con dengue en el municipio Torres, estado de Lara, Venezuela, 2008 / Clinical and epidemiological characteristics of cooperation personnel diagnosed with dengue in the municipality of Torres, state of Lara, Venezuela, 2008

Se realizó un estudio descriptivo, de corte transversal, con el objetivo de identificar las características clínicas epidemiológicas de los cooperantes con dengue en el municipio Torres, en el estado de Lara, Venezuela, del 1ro. de junio de 2007 al 31 de julio de 2008. El universo de estudio quedó conformado por los 32 casos de dengue confirmados en el período de estudio. Se estudiaron las siguientes variables: edad, sexo, tipo de misión, factores de riesgos y las manifestaciones clínicas de los casos de dengue. Como medidas de resumen se utilizaron los números absolutos, frecuencias relativas, tasas, así como la determinación del índice de infestación a Aedes aegypti en las viviendas. Entre los principales resultados de la investigación se encontró que la morbilidad por dengue en los cooperantes del municipio Torres fue elevada, con una tasa de incidencia superior a la del Estado. En la muestra predominaron el sexo masculino y las edades entre 30 y 39 años. La mitad de los cooperantes de la misión agricultura enfermó de dengue. Entre los principales factores de riesgos se encontraron la presencia del vector y los criaderos en las viviendas, así como la baja percepción del riesgo sobre la enfermedad, lo que estuvo relacionado con el no uso de repelente, todos con un riesgo relativo mayor que 1. Las principales manifestaciones clínicas que se reportaron en los pacientes fueron la fiebre, la cefalea y la artralgia

A descriptive cross-sectional study was conducted with the purpose of identifying the clinical and epidemiological characteristics of cooperation personnel diagnosed with dengue in the municipality of Torres, state of Lara, Venezuela, from 1 June 2007 to 31 July 2008. The study group was composed of 32 dengue cases confirmed during the study period. The variables studied were age, sex, mission type, risk factors and clinical manifestations. The summary measurements used were absolute numbers, relative frequencies, rates, and household infestation rates for Aedes aegypti. One of the main findings of the study was the high dengue morbidity rate among cooperation personnel in the municipality of Torres, with an incidence rate higher than that of the state. Male sex and the 30-39 age range were predominant in the sample. Half the cooperation personnel in the agriculture mission became ill with dengue. Among the risk factors identified were the presence of the vector and breeding sites in households, and low risk perception of the disease, associated with the non-use of insect repellent. The relative risk of these factors was above 1. The main clinical manifestations observed in patients were fever, headache and arthralgia

Guía de evaluación de la atención médica en un centro oftalmológico de Venezuela, 2008 / Guide of assessment of the medical care in an Ophthalmology center in Venezuela, 2008

Se realizó la presente investigación con el objetivo de brindar una herramienta para la evaluación de un centro oftalmológico, con servicios de Misión Milagro implantados en Venezuela. La guía propuesta constó de 66 criterios e indicadores que servirían para evaluar las diferentes dimensiones. En estructura se tuvieron en cuenta las características de la planta física, la disponibilidad de recursos materiales, así como la cobertura, capacitación y competencia de los recursos humanos. Para el proceso se diseñaron guías de observación con el fin de evaluar las principales actividades realizadas por el equipo de salud y para los resultados se valorá la opinión de los trabajadores y la de los pacientes por los servicios recibidos. Para operacionalizar los criterios, indicadores y estándares se contó con la colaboración de varios expertos

A developmental research was carried out to offer a tool for assessment of an Ophthalmology center with Milagro's Mission service implemented in Venezuela. The guide proposed included 66 criteria and indicators allowing assessment of the different dimensions. As regards structure authors took into account the characteristics of the physical plant, the availability of human resources. For the process observational guides were designed that will allow the assessment of the main activities performed by the health staff and for results we considered the worker opinions and that of the service received by patients came to services. To make operative the criteria, indicators and standards we took into account the cooperation of some experts

Reacción en la lepra. Presentación de un caso clínico / Reactional leprosy. A case report

La reacción en la lepra es una modalidad clínica de presentación aguda o subaguda, de orden local o general, expresión de un fenómeno inmunológico, que ocurre en el curso evolutivo de la enfermedad. Puede suceder en alrededor del 30% de los pacientes multibacilares: lepromatosos y dimorfos. En la actual investigación se hace la presentación de un caso clínico, paciente masculino, de 44 años, con diagnóstico de lepra lepromatosa, que comenzó con exacerbación del cuadro clínico, con nódulos diseminados e infiltrados, que se correspondió con una reacción leprosa tipo 2, eritema nudoso leproso.

Reactional leprosy is a clinical modality of acute and sub-acute presentation which is local or general, expression of an immunological phenomenon that occurs in the natural history of the disease. It can arise in almost the 30% of the multibacillary, lepromatous and dimorphous patients. In this current study a case of forty four-year-old male patient diagnosed as lepromatous leprosy was reported. The patient presented an exacerbated presentation of the clinical chart with disseminated and infiltrated nodules corresponding to a type-2 reactional leprosy and erythema nodosum leprosum.

Factores de riesgo del intento suicida en adolescentes, Pinar del Río / Risk factors of suicide attempt in adolescents, Pinar del Río

Se realizó un estudio observacional analítico de caso y control, con el objetivo de identificar los factores de riesgo relacionados con el intento suicida en los adolescentes del municipio Pinar del Río, en el período comprendido de enero a junio del 2009. El universo del estudio estuvo constituido por la población de 10 a 19 años con intento suicida, quedando conformada la muestra por 36 casos contra 72 controles, seleccionados por un pareo de 1:2, se analizaron los factores de riesgo individuales y familiares asociados al intento suicida. Los datos se obtuvieron mediante la aplicación de un cuestionario diseñado por la autora de la investigación, se determinó la asociación entre los factores de riesgo y el intento suicida, a través de la prueba de Chi cuadrado y la razón de productos cruzados (OR) con estimación puntual y por intervalos de confianza; entre los principales resultados se encontró asociación estadística significativa al intento suicida, de los siguientes factores de riesgo: la presencia de adolescentes con desordenes mentales como depresión y retraso mental, dificultades escolares e internamiento invo luntario y el antecedente de suicidio por otro miembro del hogar.

An observational, analytical case-control study was carried out with the purpose of identifying the risk factors related to suicide attempt in adolescents in Pinar del Rio municipality from January to June 2009. The target group was comprised of the total population from 10 to 19 years old with suicide attempts; the sample consisted of 36 cases vs. 72 controls, chosen by a matching of 1:2, individual and familial risks factors associated with suicide attempt were analyzed as well. Data were obtained by means of the application of a questionnaire designed by the author of the study, the association between the risk factors and suicide attempt was determined using chi square test and the reason of crossed products ratio by punctual estimation and by confidence intervals; among the main results a significant statistical association to suicide attempt was found and the following risk factors: presence of mental disorders in adolescents (depression), mental retardation, schooling difficulties, involuntary boarding school and history of suicide attempt in other family members.

PITASOR epidemiological study: prevalence, incidence and treatment of anaemia in radiation therapy oncology departments in Spain.

INTRODUCTION: Anemia is the most common haematological complication in cancer patients. OBJECTIVE: Analysis of the incidence, prevalence and treatment of anemia in oncologic patients treated in Radiation Oncology Departments in Spain (ROD) and monitoring of the existing recommendations for the treatment of anemia. MATERIAL AND METHODS: Observational, prospective, multicenter study which involved 19 Spanish ROD. The study was approved by the CEIC Central Defense Hospital. 477 patients with solid tumors, subsidiary of RT with radical intent referred to such centers within a period of one month (5/5/09 to 5/6/09) and gave their consent to participate in the study. We gathered the main characteristics of patients and their oncologic disease. All patients underwent a determination of Hb levels before RT, upon reaching 25-35 Gy and at the end treatment. In patients with anemia we assessed the existence of related symptoms and its treatment. RESULTS: Basal situation: The prevalence of anemia was 34.8% (166 patients). Mean Hb in patients with anemia was 11.17 ± 1.07 g/dl. Anemia-related symptoms were present in 34% of the patients. Anemia predisposing factors were: stage of the disease, previously received chemotherapy, and hormonal therapy. 39% (66 patients) received anemia treatment, with a mean Hb of 10.43 ± 1.04 g/dl. During RT: The prevalence of anemia was 38.9% (182 patients) with a mean Hb of 11.24 ± 1.21 g/dl. Predisposing factors for anemia during RT treatment were: age, male sex, chemotherapy prior to RT, basal anemia and chemotherapy during RT. 36.3% (66 patients) had anemia-related symptoms. 34.6% (63 patients) with a mean Hb of 10.5 ± 1.37 g/dl received treatment for anemia. The prevalence of anemia at the end of the RT was 38.1% (177 patients) with a mean Hb of 11.19 ± 1.18 g/dl. The predisposing factors for the appearance of anemia at the end of RT were: male sex, anemia at basal situation and during treatment and chemotherapy during RT. 34% (61 patients) had anemia-related symptoms and 73 patients (41.2%) with a mean Hb of 10.5 ± 1.22 g/dl received treatment for anemia. The presence of anemia-related symptoms was significantly correlated with the beginning of treatment for anemia. The incidence of anemia (new cases) during radiotherapy was 17.5%. CONCLUSION: The prevalence of anemia in basal situation, during RT and at the end of RT is 34.8%, 38.9% and 38.1%. During RT the incidence of anemia is 17.5%. 39.8%-41.2% of patients with anemia and 64.2%-68% of patients with anemia-related symptoms received treatment. Treatment of anemia starts with Hb<11 g/dl and the goal is to achieve Hb 12 g/dl. In our Radiotherapy Oncology Departments, the treatment of anemia complies with the current recommendations and guidelines in use.

Evaluación de la calidad de la atención médica en la línea preoperatoria del Centro Oftalmológico "Lara" (octubre, 2006) / Assessment of the medical care quality in the preoperative line of "Lara" 0phthalmology Center (October, 2006)

Se realizó una investigación evaluativa de corte transversal con el objetivo de evaluar la calidad de la atención médica en la línea preoperatoria del Centro Oftalmológico "Lara", en el municipio venezolano de Iribarren. Esta metodología tuvo en cuenta las características de la planta física y la disponibilidad de recursos materiales, así como la cobertura, la capacitación y la competencia de los recursos humanos. En el proceso se evaluó el cumplimiento de las principales actividades realizadas por el equipo de salud, mientras que en los resultados se tuvo en cuenta la atención médica a los pacientes que acudieron a la línea preoperatoria en el período analizado. Los criterios, indicadores y estándares se operacionalizaron con la colaboración de varios expertos. Se concluyó que la calidad de la atención médica en la línea preoperatoria en el centro oftalmológico "Lara" no fue satisfactoria. Se recomendó a la dirección del centro oftalmológico discutir los resultados con el colectivo de trabajo para analizar las deficiencias encontradas, y en una segunda etapa la extensión de la evaluación a las otras áreas de atención médica del centro oftalmológico, el salón y el posoperatorio.

A cross-sectional evaluative research was carried out to assess the medical care quality in the preoperative line of "Lara" Ophthalmology Center from the Venezuelan municipality of Iribarren. This methodology took into account the physical plant features and the availability of material resources, as well as the coverage, the recruitment and the competence of human resources. During process authors assessed the fulfillment of main activities performed by health staff, whereas in results we took into account the medical care to patients came to preoperative line in analyzed period. Criteria, indicators and standards were operational with the cooperation of some experts. We conclude that the medical care quality in the preoperative line in above mentioned Ophthalmology center was not satisfactory. We recommended to the management of this center to discuss the results with the working staff to analyze the deficiencies founded and in a second stage, the extent of assessment to other medical care areas of this center, the operating room and the postoperative time.

Outcome of small invasive breast cancer with no axillary lymph node involvement.

The prognosis and need or not for adjuvant therapy in patients with small breast tumors (≤1cm N0) is the subject of controversy as regards the clinical benefit obtained, toxicity, and the economical costs generated. A retrospective analysis was made of 238 patients with early-stage breast cancer (pT1≤1 cm N0M0) diagnosed between January 1993 and May 2008. As regards the systemic adjuvant treatments provided, (a) 122 (51%) received no treatment, (b) 102 (43%) received hormone therapy, (c) 9 (4%) chemotherapy, and (d) 5 (2%) received both hormone therapy and chemotherapy. An analysis was made of disease-free survival (DFS) and breast cancer-specific survival in our series of patients, and of their correlation to clinicopathological factors (age, tumor size, histological grade, estrogen receptor (ER) expression, HER-2 overexpression, and systemic adjuvant therapy). The median follow-up of this cohort was 63months (range 5-145). Some type of relapse was recorded in 4.2% of the patients (six patients presented local recurrence in all cases subjected to rescue treatment with surgery and/or radiotherapy, three patients developed distant metastases, and one patient presented a resected local recurrence followed by systemic relapse). The 5year DFS was 96%, and the 5year breast cancer-specific survival was 99.6%. A univariate analysis was made of the clinicopathological variables and their association to DFS. None of the variables was seen to be significantly correlated to shorter DSF except for an association between HER-2 overexpression and poor outcome borderline significance (p=0.07). The prognosis of our pT1≤1cm N0M0 tumors was excellent, although the absence of systemic adjuvant therapy in one-half of the patients.

Hallazgos endoscópicos en pacientes con hemorragia digestiva inferior en el Hospital General del Oeste durante los años 2003-2008 / Endoscopic findings in patients with lower gastrointestinal bleeding in the Hospital General del Oeste during the years 2003-2008

La hemorragia digestiva inferior ocupa aproximadamente el 0.5% de todas las admisiones de corta estancia en los hospitales de lo estados Unidos. La incidencia de sangrado digestivo inferior es estimada en 20 a 27 casos por cada 100 mil adultos en la población de riesgos. Es más común en hombres que en mujeres. La mortalidad global oscila al 5 % según la causa. El objetivo de nuestro trabajo fue determinar los hallazgos endoscópicos más frecuentes en pacientes con hemorragia digestiva inferior en el servicio de gastroenterología del hospital General del Oeste. Se realizo una revisión retrospectiva de los hallazgos endoscópicos en pacientes mayores de 18 años que acudieron al servicio de Gastroenterología del Hospital General del Oeste entre diciembre del 2003 y diciembre del 2008 con el diagnostico de hemorragia digestiva inferior. Un total de 389 pacientes. De los cuales el55.7 %fueron del sexo femenino y 44.3 % del sexo masculino. Con una edad promedio de 53.2 años. El principal hallazgo endoscópico fue enfermedad diverticular con un 26. 9%, seguido de hemorroides internas y externas con un 26.4% y 12.8 % respectivamente. El 15.4 % de las endoscopias digestivas inferiores fueron normales. La hemorragia digestiva inferior en nuestro centro es más frecuente en mujeres, siendo el hallazgo endoscópico más común la enfermedad diverticular y la enfermedad hemorroidal en ambos sexo...

Lower gastrointestinal bleeding represents approximately 0.5% of all short-stay admissions in United States hospitals. The incidence of lower gastrointestinal bleeding is estimated at 20-27 cases per 100.000 adults in the risk population. It is more common in men than in women. The overall mortality ranges at 5% depending on the cause. The aim of our study was to determine the endoscopic findings in patients with lower gastrointestinal bleeding in Hospital General del Oeste. Methods: We conducted a retrospective review of endoscopic findings in patients older than 18 years-old who attended the Gastroenterology Service of Hospital General del Oeste between December 2003 and December 2008, with lower gastrointestinal bleeding diagnosis. A total of 389 patients. Of which, 55.7% were female and 44.3% male; with an average age of 53.2 years-old. Diverticulitis was the main endoscopic finding with 26.9%, followed by internal and external hemorrhoids with 26.4% and 12.8% respectively. 15.4% of lower gastrointestinal endoscopies were normal. The lower gastrointestinal bleeding in our hospital is more common in women, being diverticulitis and hemorrhoids the most common endoscopic finding, in either sex...

Targeted therapy of metastatic breast cancer.

Breast cancer is a heterogeneous disease characterised by a dysregulation of multiple pathways related to cell differentiation, cell cycle control, apoptosis, angiogenesis and development of metastasis. Acting against these pathways provides therapeutic targets for new targeted biologic therapies, which, in the future, might constitute a key for fighting cancer. The development of molecular technology in recent years has allowed a further comprehension of these mutations and dysregulated pathways leading to oncogenesis. New targeted biologic therapies will block essential functions of cancer cells and tumour stroma. A growing number of therapy options, alone or in combination with background treatments (chemotherapy, hormone therapy, radiotherapy), will allow oncologists a better adaptation of treatment to patients and disease characteristics. Examples of approved targeted agents in breast cancer include agents targeting the human epidermal growth factor receptor 2 (HER2), such as trastuzumab, lapatinib and the anti-VEGF bevacizumab. In addition, there are other therapy classes under evaluation, including novel antiEGFR or antiHER2 therapies; agents fighting other tyrosine kinases, including the Src and the insulinlike growth factor receptor; agents interfering critically relevant pathways, such as PI3K/AKT/mTOR inhibitors; and agents promoting apoptosis, such as PARP inhibitors (for particular breast cancer subtypes, such as basal-like, or breast cancer with BRCA mutations) and others. The better selectivity against malignant cells of these therapies, when compared to conventional chemotherapy, gives, a priori, at least two advantages to biologic treatments: fewer side effects and a more individualised treatment of cancer depending on the tumour's molecular characteristics. The ability to identify patients' subgroups and response predicting factors will be crucial in obtaining the greatest benefit with minimal toxicity levels. Unsolved questions remain, such as appropriate patient selection based on the expression of the therapeutic target in the tumour, the study of the efficacy of the drug in not so extensively pretreated populations and with a greater chance of response, the use of new pharmacodynamic models to help to define new response predicting factors for a specific new biologic therapy, the combined and rational use of different biologic therapies having different molecular targets and fighting the same target through a complementary mechanism of action that might improve clinical efficacy.