Survival analysis and associated factors of highgrade glioma patients / Survival analysis and associated factors of highgrade glioma patients

Introduction: High-grade gliomas are the most common primary brain tumors in adults, and they usually have a quick fatal course. Average survival is 18 months, mainly, because of tumor resistance to Stupp protocol. Objective: To determine high-grade glioma patient survival and the effect of persuasion variables on survival. Materials and methods: We conducted a longitudinal descriptive study in which 80 untreated recently diagnosed high-grade glioma patients participated. A survey was conducted regarding their exposure to some risk factors, degree of genetic instability in peripheral blood using micronucleus quantification on binuclear lymphocytes, micronuclei in reticulocytes and sister-chromatid exchanges in lymphocytes. In the statistical analysis, this study constructed life tables, used the Kaplan-Meier, and the log-rank test, and in the multivariate analysis, a Cox proportional hazards model was constructed. Results: Eighty patients' clinical, demographic and lifestyle characteristics were analyzed, as well as their survival rates and the average survival time is 784 days (interquartile range: 928). Factors like age, exposure at work to polycyclic hydrocarbons and the number of sister-chromatid exchanges in lymphocytes in the first sampling was significantly survivalrelated in the multivariate analysis. Conclusion: We determined that only three of the analyzed variables have an important effect on survival time when it comes to high-grade glioma patients.

Introducción. Los gliomas de alto grado son los tumores cerebrales primarios más comunes en adultos y, por lo general, tienen un curso mortal rápido. La supervivencia media es de 18 meses, principalmente, como consecuencia de la resistencia del tumor al protocolo Stupp. Objetivo. Determinar la supervivencia de los pacientes con glioma de alto grado y el efecto de las variables de persuasión en la supervivencia. Materiales y métodos. Se llevó a cabo un estudio descriptivo longitudinal en el que participaron 80 pacientes con diagnóstico reciente de glioma de alto grado no tratados. Se hizo una encuesta sobre su exposición a algunos factores de riesgo, grado de inestabilidad genética en sangre periférica mediante cuantificación de micronúcleos en linfocitos binucleares, micronúcleos en reticulocitos e intercambios de cromátidas hermanas en linfocitos. En el análisis estadístico, se construyeron tablas de vida, se utilizó Kaplan-Meier y la prueba de rangos logarítmicos, y en el análisis multivariado, se construyó un modelo de riesgos proporcionales de Cox. Resultados. Se analizaron las características clínicas, demográficas y de estilo de vida de 80 pacientes, así como sus tasas de supervivencia y el tiempo medio de supervivencia fue de 784 días (rango intercuartílico: 928). Factores como la edad, la exposición laboral a hidrocarburos policíclicos y el número de intercambios de cromátidas hermanas en linfocitos en el primer muestreo se relacionaron significativamente con la supervivencia en el análisis multivariante. Conclusión. Según los resultados, el estudio determinó que solo tres de las variables analizadas tienen un efecto importante en el tiempo de supervivencia cuando se trata de pacientes con glioma de alto grado.

Assessing the impact of simulated ocean acidification on the photodegradation of selected microplastics.

This study investigated the impact of ocean acidification on the photodegradation of three microplastics (MPs): polypropylene (PP), expanded polystyrene (EPS), and ethylene-vinyl acetate (EVA), under accelerated UV radiation at three pH levels (i.e., 8.1, 7.8, and 7.5), simulating marine conditions. The acidification system simulated current and projected future environmental conditions. As expected, an increase in partial pressure of CO2, total inorganic carbon, bicarbonate ion, and CO2 resulted in more acidic pH levels, with the reverse being true for the carbonate ion. Structural changes of MPs were evaluated, revealing that all weathered samples underwent higher degradation rate compared to the virgin samples. The oxidation state and crystallinity of PP and EVA MPs were higher in samples exposed to the lowest pH, whereas no significant increase in the degradation rate of EPS samples was observed. Saltwater acidification in this study contributed to enhance the photo-oxidation of MPs depending on their polymeric composition.

Biomarcadores genéticos en sangre, una nueva herramienta para el diagnóstico, pronóstico y supervivencia en pacientes con gliomas de alto grado / Genetic biomarkers in blood, a new tool for diagnosis, prognosis, and survival in patients with high-grade gliomas / Biomarcadores genéticos no sangue, uma nova ferramenta para diagnóstico, prognóstico e sobrevida em pacientes com gliomas de alto grau

Durante mucho tiempo, la clasificación de los tumores del sistema nervioso central (SNC) se ha basado en hallazgos histológicos respaldados por pruebas complementarias, como la inmunohistoquímica, establecidas en tejidos. La quinta edición de la clasificación de tumores del SNC de la Organización Mundial de la Salud (OMS), publicada en 2021 (SNC-5) incorpora numerosos marcadores moleculares con utilidad clínico-patológica que son importantes para una clasificación más precisa de las neoplasias del SNC. Ello permiten ayudar a definir los gliomas difusos del adulto, oligodendroglioma mutado para el gen de la IDH (isocitrato deshidrogenasa láctica), con codeleción 1p/19q grados 2 a 3, astrocitoma mutado para IDH sin codeleción 1p/19q, grados 2 a 4 y glioblastoma (GBM) silvestre para IDH. La mediana de sobrevida en los pacientes con GBM es de solo 14.6 meses, debido a la resistencia al protocolo de terapia más utilizado en el mundo, el cual involucra cirugía, radioterapia y quimioterapia con temozolamida (TMZ), un potente alquilante genotóxico. Los criterios de selección del tratamiento y la estimación del pronóstico en pacientes con esta enfermedad son clínico-patológicos. En los últimos años se reportaron numerosas alteraciones moleculares que amplían la comprensión de la biología de estos tumores, pero solo unas pocas influyen como biomarcadores en la toma de decisiones clínicas y del tratamiento. En este artículo se revisan las alteraciones moleculares reportadas para gliomas de alto grado en sangre periférica, también se resalta la importancia de estandarizar nuevos biomarcadores junto a los hallazgos histológicos para mejorar el conocimiento de estos tumores.

For a long time, the classification of central nervous system (CNS) tumors has been based on histological findings supported by complementary tests, such as immunohistochemistry, established in tissues. The fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System, published in 2021 (CNS-5), incorporates numerous molecular markers with clinical-pathological utility that are important for a more accurate classification of CNS neoplasms. These markers help to define adult diffuse gliomas, including IDH-mutant oligodendroglioma with 1p/19q codeletion (grades 2-3), IDH-mutant astrocytoma without 1p/19q codeletion (grades 2-4), and wild-type IDH glioblastoma (GBM). The median survival in patients with GBM is only 14.6 months, primarily due to resistance to the most widely used treatment protocol worldwide, which involves surgery, radiotherapy, and chemotherapy with temozolomide (TMZ), a potent genotoxic alkylating agent. The selection criteria for treatment and the estimation of prognosis in patients with this disease are predominantly based on clinical and pathological factors. In recent years, numerous molecular alterations have been reported, expanding our understanding on the biology of these tumors. However, only a few of these molecular alterations serve as biomarkers that influence clinical decision-making and treatment strategies. This article reviews the molecular alterations reported in peripheral blood for high-grade gliomas and emphasizes the importance of standardizing new biomarkers alongside histological findings to enhance our knowledge of these tumors.

Por muito tempo, a classificação dos tumores do sistema nervoso central (SNC) baseou-se em achados histológicos respaldados por exames complementares, como a imuno-histoquímica, estabelecidos nos tecidos. A quinta edição da classificação de tumores do SNC da Organização Mundial da Saúde (OMS), publicada em 2021 (CNS-5), incorpora inúmeros marcadores moleculares com utilidade clinicopatológica importantes para uma classificação mais precisa das neoplasias do SNC. Isso permite definir gliomas difusos adultos, oligodendroglioma mutado para o gene IDH (lactic isocitrato desidrogenase), com codeleção 1p/19q graus 2 a 3, astrocitoma mutado para IDH sem codeleção 1p/19q, graus 2 a 4 e wild- tipo glioblastoma (GBM) para IDH. A sobrevida mediana em pacientes com GBM é de apenas 14,6 meses, devido à resistência ao protocolo terapêutico mais utilizado no mundo, que envolve cirurgia, radioterapia e quimioterapia com temozolamida (TMZ), um potente alquilador genotóxico . Os critérios de seleção para o tratamento e estimativa do prognóstico em pacientes com essa doença são clínico-patológicos. Nos últimos anos, foram relatadas inúmeras alterações moleculares que ampliam o entendimento da biologia desses tumores, mas apenas algumas influenciam na decisão clínica e terapêutica como biomarcadores. Este artigo revisa as alterações moleculares relatadas para gliomas de alto grau no sangue periférico, destacando também a importância da padronização de novos biomarcadores juntamente com os achados histológicos para melhorar o conhecimento desses tumores

Programme for Harmonization to the International Scale in Latin America for BCR-ABL1 quantification in CML patients: findings and recommendations.

Objectives The quantitation of BCR-ABL1 mRNA is mandatory for chronic myeloid leukemia (CML) patients, and RT-qPCR is the most extensively used method in testing laboratories worldwide. Nevertheless, substantial variation in RT-qPCR results makes inter-laboratory comparability hard. To facilitate inter-laboratory comparative assessment, an international scale (IS) for BCR-ABL1 was proposed. Methods The laboratory-specific conversion factor (CF) to the IS can be derived from the World Health Organization (WHO) genetic reference panel; however, this material is limited to the manufacturers to produce and calibrate secondary reference reagents. Therefore, we developed secondary reference calibrators, as lyophilized cellular material, aligned to the IS. Our purpose was both to re-evaluate the CF in 18 previously harmonized laboratories and to propagate the IS to new laboratories. Results Our field trial including 30 laboratories across Latin America showed that, after correction of raw BCR-ABL1/ABL1 ratios using CF, the relative mean bias was significantly reduced. We also performed a follow-up of participating laboratories by annually revalidating the process; our results support the need for continuous revalidation of CFs. All participating laboratories also received a calibrator to determine the limit of quantification (LOQ); 90% of them could reproducibly detect BCR-ABL1, indicating that these laboratories can report a consistent deep molecular response. In addition, aiming to investigate the variability of BCR-ABL1 measurements across different RNA inputs, we calculated PCR efficiency for each individual assay by using different amounts of RNA. Conclusions In conclusion, for the first time in Latin America, we have successfully organized a harmonization platform for BCR-ABL1 measurement that could be of immediate clinical benefit for monitoring the molecular response of patients in low-resource regions.

Therapeutic potential of omega fatty acids in breast cancer. Review / Potencial terapéutico de ácidos grasos omega en cáncer de mama. Revisión

Background: Breast cancer is the second cause of death in women in developed and undeveloped countries, including Colombia. A high percentage of these tumors is estrogen dependent, for which the hormonal treatment is the most used therapy in breast cancer. Currently, the first line treatment for breast tumor in postmenopausal women is the letrozole, an aromatase enzyme inhibitor that avoids the transformation of androgens to estrogens. Since letrozole produced adverse effects on patients, there is a requirement for new alternative treatments. Furthermore, omega fatty acids (ω-FA), essential as they are obtained from the normal diet or from dietary supplements, have demonstrated nutraceutical potential because of their anti-inflammatory or pro-inflammatory activity. Nonetheless, there is controversy in in vitro, in vivo and epidemiologic reports regarding their preventive or inducing activities of carcinogenesis in animals and humans, depending on the structure of the ω-FA. Objectives: This review aims to show the main in vitro, in vivo and epidemiologic evidences of the chemotherapeutic potential of ω-3 and ω-6 FA in different types of neoplasm, particularly in breast cancer, in individual or combined treatments with diverse antineoplastics. Methods: PubMed and Science Direct databases revealed the most representative studies, published during the last two decades, about ω-3 and ω-6 FA, breast cancer and the principal therapeutic strategies for this neoplasm. Findings were presented in separated topics to provide an overview of ω-FA and their potential in treatments for breast cancer. Results: Patients treated with estrogens and progesterone derivate have shown predisposition to develop breast cancer after two years of continued therapy. Furthermore, ω-FA with known nutraceutical potential have demonstrated their potential as adjuvants in the treatment against different neoplasms, like hepatic and colon cancer. Conclusions: Current therapies for breast cancer and their low efficacy in the long term led to explore new alternative treatments with ω-FA. These essential fatty acids in daily consumption could enhance the antineoplastic agent effect. Nevertheless, metabolism of the ω-FA must be considered for this use.

Antecedentes: el cáncer de mama es la segunda causa de muerte de mujeres en países desarrollados y no desarrollados, incluido Colombia. La mayoría de estos tumores son dependientes de estrógeno por esa razón, la terapia más utilizada es la hormonal. Actualmente, el tratamiento de primera línea en mujeres posmenopáusicas es el letrozol, inhibidor de la enzima aromatasa, que evita la conversión de andrógenos en estrógenos. El letrozol causa efectos adversos en las pacientes, lo cual motiva la búsqueda de nuevas alternativas que disminuyan estos efectos. Los ácidos grasos omega, esenciales en la dieta regular o suplementaria, han mostrado su potencial nutracéutico ambivalente, como antiinflamatorios o proinflamatorios. Debido a esto, existe controversia en distintos reportes a nivel in vitro, in vivo y epidemiológicos sobre la actividad preventiva o quimioterapéutica de los ω-3 y ω-6 AGOs. Objetivos: el aporte de este artículo, es mostrar las principales evidencias in vitro, in vivo y epidemiológicas del potencial quimioterapéutico de los AGOs en tratamientos individuales y combinados con antineoplásicos, en distintos tipos de cánceres, particularmente en el cáncer de mama. Métodos: se revisaron las bases de datos PubMed y Science Direct y se seleccionaron los estudios más representativos de las dos últimas décadas sobre ω-3 y ω-6 AGOs y las principales estrategias usadas en el cáncer de mama. Los hallazgos se presentan en temas separados, primero una visión general de los AGOs y luego su potencial bioactivo en tratamientos contra el cáncer de mama. Resultados: la mayoría de los estudios en pacientes con cáncer de mama, tratadas con estrógenos y derivados de progesterona, han mostrado predisposición a desarrollar cáncer de mama después de dos años de terapia continua. De otro lado, los AGOs han demostrado su potencial como adyuvantes en el tratamiento en diferentes cánceres como el de colon y hepático. Conclusiones: las terapias actuales para el cáncer de mama y su baja eficacia a largo plazo exigen explorar nuevas alternativas de terapias, que incluyen los AGOs podrían potenciar fármacos, no obstante, es necesario tener en cuenta, el metabolismo de los AGOs, para uso

Flow cytometry in peripheral blood reticulocytes as a marker of chromosome instability in highgrade glioma patients

Introduction: The quantification of chromosomal instability is an important parameter to assess genotoxicity and radiosensitivity. Most conventional techniques require cell cultures or laborious microscopic analyses of chromosomes or nuclei. However, a flow cytometry that selects the reticulocytes has been developed as an alternative for in vivo studies, which expedites the analytical procedures and increases up to 20 times the number of target cells to be analyzed. Objectives: To standardize the flow cytometry parameters for selecting and quantifying the micronucleated reticulocytesCD71+ (MN-RET) from freshly drawn peripheral blood and to quantify the frequency of this abnormal cell subpopulation as a measure of cytogenetic instability in populations of healthy volunteers (n =25), and patients (n=25), recently diagnosed with high-grade gliomas before the onset of treatment. Materials and methods: Blood cells were methanol-fixed and labeled with anti-CD-71-PE for reticulocytes, antiCD-61-FITC for platelet exclusion, and propidium iodide for DNA detection in reticulocytes. The MN-RETCD71+ cell fraction was selected and quantified with an automatic flow cytometer. Results: The standardization of cytometry parameters was described in detail, emphasizing the selection and quantification of the MN-RETCD71+ cellular fraction. The micronuclei basal level was established in healthy controls. In patients, a 5.2-fold increase before the onset of treatment was observed (p <0.05). Conclusion: The data showed the usefulness of flow cytometry coupled with anti-CD-71-PE and anti-CD-61-FITC labeling in circulating reticulocytes as an efficient and high resolution method to quantify chromosome instability in vivo. Finally, possible reasons for the higher average of micronuclei in RETCD71+ cells from untreated high-grade glioma patients were discussed.

Citometría de flujo en reticulocitos de sangre periférica como indicador de inestabilidad cromosómica en pacientes con gliomas de alto grado / Flow cytometry in peripheral blood reticulocytes as a marker of chromosome instability in highgrade glioma patients

Resumen Introducción. La cuantificación de la inestabilidad cromosómica es un parámetro importante para evaluar la genotoxicidad y la radiosensibilidad. Las técnicas convencionales requieren cultivos celulares o laboriosos análisis microscópicos de cromosomas o núcleos. La citometría de flujo en reticulocitos ha surgido como una alternativa para los estudios in vivo, ya que reduce los tiempos de análisis e incrementa hasta en 20 veces el número de células analizables. Objetivos. Estandarizar los parámetros de citometría de flujo requeridos para seleccionar y cuantificar reticulocitos micronucleados (RET-MN) a partir de muestras de sangre periférica, y cuantificar la frecuencia de esta subpoblación anormal como medida de inestabilidad citogenética en sendas poblaciones de voluntarios sanos (n=25) y pacientes (n=25) recién diagnosticados con gliomas de alto grado antes de iniciar el tratamiento. Materiales y métodos. Las células sanguíneas se marcaron con anti-CD71-PE para reticulocitos, anti- CD61-FITC para la exclusión de plaquetas y yoduro de propidio para detectar el ADN en reticulocitos. La fracción celular MN-RETCD71+ se seleccionó y se cuantificó con un citómetro de flujo automático. Resultados. Se describió detalladamente la estandarización de los parámetros citométricos, con énfasis en la selección y la cuantificación de la subpoblación celular MN-RETCD71+. Se establecieron los niveles basales de MN-RETCD71+ en la población de control y en los pacientes se encontró un incremento de 5,2 veces antes de iniciar el tratamiento (p<0,05). Conclusión. Los resultados evidenciaron la utilidad de la citometría de flujo acoplada a la marcación de las células RETCD71+ como método eficiente para cuantificar la inestabilidad cromosómica in vivo. Se sugieren posibles razones del incremento de micronúcleos en células RETCD71+ de pacientes con gliomas.

Abstract Introduction: The quantification of chromosomal instability is an important parameter to assess genotoxicity and radiosensitivity. Most conventional techniques require cell cultures or laborious microscopic analyses of chromosomes or nuclei. However, a flow cytometry that selects the reticulocytes has been developed as an alternative for in vivo studies, which expedites the analytical procedures and increases up to 20 times the number of target cells to be analyzed. Objectives: To standardize the flow cytometry parameters for selecting and quantifying the micronucleated reticulocytesCD71+ (MN-RET) from freshly drawn peripheral blood and to quantify the frequency of this abnormal cell subpopulation as a measure of cytogenetic instability in populations of healthy volunteers (n =25), and patients (n=25), recently diagnosed with high-grade gliomas before the onset of treatment. Materials and methods: Blood cells were methanol-fixed and labeled with anti-CD-71-PE for reticulocytes, antiCD-61-FITC for platelet exclusion, and propidium iodide for DNA detection in reticulocytes. The MN-RETCD71+ cell fraction was selected and quantified with an automatic flow cytometer. Results: The standardization of cytometry parameters was described in detail, emphasizing the selection and quantification of the MN-RETCD71+ cellular fraction. The micronuclei basal level was established in healthy controls. In patients, a 5.2-fold increase before the onset of treatment was observed (p <0.05). Conclusion: The data showed the usefulness of flow cytometry coupled with anti-CD-71-PE and anti- CD-61-FITC labeling in circulating reticulocytes as an efficient and high resolution method to quantify chromosome instability in vivo. Finally, possible reasons for the higher average of micronuclei in RETCD71+ cells from untreated high-grade glioma patients were discussed.

Temozolomide and Pituitary Tumors: Current Understanding, Unresolved Issues, and Future Directions.

Temozolomide, an alkylating agent, initially used in the treatment of gliomas was expanded to include pituitary tumors in 2006. After 12 years of use, temozolomide has shown a notable advancement in pituitary tumor treatment with a remarkable improvement rate in the 5-year overall survival and 5-year progression-free survival in both aggressive pituitary adenomas and pituitary carcinomas. In this paper, we review the mechanism of action of temozolomide as alkylating agent, its interaction with deoxyribonucleic acid repair systems, therapeutic effects in pituitary tumors, unresolved issues, and future directions relating to new possibilities of targeted therapy.

Antiproliferative Effects of Epigenetic Modifier Drugs Through E-cadherin Up-regulation in Liver Cancer Cell Lines.

INTRODUCTION AND AIM: Epigenetic alterations play an essential role in cancer onset and progression, thus studies of drugs targeting the epigenetic machinery are a principal concern for cancer treatment. Here, we evaluated the potential of the combination of the DNA methyltransferase inhibitor 5-aza-2'-deoxycytidine (5aza-dC) and the pan-deacetylase inhibitor Trichostatin A (TSA), at low cytotoxic concentrations, to modulate the canonical Wnt/ß-catenin pathway in liver cancer cells. MATERIAL AND METHODS: Pyrosequencing was used for DNA methylation analyses of LINE-1 sequences and the Wnt/ß-catenin pathway antagonist DKK3, SFRP1, WIF1 and CDH1. qRT-PCR was employed to verify the expression of the antagonist. Pathway regulation were evaluated looking at the expression of ß-catenin and E-cadherin by confocal microscopy and the antitumoral effects of the drugs was studied by wound healing and clonogenic assays. RESULTS: Our result suggest that 5aza-dC and TSA treatments were enough to induce a significant expression of the pathway antagonists, decrease of ß-catenin protein levels, re-localization of the protein to the plasma membrane, and pathway transcriptional activity reduction. These important effects exerted an antitumoral outcome shown by the reduction of the migration and clonogenic capabilities of the cells. CONCLUSION: We were able to demonstrate Wnt/ ß-catenin pathway modulation through E-cadherin up-regulation induced by 5aza-dC and TSA treatments, under an activation-pathway background, like CTNNB1 and TP53 mutations. These findings provide evidences of the potential effect of epigenetic modifier drugs for liver cancer treatment. However, further research needs to be conducted, to determine the in vivo potential of this treatment regimen for the management of liver cancer.

Evaluation of facet, sacral and foraminal infiltrations in the treatment of low back pain / Avaliação das infiltrações facetárias, sacrais e foraminais no tratamento das lombalgias / Evaluación de las infiltraciones facetarias, sacrales y foraminales en el tratamiento del dolor lumbar

ABSTRACT Objective: The difficulties of the study and the lumbago approach stem from several factors, among them, the lack of a reliable correlation between the clinical findings and image results and the fact the lumbar segment is innervated by a network of diffuse and intertwined nerves, making it difficult to accurately determine the location of pain origin. The treatment of this disease is mainly based on conservative measures (rest, analgesia, physical therapy) and only in a few cases, the option is surgical measures. Methods: In this study, we conducted an analysis of the results obtained with foraminal, sacral and facet infiltrations of corticoids in the lumbosacral spine in a period of three months in 83 patients with low back pain. Results: The patients showed a statistically significant reduction of pain (mean value) after infiltrations (sacral, foraminal and facet), according to the Visual Analogue Scale of 4 points in the immediate postoperative period, reduction of 3.9 points at 15 days, reduction of 3.5 points at 30 days, a reduction of 3.1 points at 45 days and a reduction of 2.7 points at 90 days. Conclusion: The sacral, foraminal and facet infiltrations of corticoids to control low back pain relieves short-term pain (30 days) and medium and long-term (30-90 days), when the indication is correct.

RESUMO Objetivo: As dificuldades do estudo e da abordagem das lombalgias decorrem de vários fatores, entre eles, inexistência de correlação fidedigna entre os achados clínicos e os de imagem e o fato de o segmento lombar ser inervado por uma rede de nervos difusa e entrelaçada, que torna difícil determinar com precisão o local de origem da dor. O tratamento dessa doença é principalmente baseado em medidas conservadoras (repouso, analgesia, fisioterapia) e em poucos casos, a opção é recorrer a medidas cirúrgicas. Métodos: No presente estudo, realizamos uma análise dos resultados obtidos com infiltrações foraminais, sacrais e facetárias com corticoides na coluna lombossacral em um prazo de 3 meses, em 83 pacientes com lombalgias. Resultados: Os pacientes apresentaram redução estatisticamente significante da dor (valor da média) depois das infiltrações (sacrais, foraminais e facetárias), segundo a Escala Visual Analógica de 4 pontos no pós-operatório imediato, redução de 3,9 pontos aos 15 dias, redução de 3,5 pontos aos 30 dias, redução de 3,1 pontos aos 45 dias e redução de 2,7 pontos aos 90 dias. Conclusão: As infiltrações sacrais, foraminais e facetárias de corticoides para controle das lombalgias alivia a dor a curto (30 dias), médio e longo prazo (30 a 90 dias), quando são indicadas corretamente.

RESUMEN Objetivo: Las dificultades del estudio y del abordaje de la lumbalgia se derivan de varios factores, entre ellos, no hay correlación fiable entre los hallazgos clínicos y los encontrados en las imágenes, además del hecho que el segmento lumbar está inervado por una red de nervios difusos y entrelazados lo que dificulta determinar la ubicación precisa de origen del dolor. El tratamiento de esta enfermedad se basa principalmente en medidas conservadoras (reposo, analgesia, terapia física) y en unos pocos, la opción es quirúrgica. Métodos: En el presente estudio, se realizó un análisis de los resultados obtenidos con infiltraciones foraminales, sacrales y facetarias en la columna lumbosacra, en un período de tres meses en 83 pacientes con dolor lumbar. Resultados: Los pacientes mostraron una reducción estadísticamente significativa en el dolor (valor medio) después de las infiltraciones (sacral, foraminal y facetaria), de acuerdo con la Escala Visual Analógica de 4 puntos en el postoperatorio inmediato, reducción de 3,9 puntos en 15 días, reducción de 3,5 puntos a los 30 días, una reducción de 3,1 puntos en 45 días y una reducción de 2,7 puntos en 90 días. Conclusión: Las infiltraciones sacrales, foraminales y facetarias de corticosteroides para controlar la lumbalgia alivia el dolor a corto (30 días), mediano y largo plazo (30 a 90 días), cuando se hayan indicado correctamente.

[Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behavior in surgical prophylaxis in 6hospitals in the metropolitan area of Monterrey, Mexico]. / Evaluación del uso de antibióticos e impacto de una intervención dirigida a modificar la conducta prescriptiva en profilaxis quirúrgica en 6hospitales del área metropolitana de Monterrey.

BACKGROUND: Improper use of antibiotics increases antimicrobial resistance. OBJECTIVE: Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. MATERIAL AND METHODS: Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. ANALYSIS: Frequencies, percentages, medians, ranges and X2 test. RESULTS: Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). CONCLUSIONS: Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

Estrés oxidativo: ¿un estado celular defectuoso para la función espermática? / Oxidative stress: a defective cell state for sperm function?

En los organismos vivos, las cantidades de radicales libres y especies reactivas del oxígeno (ROS) son controladas por un complejo sistema de homeostasis, capaz de mantener niveles fisiológicos de ROS necesarios para el funcionamiento y regulación de algunas biomoléculas. Paralelamente, los organismos poseen sistemas bioquímicos de protección contra el estrés oxidativo, que consiste en el desbalance entre la producción de especies químicas altamente reactivas y las defensas antioxidantes de la célula. Dicho estrés contribuye de manera importante a la etiología tanto de la senescencia celular como de algunas enfermedades. En el contexto reproductivo, las células espermáticas pasan por una serie de cambios fisiológicos durante los procesos de maduración, capacitación y fecundados, entre los que se incluyen las modificaciones de las proteínas existentes, reguladas por señales procedentes del entorno espermático, donde las ROS modulan importantes vías bioquímicas, involucradas en procesos fundamentales de la función del espermatozoide y que se pueden alterar en estados de estrés oxidativo. El objetivo de esta revisión de literatura es describir algunos de los procesos que contribuyen al estrés oxidativo y sus implicaciones sobre la funcionalidad espermática.

Living organisms regulate the load of free radicals and reactive oxygen species (ROS) by a complex homeostatic system, capable of maintaining physiological levels of ROS, necessary for the action and regulation of some biomolecules. In parallel, organisms harbor biochemical protection systems against oxidative stress, consisting of an unbalance state between oxygen reactive chemical species and antioxidant defense production; this kind of biochemical stress has been shown to contribute to cellular senescence and the development of different diseases. In the reproductive field, the spermatic cells undergo a serial of physiological changes during the maturation, capacitation and fertilization process. Such changes include the modification of proteins regulated by signals from the sperm environment, where ROS modulate important biochemical pathways involved in fundamental processes of sperm function, and that could be altered under oxidative stress conditions. The objective of this review is to describe some of the processes that contribute to oxidative stress and its implications on sperm functionality.

Evidencia de asociación entre el gen SLC6A4 y efectos epistáticos con variantes en HTR2A en la etiología del autismo en la población antioqueña / Evidence for association and epistasis between the genetic markers SLC6A4 and HTR2A in autism etiology

Introducción. El espectro autista constituye un grupo de trastornos graves del neurodesarrollo, con un fuerte componente genético. Se ha sugerido un papel importante del sistema serotoninérgico en el desarrollo de este grupo de trastornos, con base en los estudios de respuesta a medicamentos y la hiperserotoninemia, característica común en el autismo. Se han implicado múltiples moléculas en el metabolismo y la neurotransmisión de la serotonina; sin embargo, los resultados de los estudios han tenido poca congruencia entre diferentes poblaciones. Objetivos. Evaluar la relación entre el autismo y el polimorfismo de nucleótido simple (Single Nucleotide Polymorphism, SNP) en los genes SLC6A4, HTR2A e ITGB3, en una muestra de la población antioqueña. Materiales y métodos. Se genotipificaron 42 núcleos familiares con autismo para 10 variantes en los genes SLC6A4, ITGB3 y HTR2A. Se evaluó la asociación utilizando la prueba de desequilibrio en la transmisión. Se exploró el impacto de la interacción entre estos genes y el autismo, utilizando la reducción multidimensional. Resultados. Se encontró asociación de las variantes rs4583306 (OR=2,6, p=0,004) y rs2066713 (OR=2,2 p=0,03), en el gen SLC6A4, y asociación de combinaciones genotípicas entre los genes SLC6A4 y HTR2A y el riesgo de autismo (p=0,0001). Conclusiones. Se encontró asociación significativa con variantes en el gen transportador de serotonina con el autismo, al igual que interacción entre variantes en los genes HTR2A con SLC6A4. Estos resultados concuerdan con los de estudios previos en otras poblaciones y son pruebas a favor del papel del sistema serotoninérgico en la etiología del espectro autista.

Introduction. Autism spectrum disorders are severe neurodevelopmental disorders with a strong genetic component. The potential role of the serotoninergic system in the development of autistic disorder has been based on the observation of hyperserotoninemia in autistic subjects and the results of drug treatment studies. Multiple molecules involved in serotonin metabolism and neurotransmission have been studied; however, replication studies have been inconsistent. This may be partially related to the marked genetic heterogeneity of autism in different populations. Objectives. The relationship between autism and single nucleotide polymorphisms of SLC6A4, HTR2A and ITGB3 genes was evaluated in an urban population of northwestern Colombia. Materials and methods. In Antioquia, Colombia, 42 families with history of autism were screened for 10 SNPs in SLC6A4, HTR2A and ITGB3 genes and evaluated for associations with the transmission disequilibrium test. The interactions among these genes and autism was assessed with multidimensional reduction methods. Results. A significant main effect was seen among the SLC6A4 gene variants rs4583306 (OR=2.6, p=0.004) and rs2066713 (OR=2.2, p=0.03). No main effect of the ITGB3 or HTR2A variants was found, however, in the interaction effects, the SLC6A4 and HTR2A genes demonstrated significant evidence of association with autism (p<0.001). Conclusion. Significant association of markers were discovered within the SLC6A4 gene and the combination of SLC6A4 and HTR2A (S-A) genes to autism. These results were consistent with previous studies conducted in other populations and provide further evidence for the implication of the serotoninergic system in the etiology of autistic disorders.

GWAS reveals new recessive loci associated with non-syndromic facial clefting.

We have applied a GWAS to 40 consanguineous families segregating cases of non-syndromic cleft lip with or without cleft palate (NS CL/P) (a total of 160 affected and unaffected individuals) in order to trace potential recessive loci that confer susceptibility to this common facial malformation. Pedigree-based association test (PBAT) analyses reported nominal evidence of association and linkage over SNP markers located at 11q25 (rs4937877, P = 2.7 × 10(-6)), 19p12 (rs4324267, P = 1.6 × 10(-5)), 5q14.1 (rs4588572, P-value = 3.36 × 10(-5)), and 15q21.1 (rs4774497, P = 1.08 × 10(-4)). Using the Versatile Gene-Based Association Study to complement the PBAT results, we found clusters of markers located at chromosomes 19p12, 11q25, and 8p23.2 overcome the threshold for GWAS significance (P < 1 × 10(-7)). From this study, new recessive loci implicated in NS CL/P include: B3GAT1, GLB1L2, ZNF431, ZNF714, and CSMD1, even though the functional association with the genesis of NS CL/P remains to be elucidated. These results emphasize the importance of using homogeneous populations, phenotypes, and family structures for GWAS combined with gene-based association analyses, and should encourage. other researchers to evaluate these genes on independent patient samples affected by NS CL/P.

Somatotroph pituitary adenoma with acromegaly and autosomal dominant polycystic kidney disease: SSTR5 polymorphism and PKD1 mutation.

A 39-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) presented with acromegaly and a pituitary macroadenoma. There was a family history of this renal disorder. She had undergone surgery for pituitary adenoma 6 years prior. Physical examination disclosed bitemporal hemianopsia and elevation of both basal growth hormone (GH) 106 ng/mL (normal 0-5) and insulin-like growth factor (IGF-1) 811 ng/mL (normal 48-255) blood levels. A magnetic resonance imaging scan disclosed a 3.0 cm sellar and suprasellar mass with both optic chiasm compression and left cavernous sinus invasion. Pathologic, cytogenetic, molecular and in silico analysis was undertaken. Histologic, immunohistochemical and ultrastructural studies of the lesion disclosed a sparsely granulated somatotroph adenoma. Standard chromosome analysis on the blood sample showed no abnormality. Sequence analysis of the coding regions of PKD1 and PKD2 employing DNA from both peripheral leukocytes and the tumor revealed the most common PKD1 mutation, 5014_5015delAG. Analysis of the entire SSTR5 gene disclosed the variant c.142C>A (p.L48M, rs4988483) in the heterozygous state in both blood and tumor, while no pathogenic mutations were noted in the MEN1, AIP, p27Kip1 and SSTR2 genes. To our knowledge, this is the fourth reported case of a GH-producing pituitary adenoma associated with ADPKD, but the first subjected to extensive morphological, ultrastructural, cytogenetic and molecular studies. The physical proximity of the PKD1 and SSTR5 genes on chromosome 16 suggests a causal relationship between ADPKD and somatotroph adenoma.

Identificação de filtração glomerular reduzida e hipertensão arterial na comunidade / Identification of reduced glomerular filtration and arterial hypertension in thecommunity

JUSTIFICATIVA E OBJETIVOS: A doença renal crônica (DRC) é um problema de saúde pública mundial com aumento progressivo da sua incidência e prevalência, evolução desfavorável e alto custo. A hipertensão arterial sistêmica (HAS) também é altamente prevalente na população. A relação entre essas duas doenças e o desenvolvimento de doenças cardiovasculares é bem estabelecida. O objetivo deste estudo foi avaliar a prevalência de filtração glomerular (FG) reduzida e da hipertensão arterial (HA) em uma população da região Oeste do Paraná. MÉTODO: Estudo epidemiológico retrospectivo. Foram revisados prontuários dos pacientes que participaram do rastreio da função renal e da HAS na campanha "Dia Mundial do Rim 2009". Para comparar as variáveis foram utilizados os testes Qui-quadrado, Mann-Whitney e o Exato de Fisher. Um valor de p <0,05 foi considerado estatisticamente significativo. RESULTADOS: Avaliou-se uma população de 470 pacientes em praça pública. A média de idade desses pacientes foi de 47,6 ± 15,3 anos e 62,8% pertenciam ao sexo feminino. A prevalência da FG reduzida e da HA foi de 12,6% e 57%, respectivamente. CONCLUSÃO: A disfunção renal e a HA apresentaram elevada prevalência. O melhor entendimento destas doenças pode estimular o estabelecimento de estratégias de promoção de saúde e melhora nos programas de prevenção.

BACKGROUND AND OBJECTIVES: Chronic kidney disease( CKD) is a worldwide public health problem with increasing incidence and prevalence, poor outcomes, and high cost. Systemic arterial hypertension (SAH) is highly prevalent in the general population.Its contribution to the development and evolution of cardiovascular and renal disease is well recognized. The objectives of this study were to evaluate prevalence of reduced glomerular filtration (GF) and arterial hypertension (AH) in the West region of Paraná. METHOD: This is a retrospective epidemiological study. We reviewed medical records of patients that participated a screening of CKD and AH in the "World kidney Day 2009". To compare the variables were used: Chi-square, Mann-Whitney and Fishers Exact tests. A p value < 0.05 was considered statistically significant.RESULTS: A convenience sample of 470 patients was evaluatedin public square. Mean age of this patient was 47.6 ± 15.3 years and 62.8% were female. Prevalence of reduced GF and AH was12.6% and 57%, respectively. CONCLUSION: A dysfunction disease and AH had a high prevalence.A better understanding of these diseases can stimulate health care providers and improve early detection programs.

Peritonites em diálise peritoneal ambulatorial contínua / Peritonitis in continuous ambulatory peritoneal dialysis

JUSTIFICATIVA E OBJETIVOS: Avaliar a incidência de peritonites em pacientes submeti dos à diálise peritoneal ambulatorial contínua (CAPD) em uma unidade de diálise. MÉTODO: Estudo epidemiológico retrospectivo que analisou 111 pacientes submetidos à diálise peritoneal no período de setembro de 2000 a fevereiro de 2010. Foram coletados os seguintes dados: idade, sexo, raça, data do início e término do tratamento, situação atual dos pacientes, complicações observadas, número de episódios de peritonites, germes causadores, tratamentos realizados e evolução dos pacientes. As variáveis foram comparadas utilizando-se os testes Qui-quadrado e t de Student. O valor de p < 0,05 foi considerando estatisticamente significativo. RESULTADOS: Foram elegíveis para o estudo 111 pacientes submetidos à CAPD, sendo diagnosticados 57 casos de peritonites. Dentre os pacientes com peritonite a idade média foi de 61,8 ± 12,8 anos. O sexo masculino e a raça branca predominaram em 57,6% e 87,4% pacientes, respectivamente. A incidência de peritonites foi de 0,6 episódios por paciente/ano. A evolução foi satisfatória em 90% e a retirada do cateter foi realizada em 10% dos casos. CONCLUSÃO: A incidência de peritonite neste estudo foi baixa. Melhor observação do número de casos de peritonite em pacientes submetidos à CAPD, abordagem diagnóstica e terapêuticasão chaves fundamentais para desenvolver estratégias para reduzir a incidência de infecção entre estes pacientes.

BACKGROUND AND OBJECTIVES: Evaluate the incidenceof peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in a dialysis Unit. METHOD: We made a retrospective study on 111 patients undergoing peritoneal dialysis in the period from September, 2000 to February, 2010. Age, gender, race, date of commencement and completion of treatment, current status of the patients, complications,number of episodes of peritonitis, germs and antibiotic susceptibility, treatment and outcome were collected. Incidence of peritonitis was calculated. To compare the variables were used the Chi-square and Student's t tests. A p value < 0.05 was considered statistically significant. RESULTS: In the period 111 patients were treated by CAPD and were diagnosed 57 cases of peritonitis. Among patients with peritonitis the average age was 61.8 ± 12.8 years. The male and the white race predominated in 57.6% and 87.4%, respectively. Incidence of peritonitis was 0.6 episodes per patient per year. The outcome was satisfactory in 90%; catheter removal was performed in 10%. CONCLUSION: The incidence of peritonitis in this study was low. A closer observation of the number of cases of peritonitis in patients undergoing CAPD, diagnosis and treatment are fundamental keys to developing strategies to reduce the incidence of infection among these patients.

Níveis séricos de 25-hidroxi vitamina D em pacientes portadores de insuficiência renal crônica em tratamento dialítico / 25-hydroxy vitamin D levels in chronic kidney disease patients on dialysis therapy

JUSTIFICATIVA E OBJETIVOS: A contribuição da deficiência de vitamina D para o desenvolvimento do hiperparatireoidismo secundário e da osteodistrofia renal motiva a racional suplementação de vitamina D. A sua deficiência tem sido associada,ainda, a elevado risco cardiovascular. O objetivo deste estudo foi descrever os níveis séricos de 25-hidroxi vitamina D em pacientes portadores de insuficiência renal terminal em terapia dialítica.MÉTODO: Dados clínicos e laboratoriais foram coletados em novembro de 2009 em 168 pacientes em terapia dialítica em um único centro. Os níveis séricos de 25-hidroxi vitamina D foram medidos utilizando o método automatizado de imunoensaio desenvolvido por DiaSorin. De acordo com o Kidney Disease Outcomes and Quality Initiative Guidelines, os pacientes foram classificados em três grupos: suficientes (> 30 ng/mL), insuficientes(15 a 30 ng/mL); e deficientes (< 15 ng/mL). A prevalência de deficiência ou insuficiência de vitamina D foi calculada. Para comparar as variáveis foram usados os seguintes testes: Qui-quadrado,Exato de Fisher e t de Student. O coeficiente de correlação de Spearman foi utilizado para variáveis contínuas. O valor de p < 0,05 foi considerado estatisticamente significativo.RESULTADOS: A média ± desvio padrão de 25-hidroxi vitaminaD foi 23,8 ± 13,3 ng/mL. A prevalência de deficiência devitamina D foi de 23,9% e de insuficiência foi de 47,8%. Quando se compararam as diferenças entre homens e mulheres, idade,albumina e fósforo foram inferiores nas mulheres (p < 0,05). Os níveis de 25-hidroxi vitamina D foram significantemente inferiores em pacientes em diálise peritoneal quando comparados aos em hemodiálise (p < 0,05). Na análise univariada houve pequena correlação positiva entre 25-hidroxi vitamina D e Kt/V.CONCLUSÃO: Os níveis de 25-hidroxi vitamina D foram baixos nesta população. Estudos prospectivos para avaliar o impacto desta deficiência se fazem necessários.(AU)

BACKGROUND AND OBJECTIVES: The contribution of vitamin D deficiency to the development of secondary hyperparathyroidism and renal osteodystrophy contributes the rationale for vitamin D supplementation. Vitamin D deficiency has been associated with elevated cardiovascular risk. This study aimed investigates the serum levels of vitamin D among patients undergoing dialysis.METHOD: In November 2009, we examined clinical and laboratory data from 168 patients in dialytic therapy in a unit. Serum level of vitamin D was included in laboratory data. Serum levels of vitamin D were measured using an automated, antibody and microparticle, chemiluminescence immunoassay method developedby DiaSorin. According to the Kidney Disease Outcomes and Quality Initiative guidelines, patients were assigned to thefollowing 3 groups: sufficient vitamin D serum level (> 30 ng/mL), insufficient level (15 to 30 ng/mL) and with severe deficiency(< 15 ng/mL). Prevalence of deficiency or insufficiency of vitamin D was calculated. To compare the variables were usedthe Chi-square, Fisher Exact or Student's t tests. Spearman correlation coefficient was used for continuous variables. A p value < 0.05 was considered statistically significant.RESULTS: Patient's serum vitamin D mean level was 23.8 ± 13.3 ng/mL. Prevalence of vitamin D deficiency was 23.9%. Prevalence of vitamin D insufficiency was 47.8%. When compared differences between men and women, age, albumin and phosphorus were inferior in women (p < 0.05). Levels of vitamin D were greatly inferior in peritoneal dialysis when compared with hemodialysis (p < 0.05). In the univariate analysis there were weak positive correlations between vitamin D and Kt/V.CONCLUSION: Serum vitamin D levels in this population were low. Prospective studies to assess the impact of low level of vitamin D in patients undergoing dialysis are warranted.(AU)

Causas de óbitos em pacientes renais crônicos em programa dialítico / Causes of death in chronic kidney dialysis patients

JUSTIFICATIVA E OBJETIVOS: A terapia de diálise e uremia pode contribuir para a aterosclerose em pacientes de diálise. Conta-se quase 40% do total de óbitos de causa cardíaca entre os pacientes que recebem terapia de substituição renal. O objetivo deste estudo foi avaliar as causas de óbito em uma unidade de diálise nos últimos 10 anos. MÉTODO: Estudo epidemiológico retrospectivo. Foram revisados prontuários de pacientes que foram submetidos à diálise e que evoluíram para óbito. Para comparar as variáveis foram utilizados os testes do Qui-quadrado, Mann-Whitney e o Exato de Fisher. O valor de p < 0,05 foi considerado estatisticamente significativo. RESULTADOS: A idade média desses pacientes foi de 57,3 ± 14,6 anos e houve predomínio do sexo masculino (64%). A principal causa de óbito foi cardiovascular (66%). CONCLUSÃO: Um melhor entendimento dos fatores de risco cardiovasculares, abordagem diagnóstica e terapêutica são chaves fundamentais para desenvolver estratégias para reduzir a mortalidade por doenças cardiovasculares entre estes pacientes.

BACKGROUND AND OBJECTIVES: Dialysis therapy and factors uremic may contribute to the atherosclerosis in dialysis patients. Cardiac death accounts for almost 40% of total deaths among patients who receive renal replacement therapy. The objective of this study is to evaluate causes of deaths in a dialytic in the last of ten years. METHOD: This is a retrospective epidemiological study. We reviewed medical records of patients on dialysis and who died in the period mentioned above. To compare the variables were used: Chi-square, Mann-Whitney and Fishers Exact tests. A p value < 0.05 was considered statistically significant. RESULTS: Mean age of this patient was 57.3 ± 14.6 years and 64% of them were male. The main cause of death was cardiovascular disease (66%). CONCLUSION: A better understanding of cardiovascular risk factors, diagnostic approach and management are central keys to develop strategies to reduce cardiovascular mortality among those patients.

Cáncer gástrico y genes detoxificadores en una población colombiana / Gastric cancer and detoxifying genes in a colombian population

El objetivo fue establecer si hay asociación entre el cáncer gástrico (CG) y los polimorfismos desfavorables de los genes desintoxicadores GSTM1, GSTP1 y GSTT1. A la vez, se exploró si el hábito del tabaquismo, el consumo de alcohol y el nivel socioeconómico también interactúan como factores de riesgo en una población colombiana con alta incidencia de CG. Participaron 87 pacientes afectados por CG e igual número de controles del mismo grupo poblacional del departamento de Caldas. Todos fueron genotipíficados por medio de PCR para los polimorfismos GSTM1-nulo, GSTP1-val y GSTT1-nulo. Se colectó información acerca del tabaquismo, consumo de alcohol y nivel socioeconómico. Los resultados encontrados sugieren que es factor de riesgo significativo portar el genotipo GSTT1-nulo o el alelo GSTP1-val y pertenecer a los niveles socioeconómicos bajo o medio. También se detectó un interacción significativa entre el tabaquismo, el nivel socioeconómico bajo y el riesgo a CG. En conclusión, se evidencia interacción significativa entre ambiente-gen, particularmente entre el genotipo GSTT1-nulo, el alelo GSTP1-val, el nivel socioeconómico bajo, el tabaquismo y el riesgo a desarrollar CG en la población de esta región colombiana.

The objective was to establish whether there are associations between gastric cancer (GC) and unfavorable polymorphisms in GSTM1, GSTP1 and GSTT1 detoxifying genes. Simultaneously interactions of smoking habits, alcohol consumption and socioeconomic levels were investigated as possible risk factors in a Colombian population with a high incidence of GC. 87 patients affected by GC and 87 controls from the same population group in the Department of Caldas participated in the research. All patients were genotyped by PCR for GSTM1-null, GSTP1-val and GSTT1-null polymorphisms. Information about tobacco smoking, alcohol consumption and socioeconomic levels was collected. Results suggest that the GSTM1-nul genotype and GSTP1-val allele are significant risk factors as are low and medium socioeconomic levels. Significant interaction between tobacco smoking, low socioeconomic levels and GC risks were also detected. To conclude, there is significant interaction between environment and genes, particularly between the GSTT1-nulle genotype and GSTP1-val allele and low socioeconomic levels, tobacco smoking and the risk of GC development within this Colombian region’s population.