Niveles Plasmáticos de Citoquinas Proinflamatorias en Cáncer de Próstata / Serum levels of proinflammatory cytokines in prostate cancer

INTRODUCTION: Prostate cancer has become an important public health problem affecting millions of men worldwide every year. Like other malignant tumors, prostate cancer shows evidence of a strong inflammatory component that is dependent on the release of pro-inflammatory cytokines, which might play a major role in the development and progression of the tumor, helping in its early stage, progression and aggressiveness. AIMS: The goal of this study was to determine the relationships between the serum levels of pro-inflammatory cytokines and the different stages of prostate cancer. To this end, sera from patients enrolled by The Laboratory of Metabolic Diseases and Cancer of the Faculty of Pharmacy and Biochemistry at the University Juan Agustín Maza in Argentina, were analyzed through ELISA and their pro-inflammatory cytokines (IL-6, TNF-α and MCP-1) quantified. Patients were first classified into three groups (Control, at Risk, and Cancer subjects) and anthropometric, biochemical and histological parameters of prostate were then determined for all groups. RESULTS AND CONCLUSIONS: Despite displaying elevated serum concentrations of IL-6 and TNF-α in the Cancer and the Risk groups compared to the Control group, the differences did not reach significance. However, there was a positive correlation between these cytokines only in the Risk and Cancer groups, showing a general inflammatory behavior in these patients. The results obtained provide general data about the behavior of pro-inflammatory cytokines in prostate cancer. However, they do not demonstrate a direct correlation between serum levels and neoplastic progression. Nevertheless, these findings do not rule out a possible relationship between prostate cancer and serum levels of pro-inflammatory cytokines.

Evaluación de la transferencia de adolescentes desde una unidad de cardiología pediátrica a una de adultos / Transfering adolescents from pediatric to adult cardiology units: evaluation

Resumen: Objetivos: evaluar la transferencia de adolescentes desde Cardiología Pediátrica (CP) a Cardiología de Adultos (CA) en el Hospital Dr. Hernán Henríquez de Temuco (HHHT), determinando si recibieron su primera atención en CA en la fecha requerida y si los controles se ajustaron al plazo indicado. Evaluar si la complejidad de la cardiopatía y ruralidad se asocian al cumplimiento en ambos objetivos, en los pacientes sin seguimiento adecuado. Material y Método: revisión de fichas de pacientes atendidos en CP del HHHT que, cumplida la edad requerida, fueron transferidos a CA, entre Octubre 2014 - Julio de 2017. Resultados: De 53 pacientes transferidos de CPCA, 12 (22.6%) tuvo traspaso no efectivo; de ellos, 6 presentaban complejidad moderada-alta (66,6%) y 3 eran rurales (25%). De 28 pacientes ingresados a CA, 14 (50%) tenían seguimiento inefectivo; de ellos 13 (92.6%) tenían cardiopatías de moderada-alta complejidad y 3 (21.5%) provenían de áreas rurales. Conclusiones: la transferencia de CP - CA fue inefectiva en 22.6% de los pacientes; la complejidad de la cardiopatía no se asoció al resultado de la transferencia en este grupo. En CA el seguimiento fue inefectivo en la mitad de los pacientes; de ellos, 92.8% tenían cardiopatías de moderada-alta complejidad, lo que fue estadísticamente significativo respecto de la complejidad en todos los pacientes traspasados. El domicilio no estuvo asociado a la pérdida de pacientes en la transferencia ni en el seguimiento. Estos hallazgos nos permitieron tomar medidas de mejoría en la transferencia y los controles en CA que esperamos mejoren los resultados futuros.

Abstracts: Aim: To evaluate the transfer of adolescents from Pediatric Cardiology (PC) to Adult Cardiology (AC) at Hospital Dr. Hernán Henríquez de Temuco (HHHT). We determined whether they got their first care in AC on the required date and whether controls were performed on the period prescribed. Also, to evaluate whether the complexity of cardiac disease and the patient's place of residence influenced the accomplishment of the objectives, in patients without adequate following. Material and Method: Retrospective review of clinical records of patients that were treated in PC at HHHT who, having the required age were transferred to AC, between October 2014 and July 2017. Results: Of 53 patients that were transferred from PC to AC, 12 (22.6%) had an non effective transfer; 6 of them had moderate to high complexity cardiac lesions (66.6%) and 3 lived in rural areas (25%). Of 28 patients admitted to AC, 14 (50%) had a non effective follow up and 13 (92.8%) had moderate to high complexity forms of heart disease; 3 (21.5%) came from rural areas. Conclusions: Transfer of patients from PC to AC was not effective in 22.6% of patients. The complexity of the disease was not related to the results of transfer in this group. At AC the follow-up was not effective in half the patients; from these, 92.6% had moderate to high complexity heart disease, which was significantly different from the complexity of all patients transferred. The place of residence was not relates to transfer neither to follow-up. These findings allowed us to make improvement in the transfer processes and the follow up at AC.

Evaluación comparativa entre MELD y Child-Pugh como escalas pronósticas de sobrevida en pacientes con cirrosis hepática en Chile / Comparative evaluation of survival prognosis using MELD or Child-Pugh scores in patients with liver cirrhosis in Chile

Background: Currently, most liver units use the Child-Pugh (CP) or the Model for End-Stage Liver Disease (MELD) scores to establish survival prognosis among patients with liver cirrhosis. Which classification is superior, is not well defined. Aim: To compare CP and MELD classification scores to predict survival among adult patients with liver cirrhosis in Chile. Material and Methods: Follow-up of 137 consecutive adult patients with liver cirrhosis aged 59 ± 12 years (55% women). The diagnosis was reached by clinical, laboratory and image studies at three different centers of Santiago. Patients were staged with CP and MELD classification scores at baseline and followed over a period of 12 months. The predictive capacity of the scores for survival was analyzed using a multivariate statistical analysis (Kaplan-Meier curves). Results: The most common etiology was alcohol (37.9%). The actuarial survival rate was 79.6% at 12 months of follow-up. When comparing groups with areas under curve of receiver operating characteristic curves (AUROC), there was no statistically significant difference in survival between less severe and advanced disease, assessed with both survival scales. The AUROC for MELD and CP were 0.80 and 0.81, respectively. Conclusions: This clinical study did not find a statistically significant difference between the two classifications for the prediction of 12 months survival in patients with cirrhosis.

Caracterización clínica de pacientes con infarto agudo al miocardio sin lesiones coronarias significativas: estudio GEMI 2011-2013 / Clinical characteristics of patients with acute myocardial Infarction and no significant coronary artery lesions: GEMI study (2011-1013)

Antecedentes: El infarto agudo del miocardio (IAM) es consecuencia de la disrupción del endotelio vascular que lleva a oclusión del vaso coronario por un trombo. En la coronariografía de algunos de estos pacientes es posible encontrar arterias coronarias sin lesiones significativas. Objetivo: Comparar características basales, presentación clínica, tratamiento y mortalidad intrahospitalaria de pacientes con IAM, con y sin lesiones significativas. Métodos: Se incluyeron 3.194 pacientes registrados en la ficha electrónica GEMI que además del diagnóstico de IAM, hubiesen sido sometidos a estudio coronariográfico. Se consideró "sin lesiones significativas" si ninguna estenosis era > al 50 por ciento. Resultados: El grupo sin lesiones significativas correspondió a 116 pacientes (3,6 por ciento). La edad promedio en este grupo fue menor (60+/-14 años vs 62+/-12 años, p<0,024) y con una mayor proporción de mujeres. En este grupo se observó menor prevalencia de dislipidemia (30,2 por ciento vs 42,8 por ciento, p<0.007), diabetes mellitus (14,7 por ciento vs 28,9 por ciento, p<0.001) y tabaquismo (40,5 por ciento vs 61,3 por ciento, p<0.0001). En el ECG de ingreso predominó el IAM sin SDST y menor elevación de CK y CK-MB, junto a una mejor fracción de eyección. Durante la hospitalización se utilizó menos aspirina, clopidogrel, betabloqueadores, heparina ev y HBPM. Existió un mayor uso de antagonistas de Calcio. Conclusiones: Los pacientes con IAM sin lesiones significativas tienen una menor carga de factores de riesgo coronario, es más frecuente encontrar al ingreso ECG SSDST, menor grado de daño miocárdico y mejor fracción de eyección. Además, se observan diferencias en el tratamiento farmacológico en este grupo de pacientes.

Background: Acute myocardial infarction (AMI) is a consequence of disruption of coronary artery lesions leading to intracoronary thrombosis. Some patients with AMI show no significant lesions in a coronary angiography. Aim: To compare clinical characteristics, treatment and intrahospital mortality in patients with AMI with or without coronary artery lesions. Methods: 3194 patients from a clinical registry of AMI (GEMI) were included. AMI with no significant coronary artery lesions was defined as the abscense of any lesion >50 percent. Results: 116 patients (3.6 percent) had no significant coronary lesions (NSL). Compared to the group with significant lesions (SL), they were younger (60+/-14 years vs 62+/-12 years, p<0,024) and the proportion of women was higher. NSL patients lower prevalence of hyperlipidemia (30,2 percent vs 42,8 percent, p<0.007), diabetes mellitus (14,7 percent vs 28,9 percent, p<0.001) and smoking habit (40,5 percent vs 61,3 percent, p<0.0001). NSL patients had a higher prevalence of non ST elevation AMI and lower levels of CK and CK-MB, as well as a lower ejection fraction. During hospitalization, NSL patients received aspirin, clopidogrel, betablockers, iv heparin and LMW heparin, less frequently tan SL patients. In contrast, they received calcium antagonists more frequently. Conclusion: Patients with AMI and no significant coronary lesions have a lower prevalence of coronary artery disease risk factors. A greater frequency of non ST elevation AMI, lower indices of myocardial necrosis and better EF was also observed. The intensity of pharmacologic therapy was lower.