Promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions are associated with tumor differentiation, nodal involvement and survival.

Differentially methylated regions (DMRs) can be used as head and neck squamous cell carcinoma (HNSCC) diagnostic, prognostic and therapeutic targets in precision medicine workflows. DNA from 21 HNSCC and 10 healthy oral tissue samples was hybridized to a genome-wide tiling array to identify DMRs in a discovery cohort. Downstream analyses identified differences in promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions associated with tumor differentiation, nodal involvement and survival. Genome-wide DMR analysis showed 2,565 DMRs common to the three subsites. A total of 738 DMRs were unique to laryngeal cancer (n=7), 889 DMRs were unique to oral cavity cancer (n=10) and 363 DMRs were unique to pharyngeal cancer (n=6). Based on the genome-wide analysis and a Gene Ontology analysis, 10 candidate genes were selected to test for prognostic value and association with clinicopathological features. TIMP3 was associated with tumor differentiation in oral cavity cancer (P=0.039), DAPK1 was associated with nodal involvement in pharyngeal cancer (P=0.017) and PAX1 was associated with tumor differentiation in laryngeal cancer (P=0.040). A total of five candidate genes were selected, DAPK1, CDH1, PAX1, CALCA and TIMP3, for a prevalence study in a larger validation cohort: Oral cavity cancer samples (n=42), pharyngeal cancer tissues (n=25) and laryngeal cancer samples (n=52). PAX1 hypermethylation differed across HNSCC anatomic subsites (P=0.029), and was predominantly detected in laryngeal cancer. Kaplan-Meier survival analysis (P=0.043) and Cox regression analysis of overall survival (P=0.001) showed that DAPK1 methylation is associated with better prognosis in HNSCC. The findings of the present study showed that the HNSCC subsites oral cavity, pharynx and larynx display substantial differences in aberrant DNA methylation patterns, which may serve as prognostic biomarkers and therapeutic targets.

Prenatal ultrasound diagnosis of velamentous cord insertion: a case report and review of the literature.

PURPOSE: The velamentous cord insertion is a rare pathology in which the umbilical blood vessels branch before reaching the placenta; by varying its structure, the cord becomes prone to spontaneous internal ruptures. This pathology is an obstetric emergency, so its early diagnosis is essential. METHODS AND RESULTS: We present a 27-year-old pregnant woman who attends an antenatal check-up for a routine third-trimester examination. Ultrasound reveals grade I polyhydramnios and suggestive findings of a trivascular umbilical cord with velamentous insertion 35 mm from the nearest placental border. The ultrasound diagnosis allowed a term delivery by elective cesarean section, avoiding severe complications of the maternal-fetal binomial. CONCLUSION: Velamentous cord insertion can and should have an early prenatal diagnosis, even from the second trimester, through imaging techniques such as transabdominal ultrasound or color Doppler. Early detection and appropriate peripartum management will highly reduce complications during labor.

Impact of Secondary Prevention on Mortality after a First Ischemic Stroke in Puerto Rico.

OBJECTIVE: The objective of this study was to evaluate the impact of the prescription of secondary prevention therapies on mortality in Puerto Rican patients hospitalized with a first ischemic stroke. METHODS: This was a retrospective secondary data analysis of the 2007 and 2009 Puerto Rico Stroke Registry electronic database. Information was obtained from the medical charts of patients discharged with ICD-9 codes 434 and 436 from 20 hospitals located in Puerto Rico. Descriptive analyses were conducted for demographics and comorbidities. Chi2 statistics compared the proportion of patients prescribed secondary prevention therapy and the proportion of patients not prescribed secondary prevention therapy. Lastly, survival rates were calculated from 2007 up to and including December 2010. RESULTS: The mean age of the 3,965 patients was 70 (±14) years. Secondary prevention therapy was prescribed to only 1% of the patients. The most frequent comorbidities were hypertension (85%), diabetes (52%), and hyperlipidemia (25%). The case fatality rate for patients prescribed secondary prevention therapy was 16%, compared to 26% for patients not prescribed secondary prevention therapy (p<0.01). The mean survival for stroke patients prescribed secondary preventions was 450 days (95% CI;182−718), compared to 266 days (95% CI; 244−287) for those not prescribed secondary prevention therapy (p = 0.175). CONCLUSION: A low percentage of patients with a first ischemic stroke were prescribed secondary prevention therapy. While not statistically significant, survival analysis suggests that secondary prevention therapy decreased mortality in patients with a stroke.

HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients.

BACKGROUND: HPV-16 modifies the overall survival (OS) of patients with oropharyngeal cancer (OPSCC). HPV-16 has been established as risk factor for OPSCC, but HPV-16 infection may also reside in the larynx and oral cavity. We evaluated HPV-16 status on OS of Head and Neck Squamous Cell Carcinoma (HNSCC) patients. METHODS: HPV-16 infection was confirmed by amplification of E6 and E7 viral oncogenes through PCR assay and E6 IHC in 185 HNSCC samples. Associations between HPV-16 status and clinicopathological parameters were performed using Fisher's exact test and x(2). Survival analysis was completed using Kaplan-Meier estimator and multivariate Cox regression analysis. RESULTS: OS of HPV-16 positive patients was longer compared to HPV-16 negative patients (P = 0.002). HPV-16 positive tumors of the larynx (LSCC) and pharynx (PSCC) showed improved OS compared to HPV-16 negative tumors. Also, HPV-16 positive patients exposed to radiotherapy presented a better survival. CONCLUSIONS: HPV-16 status has a positive prognostic value in HNSCC. Addition of HPV-16 status to the TNM staging can provide better assessment in prognosis and guide treatment for HNSCC patients.

Hemoglobina glucosilada e índice leucoglucémico como determinacionespronósticas en el síndrome coronario agudo / Glycosylated hemoglobin and leukoglycemic index as prognostic determinations in acute coronary syndrome

Introducción: El síndrome coronario agudo es una de las causas más frecuentes de morbilidad y mortalidad a nivel mundial; es importante encontrar determinaciones de laboratorio de fácil alcance que ayuden a valorar el pronóstico de estos pacientes. Objetivo: Determinar el valor pronóstico de la hemoglobina glucosilada (HbA1c) y el índice leucoglucémico (ILG) en pacientes con síndrome coronario agudo. Método: Se realizó un estudio descriptivo transversal en 142 pacientes, diabéticosy no diabéticos, con síndrome coronario agudo, ingresados en el Hospital Universitario Dr. Celestino Hernández Robau de Santa Clara, Cuba, desde octubre de 2012 a octubre de 2013. Se evaluaron la HbA1c, el ILG y las complicaciones después del ingreso.Resultados: Se encontraron 40 pacientes diabéticos y 102 no, con edad promedio de 68,2 años y predominio de hipertensión arterial y dislipidemia. A medida que aumentaron las cifras del ILG aumentó también la frecuencia de complicaciones en los diabéticos (p=0,422) y en los no diabéticos (p=0,007). La HbA1c media de los diabéticos complicados (8,8 por ciento) fue superior a la de los no diabéticos (7,5 por ciento) (p<0,01). Los valores 1443 del ILG y 6,9 por ciento de la HbA1c se establecieron como puntos de corte predictores de complicaciones. Conclusiones: La valoración conjunta del ILG y la HbA1c resultó un predictor de alta especificidad y buena sensibilidad en ambos grupos de estudio(AU)

Lipoproteína(a) y fibrinógeno como predictores de complicacionesen pacientes con síndrome coronario agudo / Lipoprotein(a) and fibrinogen as predictors of complications in patients with acute coronary syndrome

Introducción: Las enfermedades cardiovasculares aportan el mayor número de defunciones anuales en el mundo desarrollado, por lo que se les considera un azote para la humanidad; entre ellas, la cardiopatía isquémica.Objetivos: Determinar el valor de la lipoproteína(a), el fibrinógeno y el índice fibrinógeno-lipoproteína(a) en la predicción de complicaciones a corto plazo en los pacientes con síndrome coronario agudo. Método: Se realizó un estudio descriptivo transversal en 115 pacientes ingresados con síndrome coronario agudo en el Hospital Dr. Celestino Hernández Robau de SantaClara, desde noviembre de 2012 a octubre de 2013. Resultados: Los pacientes fueron 43 del sexo femenino y 72 del masculino. Los factores de riesgo más frecuentes fueron la hipertensión arterial (70,43 por ciento), la dislipidemia (50,43 por ciento) y los antecedentes familiares de coronariopatía (47,83 por ciento). Se presentaron complicaciones en 39 pacientes (33,9 por ciento). Se establecieron puntos de corte en 4,50 g/L para el fibrinógeno, 341 mg/L para la lipoproteína(a) y 1,50 para el índice fibrinógeno-lipoproteína(a). Este último mostró una sensibilidad de 89 por ciento, especificidad de 94 por ciento y una capacidad predictiva dada por una razón de posibilidades de 122, por lo que clasifica como de muy buen valor predictivo. Conclusiones: El índice fibrinógeno-lipoproteína(a) mostró un excelente poder predictivo para las complicaciones a corto plazo en pacientes con síndrome coronario agudo(AU)

Maltrato infantil según la escala de estrategias de resolución de conflictos (CTSPC), en población escolarizada de la ciudad de Manizales (Colombia), 2011 / Child abuse according to conflict tactics scale (CTSPC), in school population of Manizales City (Colombia), 2011

Antecedentes: El maltrato infantil actualmente ha aumentado en frecuencia y formas, considerándose un problema de salud pública. Los niños siguen siendo los que presentan más riesgo de ser maltratados. Materiales y Métodos: se seleccionó una muestra de 449 estudiantes, de cuarto a sexto grado de tres instituciones públicas de Manizales (Colombia), se estudiaron en esta población variables demográficas, necesidades básicas, historia de maltrato, escala CTSPC versión niños. Resultados: La escala CTSPC mostró en promedio 9,21% o 29,29 en puntaje absoluto. Según el resultado de esta escala al 33,7% lo castigan pegándole con cinturón, al 9,5% con cable, el 10,9% han presentado quemaduras con plancha, el 9% han sido amenazados con abandono, o ser hechados de la casa, solo al 61,3% nunca le pegan cuando lo castigan. El valor de la escala CTSPC mostró relación significativa con género (p=0,015), funcionalidad familiar (p=0,028), el consumo de licor (p=0,013), y maltrato infantil (p=0,001) anterior de las personas que los cuidan, el pelear con los compañeros (p=0,004). El 29,1% presenta consumo de licor en la familia, el 18,3% antecedente de maltrato en algún miembro de la familia, el 51,5% presenta algún tipo de disfuncionalidad familiar. Conclusiones: Una considerable proporción de la población, según la escala CTSPC, aún sufre maltrato intrafamiliar, lo cual es inaceptable. Se hacen necesarias campañas que erradiquen imaginarios culturales anticuados y primitivos alrededor de la educación de los hijos, y que a lo único que contribuyen es a perpetuar el ambiente generalizado de violencia tan propio de Colombia...

[Alzheimer-type dementia in a sample of Puerto Rican elderly: pilot study on the usefulness and assessment of a screening battery]. / Demencia tipo Alzheimer en una muestra de ancianos puertorriqueños: estudio piloto sobre la utilidad y evaluación de una batería de cernimiento.

Dementia is one of the most prevalent conditions in the elderly. Dementia is defined as a decrease in memory, thinking and reasoning having its most common form as Alzheimer dementia. Alzheimer dementia (AD) economic cost to society is around 100 billion dollars annually. Unfortunately, at this point Puerto Rico, have neuro-psychopathology instruments limitations to perform valid and sensitive screening of DA. This study was directed to evaluate a battery of neuropsychological screening instruments for Puerto Rican elderly (60 to 100 years, n = 50) with Alzheimer's dementia. In addition, calculate the sensitivity and specificity of the instruments. The tests where composed as screening battery and included CERAD (Instruments created by the Consortium to Establish a Registry for Alzheimer's Disease), MMSE (Mini mental Status Evaluation), EIWA-III (specifically the digit retention and similarities subtest that try to evaluated memory, concentration and abstract thinking) and the Tuokkos' test (clock drawing in order to evaluated visual-constructional skills). As show by ROC Curve (Receiver Operating Characteristic Curve) for our research, the sensitivity for CERAD was 95.7% with an specificity of 49%; MMSE (Mini Mental Status Evaluation) account for 89 sensitivity and 60% specificity; EIWA-III and subtest (specifically the digit retention and similarities subtest) respectively was 80.4% sensitivity and 44.7% specificity; and sensitivity of 82.6% and specificity of 44.7%. Tuokkos' Clock Test accounted for 76.1% sensitivity, and 23.4% specificity. Reported indexes were within acceptable limits for screening tests. We suggest a sample increment and new testing with additional instruments.

[Validation of a scale of attitudes towards sexuality in a sample of Puerto Rican elderly]. / Validacion de una escala de actitudes hacia la sexualidad en una muestra de ancianos puertorriqueños.

The literature indicates that elderly population is at high risk that affects their sexual activity; however, this is not the end of sexuality expression in this population. Elderly (people 65 years and older) who are healthy and active has more opportunities of sexual expression and activity in all forms, (including masturbation, and oral sex), and these activities can continue until 74 years or older. This study tries to explore if the Scale of Attitudes towards Sexuality Behavior in the Elderly develop in Puerto Rico, is a valid and reliable instrument to measure attitudes towards the sexuality in an elderly sample. In addition, the research tries to contribute to the progress and development of instruments that measure, and screen, sexuality aspects and risk behaviors that focus in the elderly population. This may help to promote future studies and the development of preventive programs that help to fulfill specific necessities in elderly. The research subjects consist of a secondary database sample of 265 adults of 65 years or older. The design of this study was an ex post facto type. The collected data were analyzed using descriptive statistics and factorial analyses to establish an association between the study variables (i.e., attitudes towards the sexuality and sexuality) using SPSS-X program version 14; also was concluded that the instrument is a valid and reliable (Alpha Cronbach = 0.95), which is considered adequate. It's expected that the scale will be valuable for future research in this area.

Comportamiento de la violencia intrafamiliar contra la mujer en la Atención Primaria de Salud / Behavior of domestic violence against women in primary health care

Pese a la cercanía del tercer milenio la violencia intrafamiliar contra la mujer constituye un flagelo que se instala en nuestros hogares y menoscaba la integridad de la familia. En el presente trabajo se realizó un estudio descriptivo sobre la violencia intrafamiliar contra la mujer en el área de salud del consultorio médico de la familia 66-4, perteneciente al policlínico “Capitán Roberto Fleites” de Santa Clara en el período comprendido de Noviembre/2003 a Octubre/2005 con el objetivo de identificar el comportamiento de dicho fenómeno en el área de salud; la muestra seleccionada con criterio intencional quedó constituida por 97 mujeres, víctimas de violencia intrafamiliar en las edades comprendidas entre 15-59 años de edad; para la recolección de la información se revisaron sus historias clínicas individuales y familiares y se aplicó una encuesta.; para el procesamiento se realizaron análisis de frecuencia absoluta y relativa. Se obtuvieron como resultados más relevantes un predominio de mujeres violentadas en las edades comprendidas entre 31-40 años, en su mayoría amas de casa, con nivel escolar medio, los victimarios fueron en su mayoría de 31-40 años, trabajadores, con nivel medio de escolaridad. Se determinó además que no existió una marcada influencia de los hábitos tóxicos durante los actos de violencia. La violencia psicológica fue la predominante a así como las consecuencias psíquicas. A partir de estos resultados se recomienda diseñar estrategias de intervención multidisciplinarias e intersectoriales que permitan actuar sobre la violencia intrafamiliar contra la mujer en la comunidad(AU)