Manejo del cáncer de mama en tiempos de pandemia COVID-19: experiencia local / Management of breast cancer in COVID-19 pandemic: a local experience

La pandemia por COVID-19 ha generado un estancamiento mundial en la atención y resolución de todas las patologías graves y crónicas, debido al colapso de los sistemas de salud, a la dificultad de consulta, dada por la disminución de movilidad de las personas, por las cuarentenas establecidas y también por el temor de los pacientes al contagio en los centros de salud. Los enfermos oncológicos han visto canceladas sus atenciones, suspendidos o postergado sus tratamientos y diferidas sus cirugías. Esto no ha sido ajeno a las pacientes con cáncer de mama. En el presente trabajo, se reporta la experiencia de una Unidad de Patología Mamaria de un hospital público de Santiago de Chile y de las acciones realizadas para mantener la continuidad de atención en una comuna con una alta tasa de infección por SARS-CoV-2.

The COVID-19 pandemic has generated a global stagnation in the care and medical treatment of serious and chronic illnesses due to the collapse of the health systems, the difficulty of consulting due to decreased mobility caused by forced quarantines and also because of the fear of infection when attending a health center. Cancer patients have had their medical appointments canceled, their treatments suspended or postponed, and their surgeries delayed. Breast cancer patients have not been the exception. We report the experience of a Breast Pathology Unit of a public hospital in Santiago of Chile, and the actions carried out to maintain continuity of care in a community with a high infection rate of SARS-CoV-2.

Relative permittivity estimation of wheat starch: A critical property for understanding electrostatic hazards.

Wheat starch is a widely used material in the food, pharmaceutical and entertainment industry not considered hazard but recently associated to dust explosions during processing and handling. How an insulating starch grain is charged and how its ability to be polarized is affected by environmental conditions such as temperature, humidity and frequency? are fundamental questions that must be explored in order to understand the dust explosion phenomena. Here we investigate the dependence of temperature, humidity and low-frequency on the relative permittivity of wheat starch. We characterized starch at the micro and macro scales using atomic force microscopy-based techniques and capacitive planar sensor-based measurements respectively. The results show high values of permittivity (˜80) at the microscale (single starch grains) compared to the low values (10-20) at the macroscale (20 mg of wheat starch). The differences are attributed to the Maxwell-Wagner-Sillars interfacial polarization process on individual grains and potential charge exchange between grains. Permittivity is a critical property to investigate starch electrostatic hazards.

Comparative study of equivalent circuit models for photoconductive antennas.

Comparison of equivalent circuit models (ECM) for photoconductive antennas (PCA) represents a challenge due to the multiphysics phenomena involved during PCA operation and the absence of a standardized validation methodology. In this work, currently reported ECMs are compared using a unique set of simulation parameters and validation indicators (THz waveform, optical power saturation, and ECM voltages consistency). The ECM simulations are contrasted with measured THz pulses of an H-shaped 20µm gap PCA at different optical powers (20mW to 220mW). In addition, an alternative two-element ECM that accounts for both space-charge and radiation screening effects is presented and validated using the proposed methodology. The model shows an accurately reproduced THz pulse using a reduced number of circuital elements, which represents an advantage for PCA modeling.

Cáncer en mama axilar: revisión de la literatura a propósito de un caso / Axillary breast cancer: clinical case and literature review

El tejido mamario ectópico se desarrolla debido a la involución incompleta de la cresta mamaria, de localización más frecuente en la axila y más común en mujeres. Este tejido sufre cambios fisiopatológicos similares a los de la mama normal, entre los cuales se encuentra la malignización. El carcinoma primario de este tejido es infrecuente, y su manifestación más común es la masa palpable. Al igual que en la mama normal, la histología más frecuente del cáncer de mama ectópica es el Carcinoma Ductal Infiltrante y, por su localización atípica, suele diagnosticarse tardíamente, y tendría un curso más agresivo y de peor pronóstico, dado por la mayor cercanía a ganglios, piel y pared torácica. Debido a los pocos datos publicados, el diagnóstico y tratamiento no están bien establecidos, pero los esquemas disponibles son similares a los utilizados en el cáncer de mama normal. Se presenta el caso de una paciente de 41 años, con diagnóstico de cáncer de mama ectópica en la región axilar derecha, sin invasión a distancia, tratada con cirugía, quimioterapia y radioterapia, que evoluciona favorablemente, sin metástasis ni recidivas durante seguimiento.

Ectopic mammary tissue develops due to the incomplete involution of the mammary crest, which is more frequently located in the axilla and more common in women. This tissue undergoes pathophysiological changes similar to those of the normal breast, among which malignancy is found. The primary carcinoma of this tissue is infrequent and its most common manifestation is the palpable mass. As in the normal breast, the most frequent histology of ectopic breast cancer is the Infiltrating Ductal Carcinoma and, because of its atypical location, it is usually diagnosed late and it would have a more aggressive course and a worse prognosis, due to the greater proximity to lymph nodes, skin and chest wall. Because of the few published data, the diagnosis and treatment are not well established, but the available schemes are similar to those used in normal breast cancer. We present the case of a 41yearsold female patient with a diagnosis of ectopic breast cancer in the right axillary region, without distant invasion, treated with surgery, chemotherapy and radiotherapy, whoevolves favorably, without metastasis or relapses during follow-up.

Response to ODN-CpG by B Cells from patients with systemic lupus erythematosus correlates with disease activity.

Different immunological alterations may condition systemic lupus erythematosus (SLE) activity. However, it is not known whether alterations in the phenotype of circulating antigen-presenting cells (APCs) and in the response to CpG oligodeoxynucleotides (ODN-CpG) correlate with disease activity. APC expression of HLA-DR, costimulatory molecules, and TLR9 expression was determined in patients with SLE, other autoimmune diseases, and healthy controls. Monocyte and B cell response to synthetic ODN-CpG sequences was also evaluated. Monocytes from patients with moderate SLE activity had higher expression of CD40 and CD86. Decreased numbers of CD19+CD80+ and BDCA-3+CD40+ cells were found in patients with severe SLE activity. In patients with moderate SLE activity, non-adherent and enriched B cell response to ODN-CpG was similar to healthy controls. Adherent and enriched B cells from patients with severe SLE activity did not increase costimulatory molecule expression or cytokine production after ODN-CpG stimulation. APCs from patients with SLE, regardless of disease activity, displayed higher percentage of TLR9+ cells, as well as increased expression of TLR9, compared to healthy controls. Results suggest that the B cell response to ODN-CpG correlates with the SLE activity, independently of TLR9 expression, indicating that alterations in B cell response in severe activity SLE may be caused by events down-stream to TLR9.

Childhood systemic lupus erythematosus in Latin America. The GLADEL experience in 230 children.

To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were <18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p<0.05). On the other hand, myalgias, Sjögren's syndrome and cranial nerve involvement were more frequently seen in adults (p<0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.

Cytokine gene polymorphisms in Colombian patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) patients exhibit alterations in cytokine production that may be relevant to SLE pathogenesis. There is evidence that cytokine gene polymorphisms control cytokine production; thus, these polymorphisms may be associated with SLE or its clinical manifestations. To establish the association of tumor necrosis factor alpha (TNF-alpha), transforming growth factor (TGF) beta1, interleukin (IL)-10, and IL-6 gene polymorphisms in Colombian SLE patients and their clinical manifestations, 120 SLE patients and 102 healthy controls were studied. Single nucleotide polymorphisms were studied by sequence-specific primers polymerase chain reaction (SSP-PCR) at: TNFalpha-308 (G/A), TGFbeta1 codon 10 (C/T) and codon 25 (G/C), IL-10 -1082 (G/A), -819 (C/T) and -592 (C/A), and IL-6 + 174 (G/C). Human leukocyte antigen (HLA)-DRbeta1 was typed by SSP-PCR. SLE patients had increased frequency of allele C at TGFbeta1 codon 25 (P = 0.0001, odds ratio (OR): 4.25, 95% confidence interval (CI): 2.17-8.35) and allele A at TNFalpha-308 (P = 0.0004 OR: 3.9, 95% CI: 1.65-5.80) compared with healthy controls. There was higher frequency of GC genotype at TGFbeta1 codon 25 in SLE patients (P < 0.0001). Extended genotypic analysis showed that SLE patients have decreased frequency of TNFalphaLow/TGFbeta1High (0.50) compared with healthy controls (0.80) (P < 0.0001). No association was found between these polymorphisms and SLE clinical manifestations except for Sm and Ro autoantibodies that were associated with TNFalpha allele A. There is an association between TNFalpha-308A/TGFbeta1 codon 25C with SLE susceptibility in Colombian population. This association may result in a highly inflammatory response with a decrease regulatory function mediated by TNFalpha and TGFbeta1, respectively. The TNFalpha-308A/TGFbeta1 25C genotype may be one component of genetic susceptibility to SLE in Colombian population.

Association of HLA-DRB1*1602 and DRB1*1001 with Takayasu arteritis in Colombian mestizos as markers of Amerindian ancestry.

We performed HLA Class I and Class II typing in 16 patients (15 women, one man) with a confirmed diagnosis of Takayasu arteritis. We did not find any of the previously described associations with HLA-B52, and/or HLA-DRB1*1301 alleles. However, in our patients, HLA-DRB1*1602 and HLA-DRB1*1001 were significantly increased. The association of Takayasu arteritis with Amerindian and Asian HLA-DRB1 alleles (DRB1*1602 and DRB1*1001) in the Colombian mestizo patients reported here, and with HLA-B*3906 previously reported in Mexicans, suggest the possibility that some HLA and disease associations are markers for ethnicity of a population carrying a disease gene which is present in an admixed population with the disease.

Childhood-onset systemic lupus erythematosus: a comparative study of African Americans and Latin Americans.

This study compared the clinical and serologic features in two different ethnic groups of patients with childhood-onset systemic lupus erythematosus (SLE). One hundred seventy-one SLE patients comprised the study population; 61 (55 girls and 6 boys) were African American with age at onset of 13 +/- 2.9 years, and 110 (97 girls and 13 boys) were Latin American (Colombian) with age at onset of 13 +/- 3.2 years. Clinical, demographic, and laboratory data were obtained by chart review using a standard data collection form. African-American patients more commonly manifested discoid skin lesions, malar rash, pulmonary fibrosis, and pleuritis, and less commonly manifested photosensitivity, livedo reticularis, and vascular thrombosis than did Latin Americans. In addition, there was a higher frequency of anti-dsDNA, anti-Sm, anti-RNP, and anti-Ro positivity among African-Americans compared with Latin-American patients. These results suggest the presence of ethnic differences in the clinical expression of SLE.

Takayasu arteritis in Colombia.

Takayasu arteritis has been recognized in Colombia just recently, and so far we do not have any report concerning its presentation here. In this first report, some issues related to the presentation of the disease are indicated and compared with those found in the medical literature. No differences were found in age and sex. Most of the cases were diagnosed during an inactive phase of the disease with advanced manifestations due to vascular lesion which suggests the existence of some genetic factor influencing such a presentation, or may be the consequence of a delay in diagnosing the disease during initial and active stages due to not suspecting it. Comparing the vessels which are affected among other races and countries, we can find both differences and similarities. With the purpose of discovering the demographic, clinical, angiographic and laboratorial characteristics of Takayasu arteritis in Colombia, the present study was carried out by studying 35 clinical cases in different medical centers of the country.

Variability of anticardiolipin antibody isotype distribution in 3 geographic populations of patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the prevalence of anticardiolipin antibodies (aCL) and isotype distribution and their clinical associations with the features of the antiphospholipid syndrome (APS) in 3 different ethnic groups of patients with systemic lupus erythematosus (SLE). METHODS: The study population consisted of 152 African-American, 136 Afro-Caribbean (Jamaican), and 163 Hispanic (Colombian) unselected patients with SLE. Serum samples were studied for the prevalence of aCL and isotype distribution. All aCL measurements were performed in the same laboratory by ELISA. RESULTS: Positive results for 1 of the 3 aCL isotypes were found in 42 African-Americans (28%), 28 Afro-Caribbeans (21%), and 43 Hispanics (26%). IgG aCL was the dominant isotype in Hispanic and African-American patients, while IgA was the dominant isotype in Afro-Caribbeans. Of note, IgA aCL was found in all Afro-Caribbean patients who were aCL positive, while only 3 patients in this group had IgG aCL and 2 had IgM aCL. Clinical features of the APS were found to correlate better in Hispanics than in African-Americans and Afro-Caribbean patients with aCL isotypes. CONCLUSION: Our data suggest the existence of ethnic differences in the prevalence and isotype distribution of aCL as well as in their clinical relevance in patients with SLE. Further studies of the role of genetic and/or environmental factors in the observed differences are required.

Systemic lupus erythematosus in males. A study of 107 Latin American patients.

Clinical and laboratory features were analyzed in 107 Latin American male patients with systemic lupus erythematosus (SLE) who were compared with a group of 1,209 Latin American female patients with SLE to determine the presence of gender-associated differences. Males had an increased prevalence of renal disease, vascular thrombosis, and the presence of anti-dsDNA antibodies, as well as the use of moderate to high doses of corticosteroids, compared with female SLE patients. Although there was no difference in mortality from all causes, SLE-related mortality was higher in the male group. All these findings are consistent with a more severe disease in Latin American males than in female patients from the same region.

Promoción de la salud mental en niños y adolescentes victimas de la violencia armada en Puno-Perú / Mental health promotion in children and adolescents victims of armed violence in Puno-Perú

Se presenta la experiencia de un trabajo pionero de intervención en Salud Mental en zonas afectadas por la violencia armada particularmente en Puno. Se llevó a cabo un primer serminario taller con asistencia de representantes de los diferentes sectores (Salud, Educación, Iglesia, Organizaciones de la comunidad, etc.). Los participantes identificaron tanto la problemática de salud mental a ser abordada como las zonas más afectadas (Azángaro, Melgar y Ayaviri). Se diseñaron programas de capacitación en Salud Mental para los representantes de los diferentes sectores de las zonas anteriores identificadas formulándose estrategias de intervención local.

The first stage of a pioneer work in Peruvian regions affected by armed violence particularly in Puno is presented. A first workshop seminar was carried out with representatives of different sectors (Health, Education, Church, Local organizations, etc.). The participants identifies the mental health problems of the community as well as the most affected areas (Azangaro, Melgar and Ayaviri). Training programs on Mental Health for social leaders of those regions were designed and some intervention strategies were developed.

Tumor filodes: diagnóstico y tratamiento / Phylodes tumor: diagnosis and treatment

Revisamos los tumores benignos tratados entre los años 1981-1993 encontrando 1.178 entre los cuales 39 aparecen con el diagnóstico de tumor Filodes, debiendo desechar 5 de ellos por no tener segura la descripción y clasificación histológica, estudiando 34 casos comprobados, que representa el 2,89 por ciento de los tumores benignos; si sumamos a estos tumores benignos 896 cánceres de esos años, nos da un total de 2.074 y la relación se convierte en 1.64 por ciento de ese total. Encontramos 22 filodes benignos (64.7 por ciento), 7 limítrofes (20,5 por ciento) y 5 malignos (14,8 por ciento), cuyas características clínicas, histológicas y evolutivas, presentamos en este trabajo

Ginecomastias / Gynecomastia

Se estudian 21 varones con ginecomastia, siendo unilaterales el 6,29% y bilaterales el 15,71%; esto se traduce en 36 hipertrofias mamarias en el hombre, entre los cuales se descubren dos carcinomas implantados en ginecomastias (5,5%). La mayoría de las ginecomastias fueron de origen fisiológico, y su aparición ocurrió en la adolescencia, siendo variable el tiempo de latencia para consultar; 72% se descubrieron en la segunda y tercera décadas de la vida, y sólo una después de los 70 años. El mejor método de diagnóstico complementario en la mamografía, la que tiene un altísimo rendimento, descubriendo la bilateralidad por muy pequeña que sea la hipertrofia, y siendo decisiva para el diagnóstico diferencial con el carcinoma mamario masculino. Prácticamente todos los pacientes eran de configuración genotípica y fenotípica masculina, y la mayoría no tenía alteraciones endocrinas de importancia. El patologia mamaria agregada es importante la presencia de dos carcinomas mamarios, presentados en ginecomastias unilaterales y en personas mayores. El tratamiento fue la adenomastectomía subcutánea en todos lo casos. En los carcinomas, el tratamiento se adaptó a la características locales del tumor y generales del paciente. Concluimos que toda patología mamaria en el hombre, especialmente las ginecomastias, debe ser estudiada con acuciosidad, pues en el futuro del paciente puede acechar un carcinoma, que, por lo general, tiene peor pronóstico que en la mujer, considerando igualdad de condiciones

Campaña de información sobre factores de riesgos para cáncer mamario y enseñanza del autoexamen en al área oriente de Santiago: sus resultados / Information campaign about risk factors of breast cancer and the way to perform autoexam inations in the Eastern area of Santiago; its results

Se reseña brevemente la campaña de información sobre factores de riesgo mamario y enseñanza del autoexamen mamario, llevado a cabo durante dos años (1984-85), dirigida a la población femenina del Area Oriente de Santiago, a través de las matronas de los consultorios periféricos del Servicío de Gineco-Obstetricia del Hospital del Salvador. Se analizan sus resultados a través de una encuesta preparada especialmente, que contestaron en forma libre y anónima 350 mujeres de edades entre 17 y 64 años. Se desecharon 24 encuestas contradictorias y se obtuvieron los resultados en el análisis de 326 encuestas útiles. Estas mostraron la buena acogida de la campaña, y el éxito de motivación de la población femenina para captar la información y familiarizarse con la práctica del autoexamen mamario