Acerca del simposio Salud Pública Contemporánea en la provincia de Matanzas / About the symposium called Contemporary Public Health in Matanzas province

El sector de la salud requiere cada día más de la preparación de sus recursos humanos, componente esencial y necesario para la ejecución de los cambios pertinentes y lograr el desarrollo que se solicita. (1 Para transformar en positivo la situación sanitaria, las acciones tienen que ser encaminadas a responder a las necesidades reales del escenario donde se realice el análisis con identificación de los determinantes sociales de la salud, instrumentos útiles en la vigilancia epidemiológica, utilización de la gerencia y participación social e intersectorial. Es importante que hoy todos los prestadores del sistema de salud, en particular los que se desempeñan en funciones asistenciales, docentes e investigativas, enfoquen su actuar desde los determinantes sociales. El cuadro de salud debe responder a estos, a los problemas de la población del lugar, donde se analice, para que permita trazar políticas públicas que impacten de manera positiva en el estado de salud de la población y de esta forma cumplir el primer propósito de las transformaciones necesarias. La preparación es uno de los componentes esenciales e ineludibles que requieren los recursos humanos del sector salud para, a través de los cambios pertinentes, lograr el desarrollo que se requiere. La formación del egresado de las ciencias médicas, en todos los niveles de atención médica, se desarrolla a través de la integración de conocimientos y habilidades de las sociomédicas, que unido a la preparación clínico epidemiológico sólido, permiten resolver los problemas de salud que enfrentan. Podría entonces, asegurarse que es necesario el enfoque de los determinantes para que todos sean y sepan ser salubristas. 2 Se realizó el Simposio La Salud Pública Contemporánea, el 11 de enero del 2018, en la Universidad de Ciencias Médicas de Matanzas (UCMM), auspiciado por el capítulo matancero de la Sociedad Cubana de Salud Pública, a través del Consejo Provincial de Sociedades Científicas. Las palabras iniciales estuvieron a cargo de la Dra. Odalys Sánchez Barrera, presidenta del capítulo. Contó el evento científico con la participación de miembros del capítulo, profesionales del sector y estudiantes...(AU)

Diabetic concentrations of metformin inhibit platelet-mediated ovarian cancer cell progression.

Clinical studies have suggested a survival benefit in ovarian cancer patients with type 2 diabetes mellitus taking metformin, however the mechanism by which diabetic concentrations of metformin could deliver this effect is still poorly understood. Platelets not only represent an important reservoir of growth factors and angiogenic regulators, they are also known to participate in the tumor microenvironment implicated in tumor growth and dissemination. Herein, we investigated if diabetic concentrations of metformin could impinge upon the previously reported observation that platelet induces an increase in the tube forming capacity of endothelial cells (angiogenesis) and upon ovarian cancer cell aggressiveness. We demonstrate that metformin inhibits the increase in angiogenesis brought about by platelets in a mechanism that did not alter endothelial cell migration. In ovarian cancer cell lines and primary cultured cancer cells isolated from the ascitic fluid of ovarian cancer patients, we assessed the effect of combinations of platelets and metformin upon angiogenesis, migration, invasion and cancer sphere formation. The enhancement of each of these parameters by platelets was abrogated by the present of metformin in the vast majority of cancer cell cultures tested. Neither metformin nor platelets altered proliferation; however, metformin inhibited the increase in phosphorylation of focal adhesion kinase induced by platelets. We present the first evidence suggesting that concentrations of metformin present in diabetic patients may reduce the actions of platelets upon both endothelial cells and cancer cell survival and dissemination.

Leptin stimulates migration and invasion and maintains cancer stem-like properties in ovarian cancer cells: an explanation for poor outcomes in obese women.

The evidence linking obesity with ovarian cancer remains controversial. Leptin is expressed at higher levels in obese women and stimulates cell migration in other epithelial cancers. Here, we explored the clinical impact of overweight/obesity on patient prognosis and leptin's effects on the metastatic potential of ovarian cancer cells. We assessed clinical outcomes in 70 ovarian cancer patients (33 healthy weight and 37 overweight) that were validated with an external cohort from The Cancer Genome Atlas (TCGA) database. Progression-free and overall survival rates were significantly decreased in overweight patients. Similarly, a worse overall survival rate was found in TCGA patients expressing higher leptin/OB-Rb levels. We explored serum and ascites leptin levels and OB-Rb expression in our cohort. Serum and ascites leptin levels were higher in overweight patients experiencing worse survival. OB-Rb was more highly expressed in ascites and metastases than in primary tumors. Leptin exposure increased cancer cell migration/invasion through leptin-mediated activation of JAK/STAT3, PI3/AKT and RhoA/ROCK and promoted new lamellipodial, stress-fiber and focal adhesion formation. Leptin also contributed to the maintenance of stemness and the mesenchymal phenotype in ovarian cancer cells. Our findings demonstrate that leptin stimulated ovarian cancer cell migration and invasion, offering a potential explanation for the poor prognosis among obese women.

Platelets enhance tissue factor protein and metastasis initiating cell markers, and act as chemoattractants increasing the migration of ovarian cancer cells.

BACKGROUND: An increase in circulating platelets, or thrombocytosis, is recognized as an independent risk factor of bad prognosis and metastasis in patients with ovarian cancer; however the complex role of platelets in tumor progression has not been fully elucidated. Platelet activation has been associated with an epithelial to mesenchymal transition (EMT), while Tissue Factor (TF) protein expression by cancer cells has been shown to correlate with hypercoagulable state and metastasis. The aim of this work was to determine the effect of platelet-cancer cell interaction on TF and "Metastasis Initiating Cell (MIC)" marker levels and migration in ovarian cancer cell lines and cancer cells isolated from the ascetic fluid of ovarian cancer patients. METHODS: With informed patient consent, ascitic fluid isolated ovarian cancer cells, cell lines and ovarian cancer spheres were co-cultivated with human platelets. TF, EMT and stem cell marker levels were determined by Western blotting, flow cytometry and RT-PCR. Cancer cell migration was determined by Boyden chambers and the scratch assay. RESULTS: The co-culture of patient-derived ovarian cancer cells with platelets causes: 1) a phenotypic change in cancer cells, 2) chemoattraction and cancer cell migration, 3) induced MIC markers (EMT/stemness), 3) increased sphere formation and 4) increased TF protein levels and activity. CONCLUSIONS: We present the first evidence that platelets act as chemoattractants to cancer cells. Furthermore, platelets promote the formation of ovarian cancer spheres that express MIC markers and the metastatic protein TF. Our results suggest that platelet-cancer cell interaction plays a role in the formation of metastatic foci.

Metformin, at concentrations corresponding to the treatment of diabetes, potentiates the cytotoxic effects of carboplatin in cultures of ovarian cancer cells.

The use of the type 2 diabetics drug metformin has been correlated with enhanced progression-free survival in ovarian cancer. The literature has speculated that this enhancement is due to the high concentration of metformin directly causing cancer cell death. However, this explanation does not fit with clinical data reporting that the women exposed to constant micromolar concentrations of metformin, as present in the treatment of diabetes, respond better to chemotherapy. Herein, our aim was to examine whether micromolar concentrations of metformin alone could bring about cancer cell death and whether micromolar metformin could increase the cytotoxic effect of commonly used chemotherapies in A2780 and SKOV3 cell lines and primary cultured cancer cells isolated from the peritoneal fluid of patients with advanced ovarian cancer. Our results in cell lines demonstrate that no significant loss of viability or change in cell cycle was observed with micromolar metformin alone; however, we observed cytotoxicity with micromolar metformin in combination with chemotherapy at concentrations where the chemotherapy alone produced no loss in viability. We demonstrate that previous exposure and maintenance of metformin in conjunction with carboplatin produces a synergistic enhancement in cytotoxicity of A2780 and SKOV3 cells (55% and 43%, respectively). Furthermore, in 5 (44%) of the 11 ovarian cancer primary cultures, micromolar metformin improved the cytotoxic response to carboplatin but not paclitaxel or doxorubicin. In conclusion, we present data that support the need for a clinical study to evaluate the adjuvant maintenance or prescription of currently approved doses of metformin during the chemotherapeutic treatment of ovarian cancer.

Paclitaxel-PHBV nanoparticles and their toxicity to endometrial and primary ovarian cancer cells.

This report is an integrated study to include the molecular simulation, physicochemical characterization and biological analysis of a paclitaxel-loaded PHBV nanoparticle that demonstrates uptake, release and cytotoxicity in cancer cell lines. Taking this nanoparticle one step closer to its use in a clinical setting, we demonstrate that it causes significant cell death in primary cultures of stage IIIc serous ovarian cancer cells isolated from six patients. Molecular simulations revealed a high affinity of paclitaxel for the water-polymer interface, thus the drug is delivered only when the polymer near it is degraded. The Fourier transform infrared spectroscopy suggests the formation of a short-lived crystalline phase, also observed in the CG simulations, and transmission electron microscopy revealed branched structures on the surface of particles, which disappeared after 4 days. Biological analyses indicated that these particles have a 48-h window of toxicity protection, allowing for the endocytosis of the particle by the cells; this finding was corroborated by confocal microscopy and flow cytometry. The low cost to synthesize PHBV using microorganisms and the potential chemical modifications of the polymer make it attractive for inexpensive, large-scale pharmaceutical production.

Radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in IB1 cervical cancer during pregnancy.

► We expose an novel surgical technique in pregnant women with cervical cancer. ► We preserve the pregnancy in this case. ► After 40 months of monitoring both patient and her child are healthy.

Estratificación epidemiológica del riesgo de las enfermedades emergentes y reemergentes por municipios, Matanzas, 2002-2006 / Epidemiologic stratification of the emergent and re-emergent diseases risk per municipalities, Matanzas, 2002-2006

Las enfermedades emergentes y reemergentes constituyen un problema de salud que preocupa a los gobiernos y a las autoridades de Salud Pública por los efectos económicos y sociales que pueden ocasionar. Se realizó un estudio observacional descriptivo en la población de la provincia de Matanzas, distribuida geográficamente en sus municipios, para estratificar el riesgo para las enfermedades emergentes y reemergentes en el período 2002-2006. Se seleccionaron las enfermedades a estudiar y los indicadores por un grupo de expertos: para la tuberculosis y el VIH/sida fueron la tasa de prevalencia y de letalidad, para el dengue y el paludismo los casos importados y el índice de infestación, para la influenza aviar y la fiebre del Oeste del Nilo Occidental el asentamiento de aves migratorias, el arribo de viajeros de áreas endémicas y para esta última también el índice de infestación. Los datos fueron obtenidos de las tarjetas de enfermedades de declaración obligatoria y certificados de defunción de la Dirección Provincial de Salud y del Centro Provincial de Higiene, Epidemiología y Microbiología, así como del sistema de vigilancia vectorial de la Unidad Provincial de Vectores y de aves migratorias de la Dirección Provincial de Medicina Veterinaria y el CITMA. Obteniéndose como resultado que Jagüey Grande, Matanzas y Varadero fueron los municipios de mayor riesgo, constituyendo una herramienta de trabajo para los cuadros a diferentes niveles del sistema, ya que brinda un grupo de elementos con base científica para reorientar la vigilancia de estas enfermedades, organizar los servicios de salud e intervenir oportunamente.

The emergent and re-emergent diseases are a health problem worrying the governments and the public health authorities because of the economic and social effects they can have. We carried out an observational descriptive study in the population of the province of Matanzas, geographically distributed in municipalities, to stratify the risk of the emergent and re-emergent diseases in the period 2002-2006. We selected the diseases and the indicators to study for a group of experts: for the tuberculosis and HIV/AIDS were choose the indicators prevalence rate and lethality; for the dengue and malaria, the imported cases and the infestation index; for the chicken influenza and the Western Nile fever, the population of the migratory birds, the arrival of passengers from endemic areas, and for the last one the infestation index. The data were obtained from the forms of the diseases of obligatory declaration and from the decease certificates in the Provincial Health Direction and the Provincial Center of Hygiene, Epidemiology and Microbiology, and also from the system of vectorial surveillance of the Provincial Unit of Vectors. The data about the migratory birds were gathered in the Provincial Directions of Veterinary Medicine and of Sciences, Technology and Environment. The municipalities of Jagüey Grande, Matanzas and Varadero were the ones with the highest risks. This is a working tool for the persons in charge in the different levels of the system giving elements on a scientific basement to re-orientate the surveillance of these diseases, organize the health care services and the intervention on time.

Estratificación epidemiológica del riesgo de las enfermedades emergentes y reemergentes por municipios, Matanzas, 2002-2006 / Epidemiologic stratification of the emergent and re-emergent diseases risk per municipalities, Matanzas, 2002-2006

Las enfermedades emergentes y reemergentes constituyen un problema de salud que preocupa a los gobiernos y a las autoridades de Salud Pública por los efectos económicos y sociales que pueden ocasionar. Se realizó un estudio observacional descriptivo en la población de la provincia de Matanzas, distribuida geográficamente en sus municipios, para estratificar el riesgo para las enfermedades emergentes y reemergentes en el período 2002-2006. Se seleccionaron las enfermedades a estudiar y los indicadores por un grupo de expertos: para la tuberculosis y el VIH/sida fueron la tasa de prevalencia y de letalidad, para el dengue y el paludismo los casos importados y el índice de infestación, para la influenza aviar y la fiebre del Oeste del Nilo Occidental el asentamiento de aves migratorias, el arribo de viajeros de áreas endémicas y para esta última también el índice de infestación. Los datos fueron obtenidos de las tarjetas de enfermedades de declaración obligatoria y certificados de defunción de la Dirección Provincial de Salud y del Centro Provincial de Higiene, Epidemiología y Microbiología, así como del sistema de vigilancia vectorial de la Unidad Provincial de Vectores y de aves migratorias de la Dirección Provincial de Medicina Veterinaria y el CITMA. Obteniéndose como resultado que Jagüey Grande, Matanzas y Varadero fueron los municipios de mayor riesgo, constituyendo una herramienta de trabajo para los cuadros a diferentes niveles del sistema, ya que brinda un grupo de elementos con base científica para reorientar la vigilancia de estas enfermedades, organizar los servicios de salud e intervenir oportunamente(AU)

The emergent and re-emergent diseases are a health problem worrying the governments and the public health authorities because of the economic and social effects they can have. We carried out an observational descriptive study in the population of the province of Matanzas, geographically distributed in municipalities, to stratify the risk of the emergent and re-emergent diseases in the period 2002-2006. We selected the diseases and the indicators to study for a group of experts: for the tuberculosis and HIV/AIDS were choose the indicators prevalence rate and lethality; for the dengue and malaria, the imported cases and the infestation index; for the chicken influenza and the Western Nile fever, the population of the migratory birds, the arrival of passengers from endemic areas, and for the last one the infestation index. The data were obtained from the forms of the diseases of obligatory declaration and from the decease certificates in the Provincial Health Direction and the Provincial Center of Hygiene, Epidemiology and Microbiology, and also from the system of vectorial surveillance of the Provincial Unit of Vectors. The data about the migratory birds were gathered in the Provincial Directions of Veterinary Medicine and of Sciences, Technology and Environment. The municipalities of Jagüey Grande, Matanzas and Varadero were the ones with the highest risks. This is a working tool for the persons in charge in the different levels of the system giving elements on a scientific basement to re-orientate the surveillance of these diseases, organize the health care services and the intervention on time(AU)

Pronóstico del cáncer cérvico uterino estadios IIB-IIIB tratados con radio quimioterapia: experiencia Hospital Van Buren, Valparaíso, Chile / Prognosis of stage IIB-IIIB cervical cancer treated with radiochemotherapy: experience from the Van Buren Hospital, Valparaíso, Chile

Objetivo: analizar retrospectivamente resultados y factores pronósticos de pacientes con cáncer cérvico uterino estadios IIB-IIIB tratados con radioquimioterapia concomitante.Materiales y métodos: desde septiembre 1999 a diciembre del 2002, 164 pacientes ingresaron con el diagnóstico de cáncer de cérvix, seleccionándose 83 en estadios IIB-IIIB, las que fueron tratadas con radioterapia y cisplatino semanal por cinco semanas.Resultados: el 89,15 por ciento completó cinco ciclos de quimioterapia. La mediana de sobrevida global fue de 41 meses, con una sobrevida global (SG), sobrevida libre de enfermedad (SLE) y sobreviva libre de recurrencia loco-regional (SLRLR) a tres años de 68,8 por ciento, 66,3 por ciento y 83,1 por ciento, respectivamente. Factores pronósticos de sobrevida fueron etapa IIIB, diámetro tumoral clínico ≥ 7 cm, no realización de braquiterapia y enfermedad biparametrial.Conclusiones: el tratamiento con radioterapia y quimioterapia concomitante con cisplatino en pacientes con cáncer cervicouterino estadios IIB-IIIB, es posible de realizar en el Hospital Carlos Van Buren perteneciente al sistema de salud público chileno, con buena tolerancia, resultados y factores pronósticos similares a los de la literatura internacional.

Análisis de los casos de tuberculosis ingresados en el Hospital Pediátrico de Matanzas, durante los años 1983-1984 / Analysis of cases of tuberculosis admitted to the Pediatric Hospital, Matanzas, during 1983-1984

Se realiza el estudio de 5 pacientes egresados del Servicio de Enfermedades Trasmisibles del Hospital Pediátrico Docente "Eliseo Noel Caamaño" de Matanzas, durante los años 1983-1984. Se analizan los resultados obtenidos para conocer las formas anatomoclínicas más frecuentes de la tuberculosis infantil en nuestro medio, así como la presencia o no de fuentes de infección tuberculosa y la influencia de factores, como haber sido vacunados con BCG, edad, sexo y raza. Los resultados demuestran que la tuberculosis en el niño no constituye un serio problema de salud en Cuba (ejemplo para otros países que no poseen nuestro Sistema de Salud Socialista) y este trabajo constituye una prueba más de ello

Análisis de los casos de tuberculosis ingresados en el Hospital Pediátrico de Matanzas, durante los años 1983-1984 / Analysis of cases of tuberculosis admitted to the Pediatric Hospital, Matanzas, during 1983-1984

Se realiza el estudio de 5 pacientes egresados del Servicio de Enfermedades Trasmisibles del Hospital Pediátrico Docente "Eliseo Noel Caamaño" de Matanzas, durante los años 1983-1984. Se analizan los resultados obtenidos para conocer las formas anatomoclínicas más frecuentes de la tuberculosis infantil en nuestro medio, así como la presencia o no de fuentes de infección tuberculosa y la influencia de factores, como haber sido vacunados con BCG, edad, sexo y raza. Los resultados demuestran que la tuberculosis en el niño no constituye un serio problema de salud en Cuba (ejemplo para otros países que no poseen nuestro Sistema de Salud Socialista) y este trabajo constituye una prueba más de ello