Análisis estadístico de los factores de riesgo asociados a las patologías de la columna lumbar para la población empleada / Statistical analysis of risk factors associated with lumbar spine pathologies for the employed population

Objetivo: Determinar los factores de riesgo de patologías lumbares en pacientes empleados y afiliados al sistema de salud, a partir de la exploración física, hábitos, antecedentes personales y factores de riesgo laborales. Material y Métodos: El diseño del estudio es retrospectivo, transversal. En una muestra de 668 adultos trabajadores del Ecuador, se aplicó y evaluó el modelo predictivo de respuesta binaria logit para identificar factores de riesgo y se usaron métodos de aprendizaje supervisado (árboles de clasificación) para clasificar a los pacientes según el grado de patología lumbar. Resultados: El modelo predictivo logístico presentó una sensibilidad del 62,5%, una especificidad del 63,7%, el área bajo la curva ROC fue 0,63 y se determinó una precisión del 63,4%.Conclusión: Los factores que aumentan el riesgo de la patología de columna lumbar más frecuente (lumbalgia) y en orden de importancia en los pacientes son: menor edad, sexo femenino, tienden a exponerse a factores de riesgo psicosocial en su trabajo

Objective: Determine the risk factors of lumbar pathologies in patients employed and affi-liated with the health system, based on physical examination, habits, personal history, and occupational risk factors.Materials and Methods: The study design is retrospective, cross-sectional. In a sample of 668 adult workers from Ecuador. The binary logit response predictive model was applied to identify risk factors and supervised learning methodology (classification trees) was used to classify patients according to the degree of lumbar pathology.Results: The logistic predictive model has a sensitivity of 62.5%, a specificity of 63.7%, the area under the ROC curve was 0.63, and precision of 63.4% was determined.Conclusion: The factors that increase the risk of the most frequent lumbar pathology (low back pain) in order of importance in patients are: younger age, female sex, tend to be expo-sed to psychosocial risk factors at work, and lower risk of having mechanical factors.

Autophagy as a Potential Therapy for Malignant Glioma.

Glioma is the most frequent and aggressive type of brain neoplasm, being anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM), its most malignant forms. The survival rate in patients with these neoplasms is 15 months after diagnosis, despite a diversity of treatments, including surgery, radiation, chemotherapy, and immunotherapy. The resistance of GBM to various therapies is due to a highly mutated genome; these genetic changes induce a de-regulation of several signaling pathways and result in higher cell proliferation rates, angiogenesis, invasion, and a marked resistance to apoptosis; this latter trait is a hallmark of highly invasive tumor cells, such as glioma cells. Due to a defective apoptosis in gliomas, induced autophagic death can be an alternative to remove tumor cells. Paradoxically, however, autophagy in cancer can promote either a cell death or survival. Modulating the autophagic pathway as a death mechanism for cancer cells has prompted the use of both inhibitors and autophagy inducers. The autophagic process, either as a cancer suppressing or inducing mechanism in high-grade gliomas is discussed in this review, along with therapeutic approaches to inhibit or induce autophagy in pre-clinical and clinical studies, aiming to increase the efficiency of conventional treatments to remove glioma neoplastic cells.

Preparation and characterisation of silica-based nanoparticles for cisplatin release on cancer brain cells.

In the present work, the preparation, characterisation, and efficiency of two different silica nanostructures as release vehicles of Cisplatin are reported. The 1-hexadeciltrimethyl-ammonium bromide templating agent was used to obtain mesoporous silica nanoparticles which were later loaded with Cisplatin. While sol-gel silica was very fast prepared using an excess of acetic acid during the hydrolysis-condensation reactions of tetraethylorthosilicate and at the same time the Cisplatin was added. Several physicochemical techniques including spectroscopies, electronic microscopy, X-ray diffraction, N2 adsorption-desorption were used to characterise the silica nanostructures. An in vitro Cisplatin release test was carried out using artificial cerebrospinal fluid. Finally, the toxicity of all silica nanostructures was tested using the C6 cancer cell line. The spectroscopic results showed the suitable stabilisation of Cisplatin into the two different silica nanostructures. A large surface area was obtained for the mesoporous silica nanoparticles, while low areas were obtained in the silica nanoparticles. Cisplatin was released faster from mesoporous silica channels than from inside of aggregates nanoparticles silica. Cisplatin alone, as well as, cisplatin released from both silica nanostructures exerted a toxic effect on cancer cells. In contrast, both silica structures without the drug did not exert any toxic effect.

Ampulary tumors: presurgical staging by endoscopic ultrasonography. Diagnostic test study.

OBJECTIVE: To analyze the accuracy of endoscopic ultrasound (EUS) in the evaluation of ampullary tumors compared to histopathology (HP) staging. METHODS: A retrospective diagnostic test study. Patients with ampullary tumors staged by EUS and postpancreatoduodenectomy HP attended during 2012-2018 at tertiary level hospital. RESULTS: 14 patients with adenocarcinoma where included. Tumor size measured by EUS showed an adequate correlation (R = 0.65; p= 0.01) with HP. The accuracy in the evaluation of duodenal wall, pancreatic, and biliary duct invasion was 78.5, 78.5 and 57.1%, respectively. By HP, there were three T1 (21.4%), two T2 (14.2%) and nine T3 (64.2%). The accuracy of T and N staging by EUS was 71.4% (kappa = 0.50) and 50% (kappa = -0.04) respectively. There were more staging errors in patients with biliary stent. CONCLUSION: EUS was useful in estimating tumor size, duodenal wall and pancreatic invasion. Limitation was found in the evaluation of biliary duct invasion, as well as overestimation of T stage and underestimation of N stage. It is necessary an increased effort in ultrasonography training. We suggest EUS testing before biliary stenting.

OBJETIVO: Comparar el ultrasonido endoscópico (USE) en la valoración de los tumores ampulares primarios (TAp) con referencia al estudio histopatológico (HP). MÉTODO: Estudio retrospectivo prolectivo de pruebas diagnósticas en pacientes con TAp estadificados por USE y pancreatoduodenectomía con estudio HP, atendidos de 2012 a 2018 en un hospital de tercer nivel de atención. RESULTADOS: Fueron incluidos14 pacientes con adenocarcinoma. El tamaño del tumor medido por USE mostró una adecuada correlación (R = 0.65; p = 0.01) con el HP. La exactitud en la determinación de la invasión a la pared duodenal, el páncreas y el conducto biliar fue del 78.5, el 78.5 y el 57.1%, respectivamente. Por HP hubo tres T1 (21.4%), dos T2 (14.2%) y nueve T3 (64.2%). La exactitud del estadiaje T y N por USE fue del 71.4% (kappa = 0.50) y del 50% (kappa = −0.04), respectivamente. Los errores en la estadificación fueron más frecuentes en los pacientes con prótesis biliar. CONCLUSIÓN: El USE mostró utilidad en la determinación del tamaño tumoral y de la invasión al duodeno y al páncreas, y más limitada en la determinación de la invasión al conducto biliar por presencia de prótesis. Se observa una sobreestimación del estadiaje T y una subestimación del N. Es necesario mayor capacitación y sugerimos realizarse antes de colocar una prótesis biliar.

Biocidal effect of a hexane-soluble extract of Lippia graveolens Kunth (Verbenaceae) / Efecto biocida del extracto hexánico de Lippia graveolens Kunth (Verbenaceae)

Lippia graveolens Kunth (Verbenaceae) is an economically important shrub known in Mexico as Oregano. In this work, the biocidal effect of the hexane extract of L. graveolens leaves was evaluated on two crop pests. Thus, larvae of Spodoptera frugiperda were fed with mixtures of extract and artificial diet. The nematicidal activity was evaluated on juveniles of Meloydogine javanica. Regarding S. frugiperda, quantitative differences between treatments and control were observed in dead pupae, surviving adults, and deformed adults (P < 0.05). All the surviving adults from the extract treatments were deformed. Nematicidal effect was registered, the LC50 and LC90 were 0.672 (0.654-0.690) and 0.965 (0.937-0.998) mg/mL respectively. The extract was characterized by NMR and GC-MS, being thymol the most abundant component (70.6%) in addition to carvacrol (22.8%). The results suggest the consideration of the hexane extract of L. graveolens leaves within the alternatives for the biological control of pests.

Lippia graveolens Kunth (Verbenaceae) es un arbusto con importancia económica conocido en México como Orégano. En éste trabajo se evaluó el efecto biocida del extracto hexánico de hojas L. graveolens sobre dos plagas agrícolas. Así, larvas de S. frugiperda fueron alimentadas con mezclas de dieta artificial y extracto. La actividad nematicida fue evaluada en juveniles de Meloydogine javanica, Respecto a S. frugiperda, se observaron diferencias cuantitativas entre tratamiento y control en cuanto a pupas muertas, adultos sobrevivientes y adultos deformes (P < 0.05). Todos los adultos provenientes de tratamientos con extracto estuvieron malformados. Hubo efecto nematicida, calculándose CL50 y CL90 de 0.672 (0.654-0.690) y 0.965 (0.937-0.998) mg/mL respectivamente. El extracto se caracterizó por RMN y CG-EM. Los compuestos más abundantes fueron timol (70.6%), ademas del carvacrol (22.8%). Los resultados sugieren considerar al extracto hexánico de hojas de L. graveolens dentro de las alternativas para el control biológico de plagas.

Genotyping the High Altitude Mestizo Ecuadorian Population Affected with Prostate Cancer.

Prostate cancer (PC) is the second most commonly diagnosed type of cancer in males with 1,114,072 new cases in 2015. The MTHFR enzyme acts in the folate metabolism, which is essential in methylation and synthesis of nucleic acids. MTHFR C677T alters homocysteine levels and folate assimilation associated with DNA damage. Androgens play essential roles in prostate growth. The SRD5A2 enzyme metabolizes testosterone and the V89L polymorphism reduces in vivo SRD5A2 activity. The androgen receptor gene codes for a three-domain protein that contains two polymorphic trinucleotide repeats (CAG, GGC). Therefore, it is essential to know how PC risk is associated with clinical features and polymorphisms in high altitude Ecuadorian mestizo populations. We analyzed 480 healthy and 326 affected men from our three retrospective case-control studies. We found significant association between MTHFR C/T (odds ratio [OR] = 2.2; P = 0.009), MTHFR C/T+T/T (OR = 2.22; P = 0.009), and PC. The SRD5A2 A49T substitution was associated with higher pTNM stage (OR = 2.88; P = 0.039) and elevated Gleason grade (OR = 3.15; P = 0.004). Additionally, patients with ≤21 CAG repeats have an increased risk of developing PC (OR = 2.99; P < 0.001). In conclusion, genotype polymorphism studies are important to characterize genetic variations in high altitude mestizo populations.

Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: randomised trial.

BACKGROUND: Nutritional interventions have shown increased energy intake but not improvement in health-related quality of life (HRQL) or prognosis in non small cell lung cancer (NSCLC) patients. Eicosapentaenoic acid has been proposed to have anti-inflammatory, anticachectic and antitumoural effects. OBJECTIVE: To compare the effect of an oral EPA enriched supplement with an isocaloric diet on nutritional, clinical and inflammatory parameters and HRQL in advanced NSCLC patients. DESIGN: Patients with advanced NSCLC were randomized to receive diet plus oral nutritional supplement containing EPA (ONS-EPA) or only isocaloric diet (C). All patients received paclitaxel and cisplatin/carboplatin treatment. Weight, body composition, dietary intake, inflammatory parameters and HRQL were assessed at baseline and after the first and second cycles of chemotherapy. Response to chemotherapy and survival were evaluated. RESULTS: Ninety two patients were analysed (46 ONS-EPA,46 C). ONS-EPA group had significantly greater energy (p < 0.001) and protein (p < 0.001) intake compared with control. Compared with baseline, patients receiving the ONS-EPA gained 1.6 ± 5 kg of lean body mass (LBM) compared with a loss of -2.0 ± 6 kg in the control (p = 0.01). Fatigue, loss of appetite and neuropathy decreased in the ONS-EPA group (p ≤ 0.05). There was no difference in response rate or overall survival between groups. CONCLUSION: Patients with NSCLC receiving ONS-EPA significantly improves energy and protein intake, body composition. and decreased fatigue, loss of appetite and neuropathy. Registered with ClinicalTrials.gov (NCT01048970).

Prevalencia de sobrepeso y obesidad en niños de 5-11 años de la Institución Educativa Regulo Guevara Carranza. Marzo-abril ­ 2013 / Prevalence of overweight and obesity in children 5-11 years of the Regulo Guevara Carranza Educational Institution. March-April - 2013

Objetivo: Estimar la Prevalencia de sobrepeso y Obesidad en la población infantil de 5 a 11 años de la I.E. Regulo Guevara del caserío de Santa Clara. Material y métodos: El estudio fue de naturaleza descriptivo-transversal; se realizó en la jurisdicción del Puesto de Salud "Santa Clara" del caserío Santa Clara, Distrito de Pitipo, Provincia de Ferreñafe; Departamento de Lambayeque. La muestra estuvo formada por la totalidad de alumnos de 5 a 11 años que asciende a 151, a los cuales se les peso y tallo, para calcular el IMC, el cual sirvió para la valoración nutricional. Para el procesamiento de la muestra se utilizó el Excel versión 2010. Resultados: En los resultados se evidenció que La prevalencia de sobrepeso y obesidad fue de 14% y 6% respectivamente; además con respecto a la edad, existe prevalencia de sobrepeso y obesidad en la edad de 9 años, con 29% y 33% respecto a las demás edades de la infancia. De acuerdo al sexo existe prevalencia de sobrepeso en el sexo masculino con 57% y prevalencia de obesidad en el sexo femenino con 67%. Conclusiones: Teniendo en cuenta la edad para el sexo masculino, existe prevalencia de sobrepeso y obesidad en niños a las edades de 6 y 8 años respectivamente. Y respecto a la edad para el sexo femenino existe prevalencia de sobrepeso y obesidad en las niñas a los 9 años. Finalmente la valoración nutricional de la población infantil de 5 a 11 años de la I.E. Regulo Guevara del caserío (área urbano marginal-rural) de Santa Clara fue de sobrepeso 14%, obesidad 6% y desnutrición 0.7% representada por un solo caso, lo que nos lleva a evidenciar que el problema nutricional emergente en nuestra población ya no es la desnutrición sino el sobrepeso y la obesidad, al igual que en las poblaciones de la zona urbana como lo mencionan otros estudios en poblaciones de área urbana de Chiclayo.(AU)

Association of nutrition parameters including bioelectrical impedance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study.

Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life (QoL) and survival of patients with nonsmall cell lung cancer (NSCLC). Noninvasive techniques are needed to evaluate changes in body composition as part of determining nutritional status. The aim of the study was to evaluate the association of nutritional parameters in health-related quality of life (HRQL) and survival in patients with advanced NSCLC. Chemotherapy-naïve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group (ECOG) 0-2 were included prospectively in the study. We evaluated inflammatory parameters such as C-reactive protein, platelet/lymphocyte index, neutrophil/lymphocyte index, serum interleukin (IL)-6, and tumor necrosis factor-α, and nutritional variables such as body mass index (BMI) and serum albumin levels. Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started. HRQL was assessed by application of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LC13 instruments at baseline. Overall survival (OS) was calculated with the Kaplan-Meier method and analyzed with log-rank and Cox proportional hazard models. One hundred nineteen patients were included. Mean BMI was 24.8 ± 4.5 kg/m(2), average weight loss of patients was 8.4%, and median phase angle was 5.8°. Malnutrition measured by subjective global assessment (SGA), weight loss >10%, BMI >20 was associated with lower HRQL scales. Patients with ECOG 2, high content serum IL-6, lower phase angle, and malnutrition parameters showed lower OS; however, after multivariate analysis, only ECOG 2 [Hazard ratio (HR), 2.7; 95% confidence interval (95% CI), 1.5-4.7; P = 0.001], phase angle ≤5.8° (HR = 3.02; 95% CI: 1.2-7.11; P = 0.011), and SGA (HR = 2.7; 95% CI, 1.31-5.5; P = 0.005) were associated with poor survival. Patients were divided into low-, intermediate-, and high-risk groups according to regression coefficients; OS at 1 yr was 78.4, 53, and 13.8%, respectively. Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC. The results warrant prospective trials to evaluate the impact of different nutritional interventions on HRQL and survival.

Angiogenesis and expression of estrogen and progesterone receptors as predictive factors for recurrence of meningioma.

Meningiomas are benign tumors, with low rate of recurrence after surgery. The most important factor predicting recurrence is the extent of surgical resection; other factors have been studied with conflicting results. Angiogenesis, an important substratum for growth and spread of neoplasic cells, and the expression of estrogen and progesterone receptors (ER, PR), could play a role in the recurrence of meningioma. We evaluated 42 patients with meningioma diagnosis (confirmed by histopathology) treated exclusively by surgery between January 1995 and December 1999, and compared the recurring and non-recurring groups after a ten-year follow-up period. Recurrence was associated with several factors including vascular density (VD), cell proliferation index (CPI), ER, PR, and cyclin E (CE) tissue expression, as evaluated by immunohistochemistry. Complete surgical resection was achieved in 41% of patients. Recurrence of meningioma was found in 17 patients (40%). Median + or - standard deviation (SD) of recurrence time was 32 + or - 5 months. When recurrence versus no recurrence was compared, mean + or - SD of VD and CPI were 9 + or - 3.6 and 607.6 + or - 233 (40x/10 fields) respectively. Tissue expression was positive for ER, PR, and CE in 28, 62 and 91% of patients, respectively. The sole significant recurrence-associated factors were extent of resection (P = 0.003) and VD (P = 0.004). ER, PR, and CE-tissue expression were not statistically significant. The most important factor associated with meningioma relapse was vascular density, independently of hormonal status and extent of surgical resection. Patients with a high risk of recurrence could benefit from additional treatment.

Tumour Necrosis Factor alpha and Troponin T as predictors of poor prognosis in patients with stable heart failure.

INTRODUCTION: TNFalpha, a proinflammatory cytokine expressed under several conditions in the myocardium, may contribute to myocardial damage in heart failure (HF). The aim of the study was to determine TNFalpha concentrations and their relation to severity, mortality, and clinical, biochemical and echocardiographic parameters in patients with stable chronic heart failure. PATIENTS AND METHODS: In a prospective study in 128 patients with HF, average follow-up 33 mos, serum concenrations of TNFalpha were determined, and clinical, biochemical and echocardiographic characteristics and mortality were recorded. Serum TNFalpha concentrations were also determined in 35 healthy subjects. Univariate and multivariate analyses were performed to determine variables that could influence TNFalpha concentrations, and that could predict mortality. RESULTS: Patients with HF have higher serum concentrations of TNFalpha than controls (6.72+/-0.2 vs 5.5+/-0.2 pg/ml, P=0.02). Patients with functional class I had lower concenrations of TNFalpha than patients with functional classes II and III (P=0.05 and P=0.001, respectively). Variables associated with higher concentrations of TNFalpha were; lower ejection fraction (P=0.04), worse functional class (P=0.007), coronary artery disease (P=0.05), chronic renal failure (P=0.02), arterial hypertension (P=0.05), higher concentrations of epinephrine (P=0.03) and norepinephrine (P=0.05). On follow-up, factors associated with decline in ejection fraction were arterial hypertension and higher total catecholamines. Factors associated with higher mortality were hypertension, elevated concentrations of TNFalpha and troponin T. Endothelin levels correlated with worsening functional class. CONCLUSION: Serum TNFalpha and troponin T concentrations are independent predictors of severity and mortality in stable HF patients.

Vacunación en el adulto: tema olvidado / Vaccination in the adult: fear forgotten

La vacunación no recibe la misma prioridad que la del niño. Existe una falta de conocimiento en el personal médico e insuficiente cultura en la población. Hay varias razones para vacunar al adulto: exposición a riesgos diferentes que el menor, como laborales y los que derivan de la actividad sexual e inmunidad no permanente. El esquema de vacunación del adulto tiene diferentes escenarios: adulto sano y con patologías de base, embarazada, adultos con inmunodeficiencias, personal de salud, viajeros e inmigrantes. Para cada uno de estos grupos, se deben conocer factores de riesgo y antecedentes que contraindiquen el uso de cualquier vacuna, así como indicaciones de profilaxis y preexposición. Es importante, además, el conocimiento sobre los tipos de vacuna, interferencia entre ellas o con el uso de inmunoglobulinas y antimicrobianos.

Interstitial quinacrine activates a distinctive immune response effective for tumor immunotherapy.

BACKGROUND: Interstitial immunotherapy consists of the local injection of immune cells or molecules with cytotoxic properties to destroy neoplastic cells. Intratumor injection of quinacrine induces intense recruitment of activated immune cells that leads to necrosis and elimination of experimental malignant neoplasms; this effect seems to be mediated by immune molecules. METHODS: We measured the tissue content of activated immune cells and various cytokines at different times during the first 8 days after a single interstitial injection of 150 mg quinacrine in rats. RESULTS: A large cell infiltrate by macrophages, CD4(+), CD8(+), and natural killer cells was evident a few hours after quinacrine injection. In comparison with controls, tissue contents of 4 cytokines had a marked increase: macrophage chemoattractant protein-1 increased 115-fold; interleukin-6, 9-fold; RANTES (regulated on activation, normal T cell expressed and secreted), 13-fold; and macrophage inflammatory protein-2, 10-fold. Other cytokines, like interleukins 1beta, 2, 4, 10, interferon-gamma, tumor necrosis factor-alpha, complement 3, and C reactive protein did not increase significantly, indicating that the endogenous local response to quinacrine follows a singular pathway of immune activation. CONCLUSIONS: Interstitial quinacrine is a strong activator of innate immunity and is not mediated by the usual mechanisms of immune recognition. It constitutes an original approach for regional immunotherapy of neoplasms that is not mediated solely by induction of local, cytotoxic chemical necrosis.

Coexpression of hepatocyte growth factor/scatter factor (HGF/SF) and its receptor cMET predict recurrence of meningiomas.

Hepatocyte growth factor/scatter factor (HGF/SF) and its receptor, the cMET tyrosine kinase participate in cancer invasion, angiogenesis and metastasis in a wide variety of neoplastic cells. Meningioma is a bening tumour, however, it has a high rate of recurrence after surgery; the most important factor to predict relapse is the extent of surgical resection, several other potentially predictive factors have been studied with poor results. We examined by immunohistochemistry the expression of HGF/SF and its cMET receptor in a group of patients with benign meningioma with or without recurrence (n = 17 and n = 25, respectively), after a minimal follow-up of least 6 years. Expression and coexpression of HGF/SF and cMET were compared with cell proliferation index, vascular density and clinical outcome. Coexpression of HGF/SF and cMET in meningiomas had a significant association with cell proliferation index and with recurrence (P < 0.037). Determination of HGF and cMET coexpression in meningiomas could be used as a predictor of recurrence.

Hepatocyte growth factor is associated with poor prognosis of malignant gliomas and is a predictor for recurrence of meningioma.

BACKGROUND: Hepatocyte growth factor (HGF) is a cytokine that participates in multiple cell functions; it promotes proliferation, motility, and morphogenesis of epithelial cells. Some malignant tumors, such as breast carcinoma, bronchogenic carcinoma, and multiple myeloma, overexpress it and its receptor. Hepatocyte growth factor is also present in normal astrocytes; therefore, it is important to investigate whether HGF participates in the pathophysiology of malignant gliomas and other brain tumors. Intratumoral concentration of HGF in human intracranial neoplasms was measured and correlated with prognosis, tumor recurrence, vasogenic edema, cell proliferation index, and vascular density. METHODS: Hepatocyte growth factor concentration was measured in 62 intracranial tumors, including 16 anaplasic astrocytomas (AA), 16 glioblastoma multiformes (GM), 11 meningiomas, 9 hypophyseal adenomas, 7 oligodendrogliomas, and 3 cordomas, and in 4 samples of nonneoplastic brain tissue. The following parameters were correlated with HGF values: survival and tumor recurrence, cell proliferation index and vascular density as determined by immunohistopathologic analysis, and peritumoral edema as seen by magnetic resonance imaging. RESULTS: Hepatocyte growth factor concentration (pg/mL) was significantly higher in malignant gliomas (AA and GM) than in adenomas, oligodendrogliomas, and nonneoplastic brain tissue, but it was similar to that of meningiomas. Mean survival of patients with AA was 16.5 +/- 3.6 months and for patients with GM 12.3 +/- 1.3 months. Hepatocyte growth factor concentration was higher in GM than in AA (15,844 +/- 2504 vs. 7499 +/- 1703, P = 0.0375) and was correlated with the cell proliferation index and with poor prognosis. Likewise, mean tumoral concentration of HGF was higher in meningiomas that relapsed than in those without recurrence (22,887 +/- 6489 vs. 2090 +/- 497, P = 0.008). CONCLUSIONS: Intratumoral concentration of HGF in gliomas is associated with malignancy and poor prognosis. High HGF is also found in meningiomas and is related with long term recurrence. The current findings suggest that the routine measurement of HGF may be used as a predictive factor for planning therapeutic strategies in both malignant gliomas and meningiomas. The potential use of HGF inhibitors or antagonists for therapy of these tumors should be explored.

Diagnóstico clínico de las hepatitis / Diagnosis clinical of the hepatitis

La hepatitis viral aguda es causada por siete diferentes virus: virus de la hepatitis A, virus de la hepatitis B, virus de la hepatitis C, virus de la hepatitis D, virus de la hepatitis E, virus de la hepatitis F, virus de la hepatitis G. Aunque los primeros cinco virus pueden diferenciarse por sus propiedades antigénicas, los cinco producen enfermedades similares cuyo espectro clínico va desde una infección asintomática que pasa inadvertida hasta infección aguda fulminante y mortal, desde infección subclínica persistente hasta una enfermedad hepática crónica rápidamente progresiva que lleva hasta la cirrosis en incluso al carcinoma hepatocelular. No es posible distinguir con claridad los diferentes tipos de hepatitis viral basándose únicamente en características clínicas o epidemiológicas. La forma más segura de diferenciar los distintos tipos de hepatitis se basa en pruebas serloógicas específicas. El virus de la hepatitis A, hepatitis E y hepatitis F son transmitidos por la ruta fecal-oral, tienen similar pronóstico y no son causa de infección crónica. Alrededor del 10 por ciento de personas infectadas con virus de la hepatitis B desarrollan infección crónica y 20-30 por ciento de estos progresan a cirrosis. El 80 por ciento de individuos infectados por hepatitis C se hacen crónicamente enfermos y el 30-40 por ciento desarrollan carcinoma hepato-celular. El virus de la hepatitis C es un virus defectuoso que sólo puede infectar en presencia de la hepatitis B. El virus de la hepatitis G es transmitido por transfusiones y puede causar hepatitis crónica en forma similar al virus de la hepatitis C. solo hay disponibilidad de vacuna para hepatitis A y hepatitis B

Infección por virus de inmunodeficiencia humana en la mujer / HIV infection in the women

La mujer constituye uno de los puntos más vulnerables en la cadena epidemiológica en la Infección por Virus de Inmunodeficiencia Humana (HIV). Dicha vulnerabilidad está determinada por factores sociopolíticos, económicos y culturales de cada país en particular, lo cual se traduce en un incremento cada vez mayor del número de casos de Infección por VIH en este sexo. Los aspectos más dramáticos de la Infección por VIH en este segmento tan especial de la población susceptible, corresponden a: 1. el mayor número de casos se observa en mujeres jóvenes con vida sexual activa. 2. el Síndrome de Inmunodeficiencia Adquirida (SIDA) es la tercera causa de muerte en mujeres con edad comprendida entre 25 y 44 años, lo cual coloca en situación de orfandad a miles de niños a nivel mundial, con un total actual de 8.2 millones de niños huérfanos por esta causa. 3. aún cuando el porcentaje de mujeres con Infección por VIH que consultan por sintomatología primaria de enfermedad ginecológica es relativamente bajo (aproximadamente 9 por ciento), una evaluación ginecológica exhaustiva, puede demostrar patología ginecológica hasta en un 83 por ciento de los casos. 4. en relación a la transmisión vertical, en algunas regiones del mundo, el hecho de saberse infectada con el HIV no cambia en la mujer la conducta ante la concepción, por lo tanto considerando que más del 86 por ciento de la Infección por VIH en niños es adquirida de madre a hijo, es la mujer uno de los elementos claves de la cadena epidemiológica donde se deben fundamentar programas integrales de prevención y tratamiento antiretroviral efectivo para garantizar de esta forma no solo una mejor calidad de vida a la mujer infectada, sino la posibilidad de disminuir la incidencia de Infección por VIH en los niños

Aplicación de un programa educativo sobre SIDA en estudiantes del quinto año de secundaria Arequipa 1995

La presente investigación se llevó a cabo en estudiantes de dos colegios secundarios del Cercado de Arequipa, con el objetivo de conseguir el incremento de conocimientos sobre SIDA después de la aplicación de un Programa Educativo. Para tal efecto, se utilizó el Método Cuasi-experimental con diseño Pre-test y Post-test con grupo control no equivalente con muestreo no probabilístico de tipo intencional, en una población total de 635 estudiantes de 15 a 18 años, se trabajó con una muestra de 202 estudiantes; correspondiendo: 126 estudiantes al Colegio Independencia Americana (Grupo Experimental) y 76 estudiantes al Colegio Muñoz Najar (Grupo Control). Para la recolección de la información respecto al nivel de conocimientos sobre SIDA se utilizó la técnica del cuestionario, aplicando el pre-test a los sujetos en estudio. El presente formulario fue administrado en forma individual y anónima, a fin de garantizar la confiabilidad de las respuestas. Posteriormente se aplica el Programa Educativo al Grupo Experimental, en tres sesiones a través de charlas y proyección de video, previa distribución de los sujetos en estudio en grupos de 30 alumnos. Después de dos semanas se aplicó el Post-test para determinar el incremento de conocimientos sobre SIDA. Para el análisis e interpretación de los resultados se utilizó las pruebas de significación estadística: Ji - Cuadrado y Valor de Z. Los resultados demostraron que: -Después de la aplicación del Pre-test se identificó que los conocimientos que los estudiantes tenían acerca de la infección por VIH/SIDA deberían ser reforzados en los siguientes aspectos: agente causal, células afectadas por el VIH, diagnóstico de la infección, portador asintomático y algunas medidas preventivas importantes para la prevención de la enfermedad (abstinencia de relaciones sexuales y uso del condón en toda relación sexual). -Después dela aplicación del Post-test, se incrementaron los conocimientos de los estudiantes en forma muy satisfactoria, disminuyendo notablemente los conceptos erróneos.