Effectiveness and types of interventions to reduce mental illness-related stigma among Medical university students: A literature review (1997-2020).

There is a high prevalence of stigma among medical students towards mental illness, which can have far reaching negative consequences. It is essential to intervene and modify their preconceptions in order to fight against stigma.

Eficacia y tipos de intervencionespara reducir el estigma hacia laenfermedad mental en estudiantesuniversitarios de Medicina: Unarevisión de la literatura (1997-2020) / Effectiveness and types of interventions to reduce mental illness-related stigma among medical university students: A literature review (1997-2020)

Entre los estudiantes de MEDICINA existe una alta prevalencia de estigma hacia la enfermedad mental, lo que puedeprovocar consecuencias negativas de gran alcance. Es de suma importancia intervenir y modificar las cogniciones en los futuros médicos para luchar contra el estigma. El objetivo de este trabajo es describir los tipos y la efectividad de las intervenciones para la reducción del estigma hacia las enfermedades mentales entre los estudiantes de MEDICINA a través de una revisión de la literatura existente de 1997 a 2020. Se realizó una búsqueda sistemática en las bases de datos PubMed, Web of Science (WOS) y Cochrane Library según la metodología PRISMA. Se localizaron un total de 87 manuscritos, tras la lectura de sus resúmenes se procedió a la exclusión de 49 por no adaptarse a los parámetros de estudio. Se seleccionaron 38 documentos que cumplían con los criterios de inclusión y 6 añadidos de búsquedas relacionales. Se evaluaron 44 estudios con una participación de global de 20.196 estudiantes de MEDICINA. En el 97 % de los casos las metodologías de intervención de reducción de estigma fueron eficaces. Se hallaron 16 tipos de intervenciones diferentes que presentan alta heterogeneidad metodológica. Las intervenciones aplicadas para la reducción del estigma hacia las enfermedades mentales (EM) entre los estudiantes de MEDICINA demuestran efectividad prácticamente en su mayoría. Las prácticas educativas son las más eficaces a largo plazo y junto con la comprensión médica positiva, la búsqueda de ayuda y el contacto experiencial en vivo, se presentan como fuertes estrategias de combate hacia las actitudes estigmatizantes.(AU)

objective of this study is to describe the types and effectiveness of interventions to reduce mental illness-related stigmaamong medical university students through a review of theliterature published from 1997 to 2020. A systematic searchwas carried out in the following databases: PubMed, Web ofScience (WOS) and Cochrane Library, following the PRISMAmethodology. After the search, 87 manuscripts were found.49 documents met the selection criteria, and 6 additional texts were included after a search for related studies. 44studies were assessed, with a global participation of 20.196Medicine students. In 97% of the cases, the methods of intervention for the reduction of stigma towards mental disorders (TM)were effective. 16 different types of interventions were found, with a limited number of methodologies.Teaching practices are the most effective in the long-term,together with a positive medical understanding, the searchfor help and the in vivo experiential contact, which are presented as strong strategies to combat stigmatizing attitudes.(AU)

Prognostic implications of EGFR protein expression in sporadic colorectal tumors: Correlation with copy number status, mRNA levels and miRNA regulation.

Sporadic colorectal cancer (sCRC) is the third most frequent cancer worldwide and the second most common cause of cancer-related deaths (mainly due metastatic dissemination). We investigated the immunohistochemical expression of frequently altered proteins in primary tumors from 51 patients (25 liver metastatic and 26 non-metastatic cases) with a median 103 months follow-up (103 months). We evaluated EGFR copy number (using SNP arrays and FISH) and its expression and regulation (by mRNA and miRNA arrays). We found differences between metastatic and non-metastatic sCRCs for MLH1 (p = 0.05), PMS2 (p = 0.02), CEA (p < 0.001) and EGFR (p < 0.001) expression. EGFR expression was associated with lymph node metastases (p = 0.001), liver metastases at diagnosis (p < 0.001), and advanced stage (p < 0.001). There were associations between EGFR expression-, EGFR gene copy number- and EGFR mRNA levels. We found potential interactions of two miRNAs targeting EGFR expression, (miR-134 and miR-4328, in non-metastatic and metastatic tumors, respectively). EGFR expression was associated with a worse outcome (p = 0.005). Multivariate analysis of prognostic factors for overall survival identified that, the expression of EGFR expression (p = 0.047) and pTNM stage (p < 0.001) predicted an adverse outcome. EGFR expression could be regulated by amplification or polysomies (in metastatic tumors), or miRNAs (miRNA-134, in non-metastatic tumors). EGFR expression in sCRC appears to be related to metastases and poor outcome.

Spatio-temporal tumor heterogeneity in metastatic CRC tumors: a mutational-based approach.

It is well known that activating mutations in the KRAS and NRAS genes are associated with poor response to anti-EGFR therapies in patients with metastatic colorectal cancer (mCRC). Approximately half of the patients with wild-type (WT) KRAS colorectal carcinoma do not respond to these therapies. This could be because the treatment decision is determined by the mutational profile of the primary tumor, regardless of the presence of small tumor subclones harboring RAS mutations in lymph nodes or liver metastases. We analyzed the mutational profile of the KRAS, NRAS, BRAF and PI3KCA genes using low-density microarray technology in samples of 26 paired primary tumors, 16 lymph nodes and 34 liver metastases from 26 untreated mCRC patients (n=76 samples). The most frequent mutations found in primary tumors were KRAS (15%) and PI3KCA (15%), followed by NRAS (8%) and BRAF (4%). The distribution of the mutations in the 16 lymph node metastases analyzed was as follows: 4 (25%) in KRAS gene, 3 (19%) in NRAS gene and 1 mutation each in PI3KCA and BRAF genes (6%). As expected, the most prevalent mutation in liver metastasis was in the KRAS gene (35%), followed by PI3KCA (9%) and BRAF (6%). Of the 26 cases studied, 15 (58%) displayed an overall concordance in the mutation status detected in the lymph node metastases and liver metastases compared with primary tumor, suggesting no clonal evolution. In contrast, the mutation profiles differed in the primary tumor and lymph node/metastases samples of the remaining 11 patients (48%), suggesting a spatial and temporal clonal evolution. We confirm the presence of different mutational profiles among primary tumors, lymph node metastases and liver metastases. Our results suggest the need to perform mutational analysis in all available tumor samples of patients before deciding to commence anti-EGFR treatment.