Salivary Biomarkers for Oral Cancer Detection: An Exploratory Systematic Review.

Different efforts have been made to find better and less invasive methods for the diagnosis and prediction of oral cancer, such as the study of saliva as a source of biomarkers. The aim of this study was to perform a scoping review about salivary molecules that have been assessed as possible biomarkers for the diagnosis of oral squamous cell carcinoma (OSCC). A search was conducted using EBSCO, PubMed (MEDLINE), Scopus, and Web of Science. The research question was as follows: which molecules present in saliva have utility to be used as biomarkers for the early detection of oral cancer? Sixty-two studies were included. Over 100 molecules were assessed. Most of the markers were oriented towards the early diagnosis of OSCC and were classified based on their ability for detecting OSCC and oral potentially malignant disorders (OPMDs), OSCC outcome prediction, and the prediction of the malignant transformation of OPMDs. TNF-α, IL-1ß, IL-6 IL-8, LDH, and MMP-9 were the most studied, with almost all studies reporting high sensitivity and specificity values. TNF-α, IL-1ß, IL-6 IL-8, LDH, and MMP-9 are the most promising salivary biomarkers. However, more studies with larger cohorts are needed before translating the use of these biomarkers to clinical settings.

Análisis descriptivo de los trabajos científicos presentados en la Segunda Conferencia Internacional Chilena de Psicosis 2020 / Descriptive analysis of the posters abstracts submitted to the Chilean International Conference in Psychosis 2020

INTRODUCCIÓN: Dentro de los desafíos de la investigación en Psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los resúmenes de los trabajos científicos presentados en la II conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en Octubre del 2020. MÉTODOS: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. RESULTADOS: Se seleccionaron 12 trabajos. El 75% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, el 40% de los trabajos presentados provienen de regiones de la zona centro-sur de nuestro país. El 83% de los trabajos realizan un diseño experimental con reclutamiento de pacientes o discusión de casos clínicos complejos. CONCLUSIÓN: Los trabajos seleccionados dan cuenta del interés por el mejoramiento en el diagnóstico y terapéutica en este ámbito. Se debe potenciar el trabajo de investigación y asistencial en Chile en el ámbito de los EMARS.

INTRODUCTION: Within the challenges of research in Psychosis in Chile and the world is the development of academic research poles in mental states of risk (EMARS). This article makes a descriptive analysis of the summaries of the scientific papers presented at the II international conference: Clinical and therapeutic challenges in Psychosis held in October 2020. METHODS: The best work was selected and awarded according to a scoring system carried out by an ad-hoc scientific committee. The information was then systematized in a summary table for subsequent qualitative descriptive analysis. RESULTS: 12 papers were selected. 75% of the selected works address the issue of early detection and early intervention in psychosis, particularly the EMARS theme. Likewise, 40% of the papers presented come from regions of the south-central zone of our country. 83% of the works carry out an experimental design with recruitment of patients or discussion of complex clinical cases. CONCLUSION: The selected works show the interest in the improvement in diagnosis and therapy in this area. Research and assistance work in Chile should be promoted in the field of EMARS.

Early psychosis detection program in Chile: A first step for the South American challenge in psychosis research.

AIM: Early detection and intervention (EDI) is a main challenge in psychosis research. The Chilean schizophrenia (SZ) national program has universal support and treatment by law for all SZ patients, but this does not yet extend to earlier stages of illness. Therefore, we have piloted an ultra-high risk (UHR) program to demonstrate the utility and feasibility of this public health approach in Chile. METHODS: We introduce "The University of Chile High-risk Intervention Program," which is the first national EDI program for UHR youths. Longitudinal follow-up included clinical and cognitive assessments, and monitoring of physiological sensory and cognitive indices, through electroencephalographic techniques. RESULTS: We recruited 27 UHR youths over 2 years. About 92.6% met criteria for attenuated psychosis syndrome (APS). Mean Scale of Psychosis-Risk Symptoms (SOPS) ratings in the cohort were 6.9 (SD 4.6) for positive, 9.1 (SD 8.3) for negative, 5.4 (SD 5.3) for disorganized and 6.3 (SD 4.1) for general symptoms. About 14.8% met criteria for comorbid anxiety disorders and 44.4% for mood disorders. Most participants received cognitive behavioural therapy (62.9%) and were prescribed low dose antipsychotics (85.2%). The transition rate to psychosis was 22% within 2 years. CONCLUSIONS: We describe our experience in establishing the first EDI program for UHR subjects in Chile. Our cohort is similar in profile and risk to those identified in higher-income countries. We will extend our work to further optimize psychosocial and preventive interventions, to promote its inclusion in the Chilean SZ national program and to establish a South American collaboration network for SZ research.

Shifting the focus toward rare variants in schizophrenia to close the gap from genotype to phenotype.

Schizophrenia (SZ) is a disorder with a high heritability and a complex architecture. Several dozen genetic variants have been identified as risk factors through genome-wide association studies including large population-based samples. However, the bulk of the risk cannot be accounted for by the genes associated to date. Rare mutations have been historically seen as relevant only for some infrequent, Mendelian forms of psychosis. Recent findings, however, show that the subset of patients that present a mutation with major effect is larger than expected. We discuss some of the molecular findings of these studies. SZ is clinically and genetically heterogeneous. To identify the genetic variation underlying the disorder, research should be focused on features that are more likely a product of genetic heterogeneity. Based on the phenotypical correlations with rare variants, cognition emerges as a relevant domain to study. Cognitive disturbances could be useful in selecting cases that have a higher probability of carrying deleterious mutations, as well as on the correct ascertainment of sporadic cases for the identification of de novo variants.

The effect of a mindfulness-based intervention in cognitive functions and psychological well-being applied as an early intervention in schizophrenia and high-risk mental state in a Chilean sample: study protocol for a randomized controlled trial.

BACKGROUND: According to the projections of the World Health Organization, 15% of all disabilities will be associated with mental illnesses by 2020. One of the mental disorders with the largest social impacts due to high personal and family costs is psychosis. Among the most effective psychological approaches to treat schizophrenia and other psychotic disorders at the world level is cognitive behavioral therapy. Recently, cognitive behavioral therapy has introduced several tools and strategies that promote psychological processes based on acceptance and mindfulness. A large number of studies support the effectiveness of mindfulness in dealing with various mental health problems, including psychosis. This study is aimed at determining the efficiency of a mindfulness-based program in increasing cognitive function and psychological well-being in patients with a first episode of schizophrenia and a high risk mental state (those at risk of developing an episode of psychosis). METHODS AND DESIGN: This is an experimentally designed, multi-center randomized controlled trial, with a 3-month follow-up period. The study participants will be 48 patients diagnosed with schizophrenia (first episode) and 48 with a high-risk mental state, from Santiago, Chile, aged between 15 and 35 years. Participants will be submitted to a mindfulness-based intervention (MBI), which will involve taking part in eight mindfulness workshops adapted for people with psychosis. Workshops will last approximately 1.5 hours and take place once a week, over 8 weeks. The primary outcome will be the cognitive function through Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) and the secondary outcome will be psychological well-being measured by self-reporting questionnaires. DISCUSSION: The outcomes of this trial will add empirical evidence to the benefits and feasibility of MBIs for the psychotherapeutic treatment of patients with schizophrenia and high-risk mental states in reducing cognitive impairment in attention, working memory, and social cognition, as well as increasing the psychological well-being by empowering the patients' personal resources in the management of their own symptoms and psychotic experiences. TRIAL REGISTRATION: ISRCTN registration number ISRCTN24327446 . Registered on 12 September 2016.

From Molecules to the Clinic: Linking Schizophrenia and Metabolic Syndrome through Sphingolipids Metabolism.

Metabolic syndrome (MS) is a prevalent and severe comorbidity observed in schizophrenia (SZ). The exact nature of this association is controversial and very often accredited to the effects of psychotropic medications and disease-induced life-style modifications, such as inactive lifestyle, poor dietary choices, and smoking. However, drug therapy and disease-induced lifestyle factors are likely not the only factors contributing to the observed converging nature of these conditions, since an increased prevalence of MS is also observed in first episode and drug-naïve psychosis populations. MS and SZ share common intrinsic susceptibility factors and etiopathogenic mechanisms, which may change the way we approach clinical management of SZ patients. Among the most relevant common pathogenic pathways of SZ and MS are alterations in the sphingolipids (SLs) metabolism and SLs homeostasis. SLs have important structural functions as they participate in the formation of membrane "lipid rafts." SLs also play physiological roles in cell differentiation, proliferation, and inflammatory processes, which might be part of MS/SZ common pathophysiological processes. In this article we review a plausible mechanism to explain the link between MS and SZ through a disruption in SL homeostasis. Additionally, we provide insights on how this hypothesis can lead to the developing of new diagnostic/therapeutic technologies for SZ patients.

Tratamiento de adolescentes en unidad de corta estadía de fármaco-dependencia / Treatment of adolescents of brief stay in drug dependence unit

Introducción: La investigación y sistematización del tratamiento en el consumo problemático de alcohol y drogas es muy escasa en nuestro país. El objetivo del estudio fue describir el perfil clínico, social y tratamiento de adolescentes que ingresan a una unidad de fármacodependencia. Material y método: Revisión retrospectiva con protocolo de estudio previamente diseñado, de los registros clínicos de pacientes adolescentes ingresados a la unidad de corta estadía en fármacodependencia de la Clínica Psiquiátrica Universitaria de la Universidad de Chile. Periodo 2000 al 2006. Resultados: 58 adolescentes, 65,5 por ciento varones, promedio de edad de 17,1 años, rango entre 13 y 19 años. Escolaridad desfavorable en el 60 por ciento. El 79 por ciento proveniente de familias nucleares o uniparentales y el 21 por ciento de familias extendidas o con convivencia inestable. Principales motivos de hospitalización: abuso de sustancias, intento de suicidio e imposibilidad de tratamiento ambulatorio. La mayoría con poli-consumo y un patrón de consumo severo. Drogas más frecuentes: alcohol, marihuana y en menor grado, pasta base. Diagnostico de consumo: abuso 20 por ciento, abuso y dependencia en un 40 porciento y dependencia en 40 por ciento. Comorbilidades frecuentes: trastorno de personalidad, trastorno de conducta, trastorno del ánimo y trastorno por déficit de atención. El 70 por ciento completó con una duración promedio de 30,4 días. El 50 por ciento requirió más de 2 intervenciones terapéuticas en forma simultánea. El 96 por ciento de los pacientes utilizó 2 o más fármacos para el tratamiento. La derivación al momento de alta fue un 63 por ciento a tratamiento ambulatorio y un 27 por ciento a tratamiento residencial. Conclusiones: Perfil de adolescentes Con importante comorbilidad, con consumo prolongado, del tipo policonsumo, lo que modifica la sintomatología y da la expresión al consumo problemático.

Introduction: There is scarce investigation and systematization of the treatment of problematic consumption of alcohol and drugs in our country. The objective of the study was to describe the clinical and social profile and the treatment received by adolescents who were admitted in a drug dependence unit. Subjects and methods: The clinical charts of patients who were admitted from 2000 to 2006 in the unit for brief stay at the Psychiatric Clinic of the Universidad of Chile were reviewed with a previously designed study protocol. Results: 58 adolescents, 65.5 percent male, age average of 17.1 years old, range between 13 and 19 years. Abnormal scholar history in 60 percent, 79 percent belonging to nuclear families and 21 percent to extended families or with unstable coexistence. Main reasons of hospitalization were substance abuse, suicide attempt and failure or contraindication of ambulatory treatment. Most adolescents had abuse of several substances and pattern of severe consumption. Most frequent substance abuse: Alcohol, Marijuana and in smaller degree, cocaine base paste. Consumption diagnosis: abuse 20 percent, abuse and dependence 40 percent and dependence 40 percent. Frequent Comorbidity: Personality Disorder, Behavioural Disorder, Mood disorder and attention deficit disorder. 70 percent completed the treatment with average stay of 30.4 days. 50 percent required more than 2 simultaneous therapeutic interventions. 96 percent of the patients used 2 or more drugs for the treatment. At discharge, 63 percent were referred to ambulatory treatment and 27 percent to residential treatment. Conclusions: Adolescents with intreatment for substance abuse present with frequent comorbidity, with long lasting consumption, and use multiple drugs. All these factors modify the presenting symptoms and shed light to the problematic substance abuse.

Estudio piloto sobre uso de internet en adolescentes de Santiago: resumen / Pilot study about internet use in adolescent of santiago: summary

A partir del año 2006, el equipo docente de la unidad de psiquiatría infanto juvenil de la Clínica psiquiátrica Universitaria de la Universidad de Chile (PCUCh) introduce en el programa de formación de los especialistas el desarrollo de un trabajo de investigación a realizarse en el periodo de los tres años de especialización, con el fin de realizar investigación clínica y aportar en el avance del entendimiento de la salud mental de los niños y adolescentes. El presente artículo muestra un marco teórico sobre la magnitud del problema y parte de los avances del trabajo de investigación realizado durante la formación. El objetivo es evaluar y caracterizar, a través de una muestra que representa de forma parcial a jóvenes pertenecientes a establecimientos educacionales de la Región Metropolitana, la penetración del uso de Internet, el perfil de su uso y la presencia de uso problemático a través de la utilización de la escala de adicción a Internet de Young. Este trabajo pretende dar inicio a una nueva área de investigación en la población chilena, ya que si bien hay estudios internacionales sobre el uso de Internet, en Chile aún no hay ninguna investigación que evalúe cómo afecta este recurso tecnológico en los adolescentes de nuestra población.

In year 2006 an academic team from the child-youth Psychiatric Unit - Psychiatric Clinic of the Universidad de Chile (PCUCh) begins an investigation in the Specialties Training Program, in order to be finished by the end of the three years of specialization. The objectives of this studies were both doing clinic research and contributing to the understanding of children and young people’s mental health. This article shows the theoretical framework concerning this issue and is a part of the work done during those years. The aim of the research is to assess and characterize the internet penetration, user profile and the presence of troubling use, measuring this last variable through Young’s Internet Addiction Scale. With a sample that partially represents young people from Region Metropolitan, the major district of Chile’s capital. This article looks forward to start a new researching topic in Chilean people, due to the fact that, even though there is some international evidence, Chilean researchers have not raise the issue before.

Are child and adolescent responses to placebo higher in major depression than in anxiety disorders? A systematic review of placebo-controlled trials.

BACKGROUND: In a previous report, we hypothesized that responses to placebo were high in child and adolescent depression because of specific psychopathological factors associated with youth major depression. The purpose of this study was to compare the placebo response rates in pharmacological trials for major depressive disorder (MDD), obsessive compulsive disorder (OCD) and other anxiety disorders (AD-non-OCD). METHODOLOGY AND PRINCIPAL FINDINGS: We reviewed the literature relevant to the use of psychotropic medication in children and adolescents with internalized disorders, restricting our review to double-blind studies including a placebo arm. Placebo response rates were pooled and compared according to diagnosis (MDD vs. OCD vs. AD-non-OCD), age (adolescent vs. child), and date of publication. From 1972 to 2007, we found 23 trials that evaluated the efficacy of psychotropic medication (mainly non-tricyclic antidepressants) involving youth with MDD, 7 pertaining to youth with OCD, and 10 pertaining to youth with other anxiety disorders (N = 2533 patients in placebo arms). As hypothesized, the placebo response rate was significantly higher in studies on MDD, than in those examining OCD and AD-non-OCD (49.6% [range: 17-90%] vs. 31% [range: 4-41%] vs. 39.6% [range: 9-53], respectively, ANOVA F = 7.1, p = 0.002). Children showed a higher stable placebo response within all three diagnoses than adolescents, though this difference was not significant. Finally, no significant effects were found with respect to the year of publication. CONCLUSION: MDD in children and adolescents appears to be more responsive to placebo than other internalized conditions, which highlights differential psychopathology.

Variación inusual de la irrigación arterial en axila y brazo: un caso / Unusual variation of the artery irrigation in axilla and arm: report of a case

Las variaciones de la vascularización de la extremidad superior son relativamente frecuentes, existiendo algunos trabajos en la literatura moderna sobre el particular (Weathersby, 1959; Jurius, 1986). Se disecó la extremidad izquierda de un cadáver del Instituto de Anatomía Humana de la Facultad de Medicina de la UACH, de sexo masculino, 62 años y cuyo diagnóstico de defunción fue Ca. esofágico. Se trabajó con técnicas estandar de disección. La nomenclatura utilizada corresponde a la Nómina Anatómica (1986). Se pintó con hematoxilina los vasos arteriales. Se usó material fotográfico Agfa y objetivo de acercamiento. Se observa que la arteria axilar a nivel del borde inferior del pectoral menor se divide en dos troncos: 1- Póstero-interno, que proporciona la irrigación al brazo dando como colaterales un ramo áxilo cutáneo, un ramo muscular, arteria colateral ulnar superior y arteria colateral ulnar inferior; 2- Anteroexterno, que continúa hasta el antebrazo donde origina las arterias radial y ulnar. Se compara los resultados encontrados con los trabajos de Testut (1979), Weathersby (1959), Jurjus (1986), Chatain (1986) y con el desarrollo ontogenético de los vasos de la extremidad superior de la especie humana (Taure, 1960). Obtenemos un patrón de variación de las arterias axilar y braquial diferente a la descrita clásicamente, con ramas colaterales muy largas y delgadas

Variación del sistema arterial de la extremidad superior en el adulto: un caso / Variation of the arterial system of the upper extremity in the adult: report of a case

Las variaciones de la vascularización de la extremidad superior son relativamente frecuentes, existiendo algunos trabajos en la literatura moderna sobre el particular (Weathersby, 1959; Jurius, 1986). Se disecó la extremidad derecha de un cadáver del Instituto de Anatomía Humana de la Facultad de Medicina de la UACH; sexo masculino 62 años cuya causa de defunción fue Ca. esofágico. Se trabajó con técnica estandar de disección. La nomenclatura utilizada corresponde a la Nómina Anatómica (1986). Se pintó con hematoxilina los vasos arteriales. Se usó material fotográfico Agfa y objetivo de acercamiento. Se observa que la arteria braquial da como primera rama un grueso tronco que se ubica medial a ella y que desciende en forma paralela, para luego cruzar hacia lateral a nivel del codo entre la arteria braquial por atrás, y expansión radial en un plano muy superficial; dando, sobre el epicóndilo interno, como colateral la arteria ulnar inferior. La arteria braquial desciende por el brazo dando sus otras ramas y luego de cruzar el codo se transforma en arteria ulnar, la cual presenta una disposición clásica. Se compara estos resultados con los trabajos de Testut (1979) Weathersby (1959), Jurjus (1986), Chatain (1986) y con el desarrollo ontogénico de los vasos de la extremidad superior en la especie humana (Taure, 1960). Con este patrón de variación arterial del brazo y antebrazo podemos concluir un nacimiento alto de la arteria radial que se informa con una frecuencia de un 10% (Testut, 1979) y además presenta una ubicación superficial lo que la hace más vulnerable a traumatismos y hemorragia