Cacalol Acetate as Anticancer Agent: Antiproliferative, Pro-Apoptotic, Cytostatic, and Anti-Migratory Effects.

Cacalol (C), a sesquiterpene isolated from Psacalium decompositum, has demonstrated anti-inflammatory and antioxidant activities. Its cytotoxic, antiproliferative, and pro-apoptotic effects have been previously shown in an in vitro breast cancer model. A derivative, cacalol acetate (CA), shows potential in regulating these processes, which has not been previously reported. This study focused on an in vitro cervical cancer model, assessing CA's antiproliferative, pro-apoptotic, cytostatic, and anti-migratory activities using the HeLa cell line. The natural anticancer agent indole-3-carbinol (I3C) was used as a control for comparison. CA demonstrated significant antitumor activities, including inhibiting cell growth, inducing apoptosis, arresting cells in the G2 phase of the cell cycle, and inhibiting cell migration. These effects were notably greater compared to I3C. I3C, while following a similar trend, did not induce Cas-3 expression, suggesting a different apoptotic pathway. Neither CA nor I3C increased p62 and LC3B levels, indicating they do not stimulate autophagy marker expression. Both compounds inhibited HeLa cell migration and induced cell cycle arrest. Despite both holding promise as anticancer agents for cervical cancer, CA's lower cytotoxicity and stronger regulation of tumor phenotypes make it a more promising agent compared to I3C.

Unrevealing Lithium Repositioning in the Hallmarks of Cancer: Effects of Lithium Salts (LiCl and Li2CO3) in an In Vitro Cervical Cancer Model.

Lithium, a natural element, has been employed as a mental stabilizer in psychiatric treatments; however, some reports indicate it has an anticancer effect, prompting the consideration of repurposing lithium for cancer treatment. The potential anticancer use of lithium may depend on its form (salt type) and the type of cancer cells targeted. Little is known about the effects of Li2CO3 or LiCl on cancer cells, so we focused on exploring their effects on proliferation, apoptosis, migration, and cell cycle as part of the hallmarks of cancer. Firstly, we established the IC50 values on HeLa, SiHa, and HaCaT cells with LiCl and Li2CO3 and determined by crystal violet that cell proliferation was time-dependent in the three cell lines (IC50 values for LiCl were 23.43 mM for SiHa, 23.14 mM for HeLa, and 15.10 mM for HaCaT cells, while the IC50 values for Li2CO3 were 20.57 mM for SiHa, 11.52 mM for HeLa, and 10.52 mM for HaCaT cells.) Our findings indicate that Li2CO3 and LiCl induce DNA fragmentation and caspase-independent apoptosis, as shown by TUNEL, Western Blot, and Annexin V/IP assay by flow cytometry. Also, cell cycle analysis showed that LiCl and Li2CO3 arrested the cervical cancer cells at the G1 phase. Moreover, lithium salts displayed an anti-migratory effect on the three cell lines observed by the wound-healing assay. All these findings imply the viable anticancer effect of lithium salts by targeting several of the hallmarks of cancer.

Indole-3-Carbinol, a Phytochemical Aryl Hydrocarbon Receptor-Ligand, Induces the mRNA Overexpression of UBE2L3 and Cell Proliferation Arrest.

Cervical cancer (CC) is one of the most common cancers in women, and is linked to human papillomavirus (HPV) infection. The virus oncoprotein E6 binds to p53, resulting in its degradation and allowing uncontrolled cell proliferation. Meanwhile, the HPV E7 protein maintains host cell differentiation by targeting retinoblastoma tumor suppressor. The host cell can ubiquitinate E6 and E7 through UBE2L3, whose expression depends on the interaction between the aryl hydrocarbon receptor (AhR) with Xenobiotic Responsive Elements (XREs) located in the UBE2L3 gene promoter. In this study, we used cell culture to determine the effect of indole-3-carbinol (I3C) over cellular viability, apoptosis, cell proliferation, and mRNA levels of UBE2L3 and CYP1A1. In addition, patients' samples were used to determine the mRNA levels of UBE2L3 and CYP1A1 genes. We found that I3C promotes the activation of AhR and decreases cell proliferation, possibly through UBE2L3 mRNA induction, which would result in the ubiquitination of HPV E7. Since there is a strong requirement for selective and cost-effective cancer treatments, natural AhR ligands such as I3C could represent a novel strategy for cancer treatment.

The high methylation level of a novel 151-bp CpG island in the ESR1 gene promoter is associated with a poor breast cancer prognosis.

BACKGROUND: The ESR1 gene suffers methylation changes in many types of cancers, including breast cancer (BC), the most frequently diagnosed cancer in women that is also present in men. Methylation at promoter A of ESR1 is the worse prognosis in terms of overall survival; thus, the early detection, prognostic, and prediction of therapy involve some methylation biomarkers. METHODS: Therefore, our study aimed to examine the methylation levels at the ESR1 gene in samples from Mexican BC patients and its possible association with menopausal status. RESULTS: We identified a novel 151-bp CpG island in the promoter A of the ESR1 gene. Interestingly, methylation levels at this CpG island in positive ERα tumors were approximately 50% less than negative ERα or control samples. Furthermore, methylation levels at ESR1 were associated with menopausal status. In postmenopausal patients, the methylation levels were 1.5-fold higher than in premenopausal patients. Finally, according to tumor malignancy, triple-negative cancer subtypes had higher ESR1 methylation levels than luminal/HER2+ or luminal A subtypes. CONCLUSIONS: Our findings suggest that methylation at this novel CpG island might be a promising prognosis marker.

Changes in the diversity of local cervical bacteria in women with cervical cancer receiving antineoplastic treatment.

BACKGROUND: Some studies show changes in the microbiota in people undergoing antineoplastic treatment. Currently, there is not enough evidence of this effect in the treatment of cervical cancer (CC). The objective was to determine changes in the diversity of local cervical bacteria in women with CC receiving chemotherapy, radiotherapy, and brachytherapy. MATERIALS AND METHODS: A descriptive, longitudinal, and prospective study was conducted in 68 women with locally advanced CC with a treatment plan based on the administration of chemotherapy, external beam radiotherapy, and brachytherapy. Cervical-vaginal fluid samples were taken during antineoplastic treatment. The samples were used to isolate bacterial strains. The bacteria were identified at the molecular level by comparing sequences of the 16S ribosomal RNA gene. RESULTS: The bacteria identified belonged to three phyla: Firmicutes, Proteobacteria, and Actinobacteria. Nine genera and 25 species of bacteria were identified. The most frequent species were Staphylococcus epidermidis, Corynebacterium amycolatum, and Enterococcus faecalis. There were statistically significant differences when comparing bacterial diversity found in the different stages of treatment (≤0.05). Bacterial diversity decreased as antineoplastic treatment progressed and increased at the end of therapy. CONCLUSION: Antineoplastic treatments generate changes in the diversity of local cervical bacterial communities of women with CC.

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity.

OBJECTIVE: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIALS AND METHODS: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. RESULTS: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). CONCLUSIONS: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.

OBJETIVO: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). MATERIAL Y MÉTODOS: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. RESULTADOS: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017.Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraronpuntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM .55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. CONCLUSIONES: Los resultados sugieren que el atributo de equidad del ENARM está en duda.

Populations and outcome measures used in ongoing research in sarcopenia.

BACKGROUND: Sarcopenia research may be hampered by the heterogeneity of populations and outcome measures used in clinical studies. AIM: The aim of this study was to describe the inclusion/exclusion criteria and outcome measures used in ongoing research in sarcopenia. METHODS: All active intervention studies registered in the World Health Organization with the keyword sarcopenia were included. Study design, type of intervention, inclusion/exclusion criteria and outcome measures were registered and classified. RESULTS: In April 2014, 151 studies on sarcopenia were registered in the WHO database. One hundred twenty-three were intervention studies. Most trials (94.3 %) were single centre and randomized (93.5 %), 51.2 % were double blind. Nutritional interventions (36.6 %), physical exercise (12.2 %) or both (19.5 %) were the most common interventions tested. Only 54.4 % included subjects of both genders, and 46.3 % had an upper age limit. Definition of the target populations was heterogeneous, with 57.7 % including healthy subjects and none using recent definitions of sarcopenia. Lifestyle and the degree of physical activity of subjects were not described or considered in most cases (79.7 %). Subjects with cardiovascular, neuropsychiatric or metabolic disorders and those with physical disability were usually excluded. Muscle mass and muscle strength were the primary outcome variables in 28.5 and 29.5 % of studies and physical performance in 19.5 %, but only 4.1 % used the three variables used the three of them. An additional 26.8 % used biological outcome variables. Little information and agreement existed in the way muscle and physical performance parameters were measured. CONCLUSIONS: We found a large heterogeneity in trial design, definition of populations and outcome measures in present research.

Lithium: A Promising Anticancer Agent.

Lithium is a therapeutic cation used to treat bipolar disorders but also has some important features as an anti-cancer agent. In this review, we provide a general overview of lithium, from its transport into cells, to its innovative administration forms, and based on genomic, transcriptomic, and proteomic data. Lithium formulations such as lithium acetoacetate (LiAcAc), lithium chloride (LiCl), lithium citrate (Li3C6H5O7), and lithium carbonate (Li2CO3) induce apoptosis, autophagy, and inhibition of tumor growth and also participate in the regulation of tumor proliferation, tumor invasion, and metastasis and cell cycle arrest. Moreover, lithium is synergistic with standard cancer therapies, enhancing their anti-tumor effects. In addition, lithium has a neuroprotective role in cancer patients, by improving their quality of life. Interestingly, nano-sized lithium enhances its anti-tumor activities and protects vital organs from the damage caused by lipid peroxidation during tumor development. However, these potential therapeutic activities of lithium depend on various factors, such as the nature and aggressiveness of the tumor, the type of lithium salt, and its form of administration and dosage. Since lithium has been used to treat bipolar disorder, the current study provides an overview of its role in medicine and how this has changed. This review also highlights the importance of this repurposed drug, which appears to have therapeutic cancer potential, and underlines its molecular mechanisms.

Preliminary Identification of the Aerobic Cervicovaginal Microbiota in Mexican Women With Cervical Cancer as the First Step Towards Metagenomic Studies.

Cervical cancer (CC) is considered a public health problem. Recent studies have evaluated the possible relationship between the cervicovaginal microbiome and gynecologic cancer but have not studied the relationship between aerobic bacterial communities and neoplasia. The study aimed to identify the cultivable aerobic bacterial microbiota in women with cervical cancer as a preliminary approach to the metagenomic study of the cervicovaginal microbiome associated with cervical cancer in Mexican women. An observational cross-sectional study was conducted, including 120 women aged 21-71 years, divided into two study groups, women with locally advanced CC (n=60) and women without CC (n=60). Sociodemographic, gynecological-obstetric, sexual, and habit data were collected. Cervicovaginal samples were collected by swabbing, from which standard microbiological methods obtained culturable bacteria. The strains were genetically characterized by PCR-RFLP of the 16S rRNA gene and subsequently identified by sequencing the same gene. Variables regularly reported as risk factors for the disease were found in women with CC. Differences were found in the prevalence and number of species isolated in each study group. Bacteria commonly reported in women with aerobic vaginitis were identified. There were 12 species in women with CC, mainly Corynebacterium spp. and Staphylococcus spp.; we found 13 bacterial species in the group without cancer, mainly Enterococcus spp. and Escherichia spp. The advanced stages presented a more significant number of isolates and species. This study provided a preliminary test for cervicovaginal metagenomic analysis, demonstrating the presence of aerobic cervicovaginal dysbiosis in women with CC and the need for more in-depth studies.

Ranking the importance of their own diseases: A positioning analysis in rheumatic patients and their proxies.

INTRODUCTION/OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from "worst" to "least bad". Then they defined the "worst" disease and ranked 10 diseases from highest to lowest importance from a list including "my rheumatic disease/my relative's disease". The lists of the included diseases represented the mindshare from a sample of healthy adults. RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. "My disease/my relative's disease" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. DISCUSSION AND CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

Genotoxicity of Mercury and Its Derivatives Demonstrated In Vitro and In Vivo in Human Populations Studies. Systematic Review.

Beside partial coverage in three reviews so far (1994, 2009, 2019), there is no review on genotoxic studies dealing with mercury (Hg) and human exposure using the most usual genotoxic assays: sister chromatid exchanges (SCE), chromosomal aberrations (CA), cytochalasin B blocked micronucleus assay (CBMN), and single-cell gel electrophoresis (SCGE or alkaline comet assay). Fifty years from the first Hg genotoxicity study and with the Minamata Convention in force, the genotoxic potential of Hg and its derivatives is still controversial. Considering these antecedents, we present this first systematic literature overview of genotoxic studies dealing with Hg and human exposure that used the standard genotoxic assays. To date, there is not sufficient evidence for Hg human carcinogen classification, so the new data collections can be of great help. A review was made of the studies available (those published before the end of October 2021 on PubMed or Web of Science in English or Spanish language) in the scientific literature dealing with genotoxic assays and human sample exposure ex vivo, in vivo, and in vitro. Results from a total of 66 articles selected are presented. Organic (o)Hg compounds were more toxic than inorganic and/or elemental ones, without ruling out that all represent a risk. The most studied inorganic (i)Hg compounds in populations exposed accidentally, occupationally, or iatrogenically, and/or in human cells, were Hg chloride and Hg nitrate and of the organic compounds, were methylmercury, thimerosal, methylmercury chloride, phenylmercuric acetate, and methylmercury hydroxide.

Effect of phthalates exposure during perinatal period on hormonal profile in Mexican males during their first months of life.

Phthalates affect development of male reproductive system acting as an antiandrogenic agents. We sought to explore if perinatal exposure to phthalates could alter male hormone levels in humans during the first months of life. A cohort of 83 pregnant women and their male infants were studied. Five phthalate metabolites were measured in the mother's urine during the first, second, and third trimesters of pregnancy and during the first, third, and sixth months of life in the infants. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and inhibin B were analyzed. Association between phthalate exposure and hormone variation was assessed using regression models for longitudinal data. Mono-butyl phthalate reduced FSH concentration (ß = -0.0012 international units [IU]/L, p < 0.01), mono-ethylhexyl phthalate reduced inhibin B (ß = -0.0094 pg/mL, p = 0.02), monoethyl phthalate reduced testosterone (ß = -0.0071 ng/L, p = 0.07), mono-ocytl phthalate reduced LH (ß = -0.0041 IU/L, p = 0.13). No effects were observed for exposure to mono-methyl phthalate. Our results are consistent with the findings in animal and human studies. Special precaution should be taken when measuring phthalate exposure in susceptible populations such as pregnant women and infants.

Phthalates exposure during pregnancy a study in a Mexican cohort.

A prospective cohort study was conducted to measure the concentration levels of three primary phthalate metabolites (MBP, MEHP, MEP) during pregnancy in a group of women from the State of Mexico. The urinary concentration levels of the three phthalate primary metabolites were measured by gas chromatography mass spectrometry during the first, second and third trimesters of pregnancy. The geometric mean and 95 % CI for MBP was 20.38 µg/mL (15.35-27.09); for MEHP 13.43 µg/mL (8.93-20.20), and MEP 52.47 µg/mL (39.88-69.04) adjusted to one g of creatinine. No significant trends were observed among the studied metabolites during the pregnancy period. MBP was higher in less educated women, while women who resided in industrialized zones showed higher levels of MEHP and MEP than women from non-industrialized zones. Consumption of plastic bottled beverages was associated with MBP and MEHP phthalate exposure. Women who used non-registered brands of plastic food containers for storage or for microwave oven use showed the highest levels of MBP and MEP phthalates. The pregnant women in our study were exposed to the three studied primary phthalate metabolites, and this could present a risk to their newborns. To better integrate public health policies, major exploration of potential exposure sources and effects at the regional level is required.

Ranking the Importance of Their Own Diseases: A Positioning Analysis in Rheumatic Patients and Their Proxies.

INTRODUCTION/OBJECTIVE: To assess the positioning that patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and their proxies give to their diseases. METHODS: Subjects completed a self-administered questionnaire to rank 11 diseases from "worst" to "least bad". Then they defined the "worst" disease and ranked 10 diseases from highest to lowest importance from a list including "my rheumatic disease/my relative's disease". The lists of the included diseases represented the mindshare from a sample of healthy adults. RESULTS: There were 570 respondents (104 SLE, 99 RA, 82 AS, and 285 proxies). Rheumatoid arthritis was considered the third-worst disease (recoded ranking first by 41% of patients and 43% proxies, second by 49% and 44%, and third by 10% and 13%). A disease that kills was the preferred definition for the worst disease. "My disease/my relative's disease" was ranked fourth in importance (first by 41% of patients, second by 38%, and third by 21%). Rankings were not associated with age, schooling, disease duration, or setting. DISCUSSION AND CONCLUSIONS: Most respondents ranked their own disease considerably lower than other non-rheumatic conditions.

Quality and Safety in Healthcare for Medical Students: Challenges and the Road Ahead.

Background: The development of skills, behaviors and attitudes regarding patient safety is of utmost importance for promoting safety culture for the next generation of health professionals. This study describes our experience of implementing a course on patient safety and quality improvement for fourth year medical students in Mexico during the COVID-19 outbreak. The course comprised essential knowledge based on the patient safety curriculum provided by the WHO. We also explored perceptions and attitudes of students regarding patient safety. Methods: Fourth year medical students completed a questionnaire regarding knowledge, skills, and attitudes on patient safety and quality improvement in medical care. The questionnaire was voluntarily answered online prior to and after the course. Results: In total, 213 students completed the questionnaires. Most students were able to understand medical error, recognize failure and the nature of causation, perform root-cause analysis, and appreciate the role of patient safety interventions. Conversely, a disapproving perspective prevailed among students concerning the preventability of medical errors, utility of reporting systems, just culture and infrastructure (p < 0.05). Conclusion: We found students had a positive perspective concerning learning quality in healthcare and patient safety during our course; nevertheless, their perception of the usefulness of reporting systems to prevent future adverse events and prevent medical errors is uncomplimentary. Medical education should promote error reporting and just culture to change the current perception of medical students.

Breast cancer-related single-nucleotide polymorphism and their risk contribution in Mexican women.

CONTEXT: Four single-nucleotide polymorphisms (SNPs) in Mexican patients and their association with the development of breast cancer (BC). AIMS: This work is focused on determining the association of fibroblast growth factor receptor (rs12196489), TOX3 (rs3803662), human telomerase reverse transcriptase (h TERT, rs10069690), and FTO (rs17817449) polymorphisms and BC in a cohort of Mexican women. SETTINGS AND DESIGN: The study included 56 patients with a confirmed diagnosis of BC and 83 controls. Clinical characteristics were obtained from medical records. SUBJECTS AND METHODS: Genomic DNA from the samples was obtained from lymphocytes, and the genotyping of rs12196489, rs3803662, rs10069690, and rs17817449 polymorphisms was performed by real-time polymerase chain reaction using specific TaqMan probes. Statistical analysis was assessed to evaluate the distribution of genotype frequencies between cases and controls. STATISTICAL ANALYSIS: We used the STATA Statistical Package (version 10.1; STATA Corp., College Station, TX, USA). Student's t-test, χ2 test, or Fisher's exact test was used to evaluate the distribution of genotype frequencies. RESULTS: No statistical differences in allelic and genotypic frequencies were found between patients with BC and controls for SNPs: rs1219648, rs3803662, and rs17817449. Interestingly, according to the χ2 test, a significant difference was exhibited for rs10069690 (odds ratio = 0.095; 95% confidence interval = 0.038-0.214; P < 0.001). CONCLUSIONS: The h TERT (rs10069690) polymorphism might be associated with BC in Mexican women. Nevertheless, additional studies in a larger cohort are required to confirm this association and to possibly use this polymorphism as a potential biomarker in the early diagnosis of BC.

Night Shift Work and Risk of Breast Cancer in Women.

BACKGROUND: Night shift work involving circadian disruption has been associated with increased breast cancer rates in some epidemiological studies, but the evidence is still on debate. AIM OF THE STUDY: The objective of this study is to assess the association between night shift work and breast cancer in Mexican women. METHODS: A Case-control study was conducted with incident cases of breast cancer at the Instituto de Seguridad Social del Estado de México y Municipios. Cases were interviewed about past exposures prior to the final diagnosis. Controls were women without breast cancer matched on multiple sociodemographic characteristics. RESULTS: 101 cases and 101 matched controls were interviewed; this small sample size provided consistent, but wide estimates of the assessed associations. The multivariate conditional logistic regression showed that breast-feeding was associated with reduced risk for breast cancer (OR 0.12; 95% CI: 0.02-0.60); women who experienced early menarche (12 years) were more likely to develop breast cancer (OR 18.58; 95% CI 18: 2.19-148). Women who worked at night were more likely to develop breast cancer compared to women who never did (OR = 8.58; 95% CI: 2.19-33.8). CONCLUSIONS: Our results are consistent with studies from other countries, which positively associated night shift work with breast cancer.

Allopurinol-Induced Toxic Epidermal Necrolysis.

Toxic epidermal necrolysis (TEN) is an extremely rare condition characterized by separation of dermoepidermal junctions, necrosis, and subsequent detachment of the epidermis over large cutaneous areas. TEN can emerge after exposure to certain medications such as allopurinol, aromatic anticonvulsants, NSAIDs, nevirapine, and antibacterial sulfonamides. There is no standard protocol for TEN, and the therapy of choice varies from one patient to another. Some of these therapies include silver-releasing wraps/dressings, glucocorticoids, antibodies to inhibit Fas-mediated keratinocyte apoptosis, and cyclosporine A. A 35-year-old male with an allergy to antibacterial sulfonamides who was being treated for arterial hypertension and hyperuricemia with captopril and allopurinol, respectively, was admitted to hospital. The patient showed skin detachment affecting approximately 95% of his surface area, including his face, upper and lower extremities, trunk, back, oropharyngeal mucosa, anal mucosa, ocular mucosa, and genital mucosa. Intravenous methylprednisolone at a dosage of 40 mg/day for 7 days along with abrasive cures was found to be an appropriate treatment in this case.

Potential uses of an infodemiology approach for health-care services for rheumatology.

OBJECTIVES: This is a demand-based infodemiology study using the Google Trends and AdWords tools to illustrate infodemiology's potential use in rheumatology. The study investigates three questions in North American countries: (1) What terms associated with "rheumatology" and "arthritis" do people search for on Google? (2) What is the search volume for disease-modifying antirheumatic drugs (DMARDs)? and (3) What is the search volume for the term "arthritis" compared with for "hepatitis C" and "breast cancer"? METHODS: We conducted independent searches by country and search term for 2015-2017. Seventeen DMARDs were searched for 2015 through May 2018, with the turmeric remedy included for comparison. Data were exported to Excel for further analysis, adjusted by country population, and expressed as searches per 100,000 inhabitants (SpTh). RESULTS: There were approximately 550 associated terms for "arthritis" in each country, and 5679 SpTh for DMARDs across the three countries. Searches for turmeric numbered slightly lower than for all DMARDs together in Canada and the USA, but were 70% higher in Mexico. Turmeric was also searched four times more than the most-searched biological DMARD in Canada and the USA, and 60 times more in Mexico. Arthritis was more commonly searched for in Canada than hepatitis C and breast cancer, but hepatitis C was highest in the USA and breast cancer in Mexico. Monthly trends did not show expected peaks associated with arthritis awareness campaigns. CONCLUSION: Infodemiology provides preliminary information that could help in generating hypotheses, assessing health-care interventions, or even in providing patient-centered care.