Descenso de la edad al diagnóstico en el cáncer de mama

Introduction

Increasingly younger women are apparently diagnosed with breast cancer. The aim of this study was to determine whether age at diagnosis of this disease is declining.

Material and methods

We calculated incidence rates for breast cancer in Zaragoza (Spain) by age groups. The median age at diagnosis over a 20-year period was calculated. A Joinpoint regression was subsequently performed to determine the trend.

Results

The median showed a downward trend with an annual percentage change of -0.3% (95% CI -0.6, -0.1) over the 20-year period. The crude incidence rates for age groups showed that the positive trend was highest among women aged more than 85 years, PAC = 14% (95% CI 4.03; 25.9), followed by the group aged 40-44 years with a PAC of 10% (95% CI 3.4, 17.1).

Conclusions

The median age at diagnosis of breast cancer has declined over the past 20 years.     

Public hospital emergency department visits due to burns in Brazil, 2009

The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED) and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%), and the most prevalent age brackets were 30-49 years (23.1%) and 0-4 years (23%). Most burns occurred at home (62.1%), especially among females and children, and in commerce/services/industry/construction (19.1%), mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6%) and exposure to fire and flames (24.2%); among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with injuries at home, contact with heat and hot substances, and subsequent hospitalization; burns in the 15-49-year bracket were associated with exposure to fire/flames and electrical current, injuries occurring in public places, and outpatient treatment and discharge. The study highlights the importance of burn prevention strategies targeting children and workers.     

CD3<Superscript>+</Superscript>ICOS<Superscript>+</Superscript> T cells show differences in the synthesis of nitric oxide,IFN-γ, and IL-10 in patients with pulmonary tuberculosis or in healthy household contacts

Evidence indicates that more than 90 % of infected individuals never develop active tuberculosis. This fact highlights the relevance of the immune response in tuberculosis control. The inducible co-stimulator (ICOS) is a regulator of the function, differentiation, proliferation, and activation of T cells. Moreover, T cells synthesise nitric oxide (NO), interferon gamma (IFN-γ), and interleukin (IL)-10, which help regulate the immune response to tuberculosis. Therefore, we assessed the synthesis of NO, IFN-γ, and IL-10 in CD3⁺ICOS⁺ T cells from healthy individuals, household contacts (HHC), and patients with active pulmonary tuberculosis (PTB), previously stimulated with the antigen H37Rv. Our results indicated a significant increase in both the percentage of ICOS⁺ cells and CD3⁺ICOS⁺ T cells producing NO, IFN-γ, and IL-10 in cells obtained from patients with PTB (p < 0.01). In addition, a high mitochondrial membrane potential (ΔΨ _m) in CD3⁺ICOS⁺ T cells was observed in the cells from HHC and from PTB patients, and is associated with the activation of T cells. In conclusion, results show that the CD3⁺ICOS⁺ T cells obtained from PTB patients are the main producers of NO, IFN-γ, and IL-10. In addition, our results imply that NO is a modulator of ICOS expression of T cells from PTB patients.     

Cytogenetic risk stratification in chronic myelomonocytic leukemia

Background

The prognostic value of cytogenetic findings in chronic myelomonocytic leukemia is unclear. Our purpose was to evaluate the independent prognostic impact of cytogenetic abnormalities in a large series of patients with chronic myelomonocytic leukemia included in the database of the Spanish Registry of Myelodysplastic Syndromes.

Design and Methods

We studied 414 patients with chronic myelomonocytic leukemia according to WHO criteria and with a successful conventional cytogenetic analysis at diagnosis. Different patient and disease characteristics were examined by univariate and multivariate methods to establish their relationship with overall survival and evolution to acute myeloid leukemia.

Results

Patients with abnormal karyotype (110 patients, 27%) had poorer overall survival (P=0.001) and higher risk of acute myeloid leukemia evolution (P=0.010). Based on outcome analysis, three cytogenetic risk categories were identified: low risk (normal karyotype or loss of Y chromosome as a single anomaly), high risk (presence of trisomy 8 or abnormalities of chromosome 7, or complex karyotype), and intermediate risk (all other abnormalities). Overall survival at five years for patients in the low, intermediate, and high risk cytogenetic categories was 35%, 26%, and 4%, respectively (P<0.001). Multivariate analysis confirmed that this new CMML-specific cytogenetic risk stratification was an independent prognostic variable for overall survival (P=0.001). Additionally, patients belonging to the high-risk cytogenetic category also had a higher risk of acute myeloid leukemia evolution on univariate (P=0.001) but not multivariate analysis.

Conclusions

Cytogenetic findings have a strong prognostic impact in patients with chronic myelomonocytic leukemia.     

Different powered toothbrushes for plaque control and gingival health

Background: Powered brushes were first introduced commercially in the 1960s. A recent systematic review suggested the superiority of certain modes of powered over manual toothbrushing for plaque and gingivitis reduction. That review did not allow for direct comparison between different modes of powered toothbrush. Objectives: To compare different modes of powered toothbrushing against each other for plaque reduction and the health of the gingivae. Other factors to be assessed were calculus and stain removal, cost, dependability and adverse effects. Search strategy: The following databases were searched: Cochrane Oral Health Group’s Trials Register (to 26 July 2010); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE via OVID (1950 to 26 July 2010); EMBASE via OVID (1980 to 26 July 2010); CINAHL via EBSCO (1982 to 26 July 2010). There were no language restrictions. Selection criteria: Trials were considered for inclusion with the following criteria: random allocation of participants; no compromised manual dexterity; unsupervised powered toothbrushing for at least four weeks. The primary outcomes were the plaque and gingivitis scores after powered toothbrush use during trial period. Data collection and analysis: Data extraction was performed independently and in duplicate. The authors of trials were contacted to provide missing data where possible. The effect measure for each meta‐analysis was the standardized mean difference (SMD) with 95% confidence intervals (CI) using the random‐effects model. Potential sources of heterogeneity were assessed. Main results: The review included data from 15 trials with 1015 participants. Due to the dearth of trials assessing the same mode of action, no definitive conclusions can be stated regarding the superiority of one mode of powered toothbrush over any other. Only minor and transient side effects were reported. Cost, dependability were not reported. Authors’ conclusions: Further trials of good quality are required to establish if any mode of action has superiority over the other modes of action for powered toothbrushes.     

Nucleus of the solitary tract and flavor aversion learning: relevance in concurrent but not sequential behavioral test

Theories relating the nucleus of the solitary tract to taste aversion learning (TAL) have received their main support from immunohistochemical research. In the present study, a behavioral analysis was performed on the effect of lesions of the intermediate nucleus of the solitary tract (iNST) on concurrent and sequential flavor aversion learning tasks. Bilateral lesions of the iNST impaired concurrent flavor learning, in which animals must discriminate between two simultaneously presented flavors paired with intragastric administration of a noxious or innocuous substance, respectively. However, the same iNST lesions did not interrupt the development of sequential flavor aversion learning, in which each flavor is offered individually on consecutive alternate days. These results behaviorally confirm the relevance of the nucleus of the solitary tract in TAL and suggest a functional dissociation between the neural systems underlying concurrent and sequential flavor aversion learning.     

Japanese encephalitis epidemiology in Arunachal Pradesh,a hilly state in northeast India

ObjectiveTo confirm Japanese encephalitis (JE) cases from the state of Arunachal Pradesh (AP), India for the first time.MethodsSuspected acute encephalitis syndrome (AES) cases were screened from 2005-2010. The cases were initially tested for antibodies against JE by using IgM MAC ELISA kits (National Institute of Virology, Pune). RNA was extracted from the cerebrospinal fluid (CSF) samples followed by molecular amplification of JE virus specific gene primer. The data obtained were used to calculate relative risks between the age groups and between the genders. Epi info 6.0 was used for the statistical analysis.ResultsPresence of JE cases in the state of AP, India was established. JE cases from 10 out of 16 districts were recorded. As part of control and preventive measures, mass vaccination for children (0-15 years) by SA-14-14-2 JE vaccine was taken up in 2010 in the district of Lohit. Vaccination coverage of 83.09% among the target population was achieved.ConclusionsThe study presents the first report of confirmed JE cases from the state of AP, India. This finding attracts attention as JE cases are rarely seen to occur in hilly places.