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Introduction: Recently, contrast-enhanced mammography (CEM) has emerged as a reliable alternative to breast magnetic resonance imaging (MRI) for the assessment of pathological response in breast cancer patients. Our study sought to determine the diagnostic accuracy of CEM to predict pathological complete response (pCR) in patients who received neoadjuvant chemotherapy (NACT). Methods: We retrieved the medical records of patients who underwent NACT at our institution. Using post-surgery pCR, morphological evidence and CEM enhancement tumours were classified as follows: 1) radiologic complete response (rCR); 2) functional radiological complete response (frCR); and 3) non-complete response. Initially, we used multivariate analyses adjusted by clinical variables and frCR or rCR to determine which variables affected pathological response. Then, CEM diagnostic accuracy to discriminate pCR was assessed using receiver operating characteristic curves in univariate and multivariate models including either frCR or rCR. Results: A total of 48 patients were included in our study. Most patients (68.7%) were hormone receptor (HR)+ and 41.6% (20) of the patients achieved pCR. Using univariate logistic regression analyses we found that HR status, HER2 status, rCR and frCR had a significant impact on CEM diagnostic accuracy. Exploratory analyses found that CEM sensitivity was higher for HR- tumours. Multivariate logistic regression analyses found 60% sensitivity, 92.9% specificity and 79.2% accuracy in a model that included clinical variables and rCR. Conclusion: CEM is a reliable alternative to high-cost, time-consuming breast MRI that predicts pCR in patients undergoing NACT; CEM diagnostic accuracy was higher among patients who harboured HR- tumours.

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PURPOSE: The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for "opportunistic" mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients. METHODS: Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records. RESULTS: A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and "luminal" BC (HR + /HER2 -) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that non-SDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001). CONCLUSION: We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.

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ABSTRACT Background: About 80% of breast cancer (BC) cases express estrogen receptor (ER), which has been correlated with good prognosis and response to estrogen deprivation Aim: To characterize ER positive advanced BC (ABC) patients treated at our institution assessing the impact of clinical pre-sentation (stage IV, de novo disease at diagnosis versus systemic recurrence) and BC subtype on survival rates. Material and Methods: We evaluated 211 ER+ advanced BC (ABC) patients, treated between 1997 and 2017. Results: The median overall survival (OS) was 37 months. Median OS for the period 1997/2006 and 2007/2017 were 33 and 42 months, respectively (p = 0.47). Luminal A, ABC stage IV disease at diagnosis displayed better OS rates than Luminal B stage IV tumors (100 and 32 months respectively, p < 0.01). Conclusions: Clinical presentation (stage IV vs. systemic recurrence) and tumor subtype are key determinants of OS in ABC.

Antecedentes: Casi el 80% de los casos de cáncer de mama (CM) son positivos para receptores de estrógenos (RE+). Éstos se caracterizan por una mejor sobrevida y respuesta a terapia endocrina. Objetivo: Caracterizar a pacientes con CM avanzado (CMA), RE+, y determinar sobrevida según presentación clínica y subtipos. Material y Métodos: Analizamos en nuestra base de datos los antecedentes de 211 pacientes con CMA RE+, tratados en nuestra institución en el período 1997-2017. Se evaluó el impacto de la presentación clínica (estadio IV al diagnóstico, enfermedad de novo, versus recurrencia sistémica) y subtipo de CM, en los niveles de sobrevida. Resultados: La mediana de sobrevida global (SG) fue de 37 meses. La mediana de SG para el período 1997/2006 y 2007/2017 fue de 33 y 42 meses; respectivamente (p = 0,47). Pacientes con CMA, estadio IV, Luminal A al momento del diagnóstico mostraron mejores tasas de SG frente al estadio IV del Luminal B (100 y 32 meses respectivamente (p < 0,01). Conclusiones: La presentación clínica (estadio IV, de novo, versus recurrencia sistémica) y subtipo son determinantes clave de la SG en CMA.

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Breast cancer (BC) is the most common malignancy in women. We retrieved medical records from >2,000 Chilean BC patients over the 1997-2018 period. The objective was to assess changes in clinical presentation or prognosis of our patients throughout these 20 years of practice. Although most variables did not display significant variations, we observed a progressive increase in stage IV BC over this period. Our data showed that tumour stage III/IV or HER2-enriched subtype tumours were associated with poorer prognosis. In contrast, we found that patients diagnosed by mammography had better overall survival. We speculate that better screenings and more sensitive imaging could explain the unexpected rise in stage IV cases. Our results support mammography screenings as an effective measure to reduce BC-related mortality.

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BACKGROUND: About 80% of breast cancer (BC) cases express estrogen receptor (ER), which has been correlated with good prognosis and response to estrogen deprivation Aim: To characterize ER positive advanced BC (ABC) patients treated at our institution assessing the impact of clinical pre-sentation (stage IV, de novo disease at diagnosis versus systemic recurrence) and BC subtype on survival rates. MATERIAL AND METHODS: We evaluated 211 ER+ advanced BC (ABC) patients, treated between 1997 and 2017. RESULTS: The median overall survival (OS) was 37 months. Median OS for the period 1997/2006 and 2007/2017 were 33 and 42 months, respectively (p = 0.47). Luminal A, ABC stage IV disease at diagnosis displayed better OS rates than Luminal B stage IV tumors (100 and 32 months respectively, p < 0.01). CONCLUSIONS: Clinical presentation (stage IV vs. systemic recurrence) and tumor subtype are key determinants of OS in ABC.

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INTRODUCTION: The optimal management of breast lesions with atypia (BLA), detected in percutaneous biopsies after screening mammograms, is a controversial issue. The aim of this paper is to compare histological diagnosis by percutaneous biopsy with the results of the surgical biopsy of these lesions and to analyse the changes to clinical approach this would imply. METHOD: A retrospective study was carried out on patients operated on between June 2007 and June 2017 with a diagnosis of BLA. One hundred and forty-seven patients were identified with a pre-operative diagnosis of flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, lobular carcinoma in situ and other atypia. RESULTS: The average age at diagnosis of BLAs was 52 ± 9.4 years. Radiologically, the lesions presented as microcalcifications in 79%, nodules in 15.6% and other lesions 5.4%. 73.5% of these were biopsied by means of digital stereotaxis. All of the patients analysed underwent a partial mastectomy. Changes in a biologically high-risk lesion were observed in 26.5% of the surgical specimens, of which 75.5% corresponded with ADH and FEA. In the percutaneous biopsies consistent with ADH (40.1%), ductal carcinoma was discovered in 6.8% (5.1% in situ and 1.7% invasive), which implied specific, multi-disciplinary management. Of the FEAs, 84.8% required a second treatment (surgery and/or hormone therapy ± radiotherapy, depending on whether it concerned FEA 59.6%, ADH 21.2% or ductal carcinoma in situ 3.8%). CONCLUSION: These data show the clinical relevance in the diagnosis of ADH and FEA in percutaneous biopsies. For the diagnosis of FEA in particular, the associated risk of biologically high-risk lesions and ductal carcinoma is made evident.

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Metastatic breast cancer (MBC) management is based on systemic treatment (ST), while the local therapy role remains controversial. We present the case of a 36-year-old woman with a diagnosis of hormone receptor-positive and human epidermal growth factor receptor type 2-positive breast cancer and isolated sternal metastasis, who received neoadjuvant ST with complete remission and later primary tumour surgery. Oligometastatic patients are a subgroup of MBC that can benefit from aggressive local therapies, even with curative intent.

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The association of granulomatous lobular mastitis and carcinoma of the breast is very infrequent. We present the case of a 44-year-old woman with concurrent granulomatous lobular mastitis with coryneform bacteria and ductal carcinoma in situ in the same breast.

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Background: HER2+ breast cancer (BC) subtype overexpresses the Human Epidermal growth factor Receptor type-2 (HER2) and is characterized by its aggressiveness and its high sensitivity to monoclonal antibody-based HER2-targeted therapies. Aim: To assess the prognosis and evaluate the impact of novel anti-HER2 therapies on advanced HER2+ BC patients treated at our institution over the last decades. Material and Methods: Analysis of the patient database at a cancer center of a university hospital. Information about the subtype of cancer was obtained in 2,149 of 2,724 patients in the database. Eighteen percent of the latter were HER2+. We analyzed data of 83 of these patients with advanced disease. Results: Median overall survival (OS) was 24 months. For patients treated between 1997-2006 median OS was 17 months and for those treated in the period 2007-2017 median OS was 32 months (p = 0.09). Conclusions: A non-significant trend towards better survival in the last decade was observed. HER2+ BC overall survival has improved in our center. This can be probably attributed to the use of novel more effective anti-HER2 therapies.

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BACKGROUND: HER2+ breast cancer (BC) subtype overexpresses the Human Epidermal growth factor Receptor type-2 (HER2) and is characterized by its aggressiveness and its high sensitivity to monoclonal antibody-based HER2-targeted therapies. AIM: To assess the prognosis and evaluate the impact of novel anti-HER2 therapies on advanced HER2+ BC patients treated at our institution over the last decades. MATERIAL AND METHODS: Analysis of the patient database at a cancer center of a university hospital. Information about the subtype of cancer was obtained in 2,149 of 2,724 patients in the database. Eighteen percent of the latter were HER2+. We analyzed data of 83 of these patients with advanced disease. RESULTS: Median overall survival (OS) was 24 months. For patients treated between 1997-2006 median OS was 17 months and for those treated in the period 2007-2017 median OS was 32 months (p = 0.09). CONCLUSIONS: A non-significant trend towards better survival in the last decade was observed. HER2+ BC overall survival has improved in our center. This can be probably attributed to the use of novel more effective anti-HER2 therapies.

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Vasomotor symptoms are one of the main reasons for climateric women to consult a physician. Hormone therapy is the first treatment choice, but it is not indicated to all patients. Veralipride is an option for those who cannot or will not try hormone treatment. The Mexican Association for the Study of Climateric (AMEC) assembled an interdisciplinary group of medical experts so that they revised the medical literature on the subject and reached a consensus on veralipride indication, doses, counterindications and safety. The recommendations of the consensus conference on veralipride are: (1) Physicians must be familiar with its indication, side effects, pharmacokinetics and dosage. (2) Patients must be informed on other therapeutical options. (3) Patients' mental and neurological state must be evaluated, in particular to identify movement disorders, extrapyramidal symptoms (tremor or dystonia), anxiety and depression that can be mistaken for climateric symptoms. (4) Any adverse effect associated with the drug must be reported. (5) A random multicenter trial must be carried out in order to identify the frequency and severity of side effects, and (6) Written information on possible health risks when using the drug must be provided.

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Con la finalidad de realizar una actualización de los conocimientos sobre la aplicación de la acupuntura en estomatología, se realiza una revisión bibliográfica sobre este tema basado en la información obtenida de textos y revistas consultadas en centros de referencia y a través de localizadores electrónicos como Pubmed, Medline y Google de los últimos años. Según se pudo constatar esta temática tiene vigencia y su aplicación resulta de gran utilidad en el tratamiento de las afecciones estomatológicas.(AU)

To carry out an updating of knowledges on implementation of Acupuncture in Stomatology, a bibliographic review was conducted on this subject on the base of information gathered from texts and journals consulted in reference center and through electronic localization devices like Pubmed, Medline and Google of the past years. It was confirmed that this subject matter has validity and its implementation is very useful in the treatment of stomatologic affections.(AU)

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Con la finalidad de realizar una actualización de los conocimientos sobre la aplicación de la acupuntura en estomatología, se realiza una revisión bibliográfica sobre este tema basado en la información obtenida de textos y revistas consultadas en centros de referencia y a través de localizadores electrónicos como Pubmed, Medline y Google de los últimos años. Según se pudo constatar esta temática tiene vigencia y su aplicación resulta de gran utilidad en el tratamiento de las afecciones estomatológicas(AU)

To carry out an updating of knowledges on implementation of Acupuncture in Stomatology, a bibliographic review was conducted on this subject on the base of information gathered from texts and journals consulted in reference center and through electronic localization devices like Pubmed, Medline and Google of the past years. It was confirmed that this subject matter has validity and its implementation is very useful in the treatment of stomatologic affections(AU)

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Recent evidence suggests that fluoride (F) and arsenic (As) may adversely affect intelligence quotient (IQ) scores. We explore the association between exposure to F and As in drinking water and intelligence in children. Three rural communities in Mexico with contrasting levels of F and As in drinking water were studied: Moctezuma (F 0.8+/-1.4 mg/L; As 5.8+/-1.3 microg/L); Salitral (F 5.3+/-0.9 mg/L; As 169+/-0.9 microg/L) and 5 de Febrero (F 9.4+/-0.9 mg/L; As 194+/-1.3 microg/L). The final study sample consisted of 132 children from 6 to 10 years old. After controlling for confounders, an inverse association was observed between F in urine and Performance, Verbal, and Full IQ scores (beta values = -13, -15.6, -16.9, respectively). Similar results were observed for F in drinking water (beta values = -6.7, -11.2, -10.2, respectively) and As in drinking water (beta values= -4.30, -6.40, -6.15, respectively). The p-values for all cases were < 0.001. A significant association was observed between As in urine and Full IQ scores (beta = -5.72, p = 0.003). These data suggest that children exposed to either F or As have increased risks of reduced IQ scores.

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Recent evidence suggests that fluoride (F) and arsenic (As) may adversely affect intelligence quotient (IQ) scores. We explore the association between exposure to F and As in drinking water and intelligence in children. Three rural communities in Mexico with contrasting levels of F and As in drinking water were studied: Moctezuma (F 0.8±1.4mg/L; As 5.8±1.3µg/L); Salitral (F 5.3±0.9mg/L; As 169±0.9µg/L) and 5 de Febrero (F 9.4±0.9mg/L; As 194±1.3µg/L). The final study sample consisted of 132 children from 6 to 10 years old. After controlling for confounders, an inverse association was observed between F in urine and Performance, Verbal, and Full IQ scores (beta values = -13, -15.6, -16.9, respectively). Similar results were observed for F in drinking water (beta values = -6.7, -11.2, -10.2, respectively) and As in drinking water (beta values= -4.30, -6.40, -6.15, respectively). The p-values for all cases were < 0.001. A significant association was observed between As in urine and Full IQ scores (beta = -5.72, p = 0.003). These data suggest that children exposed to either F or As have increased risks of reduced IQ scores.

Estudios recientes sugieren que el flúor (F) y el arsénico (As) pueden tener efectos adversos sobre el coeficiente intelectual (CI). En este estudio exploramos la asociación entre el F y el As y la inteligencia en niños expuestos a estas sustancias a través del agua. Tres comunidades rurales de México con diferentes niveles de F y As fueron estudiadas: Moctezuma (F 0,8±1,4mg/L; As 5,8±1,3µg/L); Salitral (F 5,3±0,9mg/L; As 169±0,9µg/L) y 5 de Febrero (F 9,4±0,9mg/L; As 194±1,3µg/L). La muestra final fue de 132 niños de 6 a 10 años de edad. Después de controlar por confusores, se obtuvieron asociaciones inversas entre F en orina y las puntuaciones de los CI (Desempeño, Verbal y Total) (valores beta = -13, -15,6, -16,9, respectivamente) p < 0,001 en todos los casos. Resultados similares se obtuvieron con F en agua (valores beta = -6,7, -11,2, -10,2, respectivamente) y con As en agua (valores beta = -4,30, -6,40, -6,15, respectivamente). En todos los casos p < 0,001. Para As en orina, se obtuvo una asociación inversa con las puntuaciones del CI total (beta= -5,72; p = 0,003). Estos datos sugieren que los niños expuestos al F o al As tienen mayor riesgo de tener disminución en las puntuaciones del CI.

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El presente artículo tiene como objetivo identificar los aspectos conceptuales esenciales de las tendencias y enfoques pedagógicos contemporáneos, centrando el análisis en la pedagogía tradicional, así como en un enfoque histórico-cultural. Se muestra una comparación entre ambas corrientes basada en aspectos fundamentales como son: la relación profesor-alumno, la metodología empleada en enseñanza, la evaluación del aprendizaje y la repercusión social de cada una de estas corrientes. Se efectuó una revisión de la literatura existente en nuestro medio en las últimas décadas, que permitió establecer los aspectos positivos, limitaciones de las tendencias, así como la importancia de profundizar en este interesante tema(AU)

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El presente artículo tiene como objetivo identificar los aspectos conceptuales esenciales de las tendencias y enfoques pedagógicos contemporáneos, centrando el análisis en la pedagogía tradicional, así como en un enfoque histórico-cultural. Se muestra una comparación entre ambas corrientes basada en aspectos fundamentales como son: la relación profesor-alumno, la metodología empleada en enseñanza, la evaluación del aprendizaje y la repercusión social de cada una de estas corrientes. Se efectuó una revisión de la literatura existente en nuestro medio en las últimas décadas, que permitió establecer los aspectos positivos, limitaciones de las tendencias, así como la importancia de profundizar en este interesante tema(AU)

The present article is aimed at identifying the essential conceptual aspects of the contemporary pedagogical trends and approaches, focussing the analysis on traditional pedagogy, as well as on a historical and cultural approach. A comparison was made between both currents based on fundamental aspects, such as the professor-student relationship, the methodology used in teaching, the evaluation of learning and the social repercussion of each of these currents.A review of the literature existing in our environment during the last decades was made. It allowed to establish the positive aspects, the limitations to trends, and the importance to go deep into this interesting topic(AU)

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Se evalúa la eficacia del osteocoral como material de implante en el tratamiento de bolsas infraóseas en dientes multirradiculares. Se analizaron 14 pacientes que se dividieron en 2 grupos: el primero incluyó a 6 pacientes con un total de 12 defectos, los cuales se evaluaron hasta los 6 meses. El segundo, con 8 pacientes y 16 defectos, que se reevaluaron a los 12 y 24 meses. En los 2 grupos se incluyeron pacientes de ambos sexos, que fueron implantados con osteocoral (grupo estudio) y con hidroxiapatita (grupo control). Se realizó reparación inicial que incluyó remoción de cálculo y pulido de la superficie dentaria, educación y motivación y evaluación del cepillado, que debía mostrar valores iguales o mayores del 80 porciento en la remoción de placa dentobacteriana. Posteriormente se realizó el implante mediante operación a colgajo. Se realizaron radiografías de control a los 14 días, 6 meses (para el primer grupo) y 12 y 24 meses (para el segundo grupo). Se controló sistemáticamente la higiene bucal en ambos grupos. Se controlaron nuevamente los indicadores clínicos a los 6 meses para el primer grupo, y a los 12 y 24 meses para el segundo. Se observó una disminución estadísticamente significativa en el índice gingival, profundidad de la bolsa y movilidad dentaria para ambos materiales implantológicos, sin que se reportaran grandes diferencias entre éstos. Radiográficamente se observó la presencia de relleno en el defecto original, y no hubo reacciones locales adversas, por lo que se consideró efectivo el tratamiento(AU)

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Se estudiaron 30 sitios o áreas periodontales que presentaban gingivitis y 30 con periodontitis, con el objetivo de determinar la relación existente entre el sangramiento gingival y la flora microbiana presente en la gingivitis y la periodontitis. Los pacientes seleccionados no presentaban antecedentes de enfermedad general y no habían recibido medicación antimicrobiana ni tratamiento periodontal en los últimos 6 meses; en el caso de las mujeres, no podían estar embarazadas. En los dientes seleccionados se procedió a tomar la muestra cumpliendo con los requisitos establecidos; luego se examinó inmediatamente en el microscopio de campo oscuro. Los resultados obtenidos indica que no hubo relación entre los morfotipos microbianos y los diferentes valores del índice de sangramiento gingival(AU)

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Se estudiaron 50 estudiantes de 4to. año de la Facultad de Estomatología del ISCH-H con el objetivo de conocer la eficiencia del cepillado gingivodental y su relación con la forma y el tiempo empleado para realizar el mismo. Los alumnos fueron seleccionados del total que asistían a las clínicas de parodoncia, exodoncia e infantil, de la Facultad. Se utilizó la fuschina al 0,2

como sustancia reveladora de placa y se determinó la presencia de la misma mediante el índice de análisis de higiene bucal de Love. Se orientó a los alumnos que efectuaran el cepillado en la forma y el tiempo por ellos acostumbrada. Según los resultados obtenidos se detectó que la técnica más eficiente fue la circular siguiéndole por orden la vertical y la menos eficiente fue la horizontal. El tiempo empleado durante el cepillado no guardó relación con la eficiencia del mismo (AU)

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