RESUMO
BACKGROUND: Vitamin D deficiency is associated with higher risk of cancer, possibly due to its antiproliferative, antiangiogenic, proapoptotic, cell-differentiating and anti-invasive effects. The anticarcinogenic role of vitamin D in melanoma is still a matter of debate. Loss of nuclear and cytoplasmic vitamin D receptor (VDR) expression in melanoma cells has been reported. OBJECTIVES: To analyse VDR immunohistochemical expression in benign dermal naevi (DN) and malignant melanoma (MM). METHODS: A case-control study evaluated nuclear and cytoplasmic VDR immunohistochemical staining in 54 DN and 55 MM tissue samples. RESULTS: There was significantly higher cytoplasmic VDR positivity in DN compared with MM (59% vs. 16%, P < 0·001). The mean VDR cytoplasmic expression was also higher in DN vs. MM (P < 0·001). No differences in nuclear VDR positivity were observed between groups, but mean nuclear VDR expression was significantly lower in DN vs. MM (P = 0·02). The loss of cytoplasmic VDR in MM was associated with Clark level, tumour staging and American Joint Committee on Cancer pTNM staging (P=0·004, 0·009 and 0·02, respectively). CONCLUSIONS: Alterations in VDR expression and localization are found in MM compared with DN. Loss of cytoplasmic VDR was associated with melanoma tumour size, suggesting that loss of cytoplasmic VDR may be a prognostic factor.
Assuntos
Melanoma/patologia , Nevo Pigmentado/patologia , Receptores de Calcitriol/metabolismo , Neoplasias Cutâneas/patologia , Biomarcadores Tumorais/metabolismo , Estudos de Casos e Controles , Núcleo Celular/química , Citoplasma/química , Extremidades , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Tronco , Carga TumoralRESUMO
Vitamin D (VD) deficiency has been linked to increased incidence and morbidity of tuberculosis (TB). Chile has large variations in solar radiation (SR; a proxy of VD status) and high prevalence of VD deficiency in its southernmost regions with low SR. We investigated the correlation between regional SR and rates of TB incidence, admissions and deaths in Chile by reviewing national records on prospectively collected mandatory disease notifications, admissions and mortality between 2001 and 2011. Over the study period, 26 691 new TB notifications were registered. The TB incidence rate was 14·77 (95% confidence intervals (CIs) 14·60-14·95), admission rate was 12·12 (95% CI 11·96-12·28) and mortality rate was 1·61 (95% CI 1·55-1·67) per 100 000 population per year. Multivariable linear regressions adjusting for significant demographic TB risk factors in Chile (regional prevalence of HIV infection, rates of migration from TB-endemic countries and rates of imprisonment) revealed an independent and highly statistically significant inverse association between SR and TB incidence rate (ß -1·05, 95% CI -1·73 to -0·36, P = 0·007), admission rate (ß -1·58, 95% CI -2·23 to -0·93, P < 0·001), and mortality rate (ß -0·15, 95% CI -0·23 to -0·07, P = 0·002). These findings support a potential pathogenic role of VD deficiency in TB incidence and severity.
Assuntos
Luz Solar , Tuberculose/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Idoso , Chile/epidemiologia , Feminino , Geografia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tuberculose/microbiologia , Tuberculose/mortalidade , Deficiência de Vitamina D/etiologiaRESUMO
BACKGROUND: The epidemiology and hospitalisation trends of primary immunodeficiency (PID) in Chile are unknown. We aimed to evaluate hospitalisation trends and demographic characteristics of PID admissions in Chile. METHODS: PID admissions between 2001 and 2010 (ICD-10 codes D70.0, D70.4, D71, 72.0, D76.1, D80-D84, E70.3, G11.3) were reviewed using national hospital discharge databases. RESULTS: During the study period, 5486 admissions due to PID were registered (0.03% of total). 58.5% of patients were male and 66.3% were under 18 years. Median length of stay was one day (range 1-403 days). The most frequent diagnoses were hypogammaglobulinaemia (27.6%), unspecified immunodeficiency (21.9%), haemophagocytic lymphohystiocytosis (18.3%) and common variable immunodeficiency (11.2%). There was a significant increase in PID admission rate and in one-day hospitalisations during this period (ß=0.2; P=0.001 and ß=33; P≤0.001, respectively), however no significant variation was found for longer admissions (ß=4.8; P=0.175). The increasing trend in PID admission rate was significant in patients with private, but not public insurance (ß=0.53; P≤0.001 vs. ß=0.08; P=0.079, respectively). CONCLUSIONS: We report an increasing trend in admissions due to PID in Chile over a 10-year period. Increase is mainly due to short hospitalisations, possibly accounting for improvements in IVIG access. Higher admission rates in patients with private vs. public insurance suggest socioeconomic disparities in access to PID treatment. ICD-10 coded hospitalisation databases may be useful to determine hospitalisation trends and demographic characteristics of PID admissions worldwide.
Assuntos
Síndromes de Imunodeficiência/epidemiologia , Classificação Internacional de Doenças , Adolescente , Adulto , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Hospitalização , Humanos , Síndromes de Imunodeficiência/classificação , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Fatores Socioeconômicos , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Food allergy (FA) prevalence is well documented in developed countries and appears to be increasing, but remains unknown in most Latin American countries. We aimed to evaluate on a population basis the parent-reported prevalence of FA and its clinical characteristics in Mexican schoolchildren. METHODS: A validated Spanish version of a structured written questionnaire was administered to parents of schoolchildren aged 5-13 years old from Culiacan, Mexico. RESULTS: A total of 1049 parents responded to the survey (response rate, 84%). The estimated prevalence rates (95% CI) were: adverse food reactions 10.0% (8.3-11.9), "perceived FA, ever" 5.5% (4.3-7.0), "physician-diagnosed FA, ever" 4.9% (3.7-6.3), "immediate-type FA, ever" 4.4% (3.3-5.8), "immediate-type FA, current" 3.5% (2.6-4.8), and anaphylaxis 1.2% (0.72-2.1). Immediate hypersensitivity reactions were mainly triggered by the consumption of shrimp (1.3%), other shellfish (0.7%), strawberry (0.6%), chocolate (0.5%), and egg (0.4%). Schoolchildren with "immediate-type FA, current" had more atopic dermatitis and allergic rhinitis (p<0.05), but not asthma or drug allergy (p>0.05) than children without FA. All cases of anaphylaxis sought medical attention, but only one child had physician-diagnosed anaphylaxis and was advised to acquire an epinephrine autoinjector. CONCLUSIONS: The prevalence of "immediate-type FA, current" to any food is 3.5% in Mexican schoolchildren. The poor recognition of anaphylaxis and the low frequency of prescription of epinephrine autoinjectors suggest that acute food-induced allergic reactions are not optimally managed in Mexico.
Assuntos
Anafilaxia/prevenção & controle , Hipersensibilidade Alimentar/epidemiologia , População , Adolescente , Anafilaxia/etiologia , Criança , Pré-Escolar , Feminino , Hipersensibilidade Alimentar/complicações , Humanos , Imunoglobulina E/sangue , Masculino , México/epidemiologia , Pais , Prevalência , Autorrelato , Inquéritos e QuestionáriosRESUMO
Vitamin D (VD) is a secosteroid hormone that is mainly synthesized in the skin upon exposure to UVB radiation. VD is widely known for its role in calcium metabolism; however, multiple endocrine, paracrine and autocrine functions of VD have been described, including a prominent role on carcinogenesis. In recent years, multiple associations between VD deficiency and different types of cancer have been described, supported by evidence of anti-proliferative, anti-angiogenic, pro-apoptotic, cell-differentiating and anti-invasive effects of this hormone. An immunomodulatory role of VD associated to cancer microenvironment has also been suggested. Regarding skin cancer, it has been shown that VD inhibits tumor development in basal cell carcinoma, squamous cell carcinoma, and melanoma in vitro. Some studies have suggested that lower VD levels may be a risk factor for skin cancer, while others have shown the opposite; there is also preliminary evidence on the role of VD supplementation for the prevention of melanoma in vivo. In this review, we explore the mechanisms of VD effects on carcinogenesis and the available scientific evidence of the interplay between VD and the genesis of both non-melanoma and melanoma skin cancer. (AU)
Assuntos
Humanos , Neoplasias Cutâneas/diagnóstico , Vitamina D/efeitos adversos , Carcinoma Basocelular/prevenção & controle , Carcinoma de Células Escamosas/prevenção & controle , Prevenção de Doenças , Carcinogênese , Melanoma/prevenção & controleRESUMO
BACKGROUND: Food allergies (FAs) affect 2-4% of school-aged children in developed countries and strongly impact their quality of life. The prevalence of FA in Chile remains unknown. METHODS: Cross-sectional survey study of 488 parents of school-aged children from Santiago who were asked to complete a FA screening questionnaire. Parents who reported symptoms suggestive of FA were contacted to answer a second in-depth questionnaire to determine immediate hypersensitivity FA prevalence and clinical characteristics of school-aged Chilean children. RESULTS: A total of 455 parents answered the screening questionnaire: 13% reported recurrent symptoms to a particular food and 6% reported FA. Forty-three screening questionnaires (9%) were found to be suggestive of FA. Parents of 40 children answered the second questionnaire; 25 were considered by authors to have FA. FA rate was 5.5% (95% CI: 3.6-7.9). Foods reported to frequently cause FA included walnut, peanut, egg, chocolate, avocado, and banana. Children with FA had more asthma (20% vs. 7%, P<0.02) and atopic dermatitis (32% vs. 13%, P<0.01) by report. The parents of children with FA did not report anaphylaxis, but 48% had history compatible with anaphylaxis. Of 13 children who sought medical attention, 70% were diagnosed with FA; none were advised to acquire an epinephrine autoinjector. CONCLUSION: Up to 5.5% of school-aged Chilean children may suffer from FA, most frequently to walnut and peanut. It is critical to raise awareness in Chile regarding FA and recognition of anaphylaxis, and promote epinephrine autoinjectors in affected children.
Assuntos
Hipersensibilidade Alimentar/epidemiologia , Adolescente , Alérgenos/imunologia , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Asma/epidemiologia , Asma/etiologia , Criança , Pré-Escolar , Chile , Estudos Transversais , Dermatite Atópica/epidemiologia , Dermatite Atópica/etiologia , Feminino , Hipersensibilidade Alimentar/etiologia , Humanos , Masculino , Pais , Prevalência , AutorrelatoRESUMO
BACKGROUND: Hip fractures are the most severe complication of osteoporosis, yet patients who suffer hip fracture rarely receive adequate treatment. AIM: To assess diagnosis and treatment of osteoporosis in patients with hip fracture. PATIENTS AND METHODS: A retrospective study in 203 patients admitted for hip fracture surgery at two medical institutions in Santiago, Chile. Clinical data from 101 patients from the Hospital Clínico Pontificia Universidad Católica de Chile (a university tertiary care hospital, HCPUC) and 102 patients from Hospital de Urgencia de la Asistencia Pública (a public emergency hospital, HUAP) were reviewed. We also evaluated incidence of new fractures, further treatment of osteoporosis and functionality, by means of a telephonic survey of 48 per cent of patients (n = 99) 12.3 +/- 5.3 months after hip fracture in HCPUC and 16.5 +/- 3.0 months for HUAP. RESULTS: A previous diagnosis of osteoporosis was present in 2.9 per cent and 1 per cent of cases, and treatment prior to fracture in 3.9 per cent and 0 per cent of cases from HCPUC and HUAP, respectively. None of the patients in HUAP were diagnosed with osteoporosis during hospital stay or given treatment for this condition at discharge, in comparison to 0.9 per cent (n = 1) and 2 per cent (n = 2), respectively, in HCPUC. Seven and six percent of cases presented prior hip fractures. Telephonic follow up of patients revealed that 75.6 per cent persisted without treatment for osteoporosis. At follow up, 2.9 per cent and 3 per cent of patients in HCPUC and HUAP had presented new hip fractures. At the time of survey 30.9 per cent and 34 per cent of patients, respectively, were considered invalid. CONCLUSIONS: Missed diagnosis and failure to treat osteoporosis occurred in over 90 per cent of patients admitted for hip fracture, regardless of the different complexities in the hospitals of admission. The data suggest that lack of medical action on these issues may play a role in failure to prevent new hip fractures.