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BACKGROUND: The influence of Helicobacter-pylori (H. pylori) infection and the characteristics of gastric cancer (GC) on tumor-infiltrating lymphocyte (TIL) levels has not been extensively studied. Analysis of infiltrating-immune-cell subtypes as well as survival is necessary to obtain comprehensive information. AIM: To determine the rates of deficient mismatch-repair (dMMR), HER2-status and H. pylori infection and their association with TIL levels in GC. METHODS: Samples from 503 resected GC tumors were included and TIL levels were evaluated following the international-TILs-working-group recommendations with assessment of the intratumoral (IT), stromal (ST) and invasive-border (IB) compartments. The density of CD3, CD8 and CD163 immune cells, and dMMR and HER2-status were determined by immunohistochemistry (IHC). H. pylori infection was evaluated by routine histology and quantitative PCR (qPCR) in a subset of samples. RESULTS: dMMR was found in 34.4%, HER2+ in 5% and H. pylori-positive in 55.7% of samples. High IT-TIL was associated with grade-3 (P = 0.038), while ST-TIL with grade-1 (P < 0.001), intestinal-histology (P < 0.001) and no-recurrence (P = 0.003). dMMR was associated with high TIL levels in the ST (P = 0.019) and IB (P = 0.01) compartments, and ST-CD3 (P = 0.049) and ST-CD8 (P = 0.05) densities. HER2- was associated with high IT-CD8 (P = 0.009). H. pylori-negative was associated with high IT-TIL levels (P = 0.009) when assessed by routine-histology, and with high TIL levels in the 3 compartments (P = 0.002-0.047) and CD8 density in the IT and ST compartments (P = 0.001) when assessed by qPCR. A longer overall survival was associated with low IT-CD163 (P = 0.003) and CD8/CD3 (P = 0.001 in IT and P = 0.002 in ST) and high IT-CD3 (P = 0.021), ST-CD3 (P = 0.003) and CD3/CD163 (P = 0.002). CONCLUSION: TIL levels were related to dMMR and H. pylori-negativity. Low CD8/CD3 and high CD163/CD3 were associated with lower recurrence and longer survival.
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Introduction: A high prevalence of advanced breast cancer (BC) is a common scenario in Latin America. In Peru, the frequency of BC at Stages III/IV is ≈50% despite implementation of a programme for breast cancer screening (BCS) along the country. We carried out a study to assess the feasibility and develop an instrument to evaluate the knowledge, barriers and perception about BCS in a nationwide pilot study in Peru among candidates for BCS. Methods: We conducted a systematic review of 2,558 reports indexed in PubMed, Scopus, Web of Science, Medline-Ovid and EMBASE, regarding to our study theme. In total, 111 were selected and a 51-items survey was developed (eight items about sociodemographic characteristics). Patients were recruited in public hospitals or private clinics, in rural and urban areas of nine departments of Peru. Results: We surveyed 488 women from: Lima (150), Cajamarca (93), Ica (59), Arequipa (56), Loreto (48), Ancash (38), Junín (15), Puerto Maldonado (15) and Huancavelica (14); 27.9% of them were from rural areas. The mean of age was 53.3 years (standard deviation ± 9.1). Regarding education level, 29.8% had primary, 33.2% secondary and 37.0% higher education. In total, 28.7% of women did not know the term 'mammogram' and 47.1% reported never receiving a BCS (36.9% from urban and 73.5% from rural population). In women that underwent BCS, only 67% knew it is for healthy women. In total, 54.1% of patients had low levels of knowledge about risk factors for BC (i.e. 87.5% of women respond that injuries in the breast produce cancer). Cultural, economic and geographic barriers were significantly associated with having a mammogram where 56.9% of participants considered a cost ≤ 7 USD as appropriate. Mammogram was perceived as too painful for 54.9% of women. In addition, women with a self-perception of low-risk for BC and a fatalistic perception of cancer were less likely to have a BCS. Conclusion: We found that it is feasible to conduct a large-scale study in Peru. The results of this pilot study highlight an urgent need of extensive education and awareness about BCS in Peru.
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Introducción: El objetivo del presente estudio fue determinar las características clínicas y pronóstico de los pacientes con Leucemia/Linfoma de Células T del Adulto (ATL) en el Instituto Nacional de Enfermedades Neoplásicas (INEN) de Perú. Metodología: Se realizó un estudio transversal, que incluyó por Se revisaron 188 historias clínicas y estudio patológico de pacientes con infección por HTLV-1 diagnosticados en el INEN durante 10 años, de quienes 150 tuvieron ATL. Resultados: 62% de los pacientes tuvieron el subtipo ATL linfoma, 37% subtipo agudo y 1% crónico. La mediana de edad fue 53 años (20-89); 51% fueron mujeres. Dentro de las características clínicas: ECOG ≥ 2 (56%); estadio clínico III-IV (80%), síntomas B (58%); incremento de la deshidrogenasa láctica, LDH, (74%); leucocitosis (50%); hipercalcemia (46%) y anemia (36%). 122 pacientes (81,3%) recibieron tratamiento, 79% con quimioterapia (QT) y 4,6% radioterapia complementaria (RT); CHOP fue el esquema de QT más frecuente (89%). De los pacientes con QT tuvieron 18% RC, 32% RP, 7% EE y 13% PE. Conclusión: En este reporte en pacientes con ATL, la forma linfoma es el subtipo más frecuente, existe alta prevalencia de inmunofenotipo atípico y pobre respuesta al CHOP.
Introduction: The objective of this study was to determine the clinical characteristics and progno-sis of patients with adult T-cell leukemia/lymphoma (ATL) at the National Institute of Neoplastic Diseases (INEN) of Peru. Methodology: A cross-sectional study was carried out, which included 188 clinical histories and a pathological study of patients diagnosed with HTLV-1 infection diagnosed at the INEN for ten years, of whom 150 had ATL. Results: Sixty-two percent of the patients had the ATL lymphoma subtype, 37% had the acute sub-type, and 1% had the chronic subtype. The median age was 53 (20-89); 51% were women. Within the clinical characteristics: ECOG ≥ 2 (56%); clinical stage III-IV (80%), symptoms B (58%); increased lactic dehydrogenase, LDH, (74%); leukocytosis (50%); hypercalcemia (46%) and anemia (36%). A total of 122 patients (81.3%) received treatment, 79% with chemotherapy (CT) and 4.6% with complementary radiotherapy (RT); CHOP was the most frequent QT regimen (89%). Of the patients with QT, 18% had CR, 32% PR, 7% EE, and 13% PE. Conclusion: In this report, in patients with ATL, the lymphoma form was the most frequent subtype, and there was a high prevalence of atypical immunophenotype and poor response to CHOP.
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Humanos , Pessoa de Meia-Idade , Idoso , Vírus Linfotrópico T Tipo 1 Humano , Leucemia-Linfoma de Células T do Adulto , Tratamento Terciário , Imunofenotipagem , Características do EstudoRESUMO
BACKGROUND: Lung cancer is still a prevalent and fatal neoplasm in developing countries. In the last decades, chemotherapy (CHT) maintenance occupied an important role in the treatment, as well as targeted therapies. We aimed to evaluate the survival impact of targeted therapy in advanced lung cancer at a private Peruvian institution (Oncosalud - AUNA). METHODS: We reviewed retrospectively medical records of patients with advanced-stage non-small cell lung cancer (NSCLS) (clinical stage III-IV) who received CHT and maintenance treatment with target therapy (TT) or CHT. The impact was assessed by progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method, and comparisons of survival curves were performed using log-rank or Breslow test and Cox model. RESULTS: The median age of the patients was 65 years. Clinical characteristics, as well as the treatment type, showed no significant difference between the two groups. The maintenance schedule in those receiving CHT was generally pemetrexed (70%) and in those receiving TT was erlotinib (60.7%). In patients receiving TT, the median PFS was 13 months compared to 7 months in those receiving CHT; likewise, the median OS was 45 and 17 months, respectively. The PFS and OS curves showed significant differences (P < .05), achieving a better survival in subjects treated with TT. CONCLUSION: Progression-Free Survival and OS were superior in patients who received targeted therapy than those treated only with CHT, the 2 years rate of PFS and OS was nearly double to those who received only CHT-based treatments.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Peru , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The Coronavirus Disease 2019 (COVID-19) pandemic continues to produce significant emotional consequences at the individual, community, societal, and global levels. This study describes the psychometric properties of the Spanish version of the Fear of COVID-19 Scale (FCV-19S) in Peruvian medical students. Data were collected by a convenience sampling method, resulting in a total of 1238 medical students from different medical schools in Peru. Our analyses suggest that a two-factor model explains the underlying two-dimensional structure of the FCV-19S. The results indicated that the Spanish version of the FCV-19S scale was found to have adequate psychometric properties.
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COVID-19 , Estudantes de Medicina , Medo/psicologia , Humanos , Peru , Psicometria/métodos , Reprodutibilidade dos TestesRESUMO
Cyclosporine (CsA) and tacrolimus (TAC) are immunosuppressant drugs characterized by a narrow therapeutic range and high pharmacokinetic variability. The effect of polymorphisms in genes related to the metabolism and transport of these drugs, namely CYP3A4, CYP3A5, MDR1 and POR genes, has been evaluated in diverse populations. However, the impact of these polymorphisms on drug disposition is not well established in Latin American populations. Using TaqMan® probes, we determined the allelic frequency of seven variants in CYP3A4, CYP3A5, MDR1 and POR in 139 Chilean renal transplant recipients, of which 89 were treated with CsA and 50 with TAC. We tested associations between variants and trough and/or 2-hour concentrations, normalized by dose (C0/D and C2/D) at specific time points post-transplant. We found that CYP3A5*3/*3 carriers required lower doses of TAC. In TAC treated patients, most CYP3A5*3/*3 carriers presented higher C0/D and a high proportion of patients with C0 levels outside the therapeutic range relative to other genotypes. These results reinforce the value of considering CYP3A5 genotypes alongside therapeutic drug monitoring for TAC treated Chilean kidney recipients.
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BACKGROUND: Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. PATIENTS AND METHODS: We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. RESULTS: In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). CONCLUSION: A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.
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Quimioterapia Adjuvante/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Neoplasias de Mama Triplo Negativas/terapia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/patologiaRESUMO
Progressive diabetic nephropathy (DN) and loss of renal function correlate with kidney fibrosis. Crosstalk between TGF-ß and adenosinergic signaling contributes to the phenotypic transition of cells and to renal fibrosis in DN models. We evaluated the role of TGF-ß on NT5E gene expression coding for the ecto-5`-nucleotidase CD73, the limiting enzyme in extracellular adenosine production. We showed that high d-glucose may predispose HK-2 cells towards active transcription of the proximal promoter region of the NT5E gene while additional TGF-ß results in full activation. The epigenetic landscape of the NT5E gene promoter was modified by concurrent TGF-ß with occupancy by the p300 co-activator and the phosphorylated forms of the Smad2/3 complex and RNA Pol II. Transcriptional induction at NT5E in response to TGF-ß was earlier compared to the classic responsiveness genes PAI-1 and Fn1. CD73 levels and AMPase activity were concomitantly increased by TGF-ß in HK-2 cells. Interestingly, we found increased CD73 content in urinary extracellular vesicles only in diabetic patients with renal repercussions. Further, CD73-mediated AMPase activity was increased in the urinary sediment of DN patients. We conclude that the NT5E gene is a target of the profibrotic TGF-ß cascade and is a traceable marker of progressive DN.
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5'-Nucleotidase/genética , Nefropatias Diabéticas/genética , Fibrose/genética , Fator de Crescimento Transformador beta/genética , Adenosina/biossíntese , Biomarcadores/metabolismo , Linhagem Celular , Nefropatias Diabéticas/patologia , Proteína p300 Associada a E1A/genética , Epigênese Genética/genética , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Fibrose/patologia , Proteínas Ligadas por GPI/genética , Regulação da Expressão Gênica , Humanos , Rim/metabolismo , Rim/patologia , Túbulos Renais Proximais/metabolismo , Túbulos Renais Proximais/patologia , Nucleotidases/genética , Regiões Promotoras Genéticas/genética , RNA Polimerase II/genéticaRESUMO
INTRODUCTION: Acute appendicitis is the main cause of emergency surgical care. Post-operative patients with complicated acute appendicitis present complications, many of them expected. The use of drains is one of the measures to prevent these complications; however, recent meta-analyzes do not justify this therapeutic measure. This study evaluates the relationship between use and non-use of drains, post-operative complications in patients with complicated peritonitis secondary to acute appendicitis. METHODS: A retrospective observational cohort study was conducted. The outcomes were analyzed by Chi-square test and Student's t-test; Fisher exact test was performed. RESULTS: The average operating time was 1.46 h (1.0-2.5) and 1.66 (1-3) for patients without drains and with drains, respectively, the difference was significant (p = 0.001). Post-operative fever was more prevalent in group with a drains odds ratio (OR) 3.4 (confidence interval [CI] 95% 1.4-7.9). The mean time of hospitalization was 7.3 (3-20) and 8.8 days (3-35) for patients without drains and with drains, respectively. (p = 0.01). The Chi-square analysis was significant for evisceration Grade III and residual collection p = 0.036, OR not evaluable. Reoperation was not significant among both groups, p = 0.108 OR 6.3 (CI 95% 0.6-62.4). CONCLUSIONS: There is a relationship between the non-use of drains and collections and evisceration in post-operative patients with open appendectomy, by complicated acute appendicitis.
ANTECEDENTES: La apendicitis aguda es la principal causa de emergencia quirúrgica. Los pacientes posoperados de apendicitis aguda complicada presentan complicaciones, muchas de ellas esperadas. El uso de drenajes es una de las medidas para prevenir estas complicaciones; sin embargo, recientes metaanálisis no justifican esta medida terapéutica. Este estudio evalúa la relación del uso o no uso de drenajes con las complicaciones en los pacientes con peritonitis secundaria a apendicitis aguda. MÉTODO: Se realizó un estudio de cohorte observacional retrospectivo. Los resultados se analizaron mediante la prueba de ji al cuadrado, la prueba t de Student y la prueba exacta de Fisher. RESULTADOS: El tiempo operatorio promedio fue de 1.46 horas (rango: 1.0-2.5 h) y de 1.66 horas (rango: 1-3 h) para pacientes sin drenajes y con drenajes, respectivamente; la diferencia fue significativa (p = 0.001). La fiebre posoperatoria fue más prevalente en el grupo con drenajes (odds ratio [OR]: 3,4; intervalo de confianza [IC] del 95%: 1,4-7,9). El tiempo promedio de hospitalización fue de 7.3 días (rango: 3-20 días) y de 8.8 días (rango: 3-35 días) para los pacientes sin y con drenajes, respectivamente (p = 0.01). La prueba de ji al cuadrado fue significativa para evisceración de grado III más colección residual (p = 0.036; OR no evaluable). Las tasas de reoperación no fueron significativamente diferentes entre ambos grupos (p = 0.108; OR: 6.3; IC 95%: 0.6-62.4). CONCLUSIONES: Existe relación entre la no utilización de drenajes y la presencia de colecciones y evisceración en pacientes posoperados con apendicetomía abierta por apendicitis aguda complicada.
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Apendicite/complicações , Drenagem , Peritonite/etiologia , Complicações Pós-Operatórias/etiologia , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Terapia Combinada , Drenagem/efeitos adversos , Feminino , Febre/epidemiologia , Febre/etiologia , Hospitais Públicos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , México/epidemiologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Utilização de Procedimentos e Técnicas , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos DesnecessáriosRESUMO
OBJECTIVE: To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS: There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS: The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS: This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.
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Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Programas Nacionais de Saúde , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Peru , Fatores Socioeconômicos , Adulto JovemRESUMO
Breast cancer (BC) is a highly prevalent malignancy in Latin American women, most cases being diagnosed at locally advanced or metastatic stages when options for cancer care are limited. Despite its label as a public health problem in the region, Latin American BC patients face several barriers in accessing standard of care treatment when compared with patients from developed countries. In this review, we analyse the landscape of the four main identified barriers in the region: i) high burden of locally advanced/advanced BC; ii) inadequate access to medical resources; iii) deficient access to specialised cancer care and iv) insufficient BC research in Latin America. Unfortunately, these barriers represent the main factors associated with the BC poor outcomes seen in the region. Targeted actions should be conducted independently by each country and as a region to overcome these limitations and create an enhanced model of BC care.
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Introducción. Las enfermedades digestivas (ED) no neoplásicas son causas importantes de consulta médica y hospitalización. Objetivo. Determinar la mortalidad por ED no neoplásicas en la población adulta del Perú entre 2010 y 2015. Métodos. Análisis secundario del registro de defunciones por ED no neoplásicas en la población mayor de 18 años entre los años 2010 y 2015 de la Oficina General de Estadística e Informática del Ministerio de Salud del Perú. La población para el mismo periodo se obtuvo del Instituto Nacional de Estadística e Informática. Se calcularon las tasas de mortalidad estandarizada (TME x 100 000 personas-año). Resultados. Durante el período 2010-2015 se registraron 39 889 muertes por ED no neoplásicas. Las TME más altas fueron para el grupo de las enfermedades del hígado (12,2 x 100 000 personas-años), siendo la fibrosis y cirrosis del hígado la de mayor mortalidad (9,1). La pancreatitis aguda (1,0) tuvo mayor TME que la úlcera gástrica (0,7). Las TME, según las regiones del Perú, fueron altas por fibrosis y cirrosis del hígado en Piura (16,3), Lambayeque (14,6) y La Libertad (14,4); por colelitiasis (1,1) y colecistitis aguda (1,7), en Puno; por pancreatitis aguda (2,2), en Tacna; y por úlcera gástrica fue mayor en Huancavelica (3,6) y Huánuco (2,3). Conclusiones. La fibrosis y cirrosis del hígado fue la ED no neoplásica con mayor tasa de mortalidad en la población adulta del Perú, principalmente en la costa norte del país.
Introduction. Non-neoplastic digestive diseases (DD) are important causes of medical consultation and hospitalization. Objective. To determine the mortality by non-neoplastic DD in the adult population of Peru between 2010 and 2015. Methods. Secondary analysis of the registry of non-neoplastic DD deaths in the population over 18 years old between 2010 and 2015 of the General Office of Statistics and Informatics of the Ministry of Health of Peru. The population for the same period was obtained from the National Institute of Statistics and Informatics. The standardized mortality rates (SMR x 100 000 person-years) were calculated. Results. During the period 2010-2015 there were 39 889 deaths due to non-neoplastic DD. The highest SMR were for the group of liver diseases (12,2 x 100 000 person-years), with fibrosis and cirrhosis of the liver having the highest mortality (9,1). Acute pancreatitis (1,0) had higher SMR than gastric ulcer (0,7). The SMR, according to the regions of Peru, were high due to fibrosis and cirrhosis of the liver in Piura (16,3), Lambayeque (14,6) and La Libertad (14,4); by cholelithiasis (1,1) and acute cholecystitis (1,7), in Puno; for acute pancreatitis (2,2), in Tacna; and gastric ulcer was higher in Huancavelica (3,6) and Huánuco (2,3). Conclusions. Liver fibrosis and cirrhosis was non-neoplastic DD with a higher mortality rate in the adult population of Peru, mainly in the northern coast of the country.
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ABSTRACT OBJECTIVE To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.
RESUMEN OBJETIVO Reportar el diseño, metodología y resultados iniciales de la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. MÉTODOS La Encuesta se ejecutó en los 24 departamentos del país. Los temas investigados fueron: características de la vivienda y miembros del hogar, educación, salud, empleo e ingreso y gastos del hogar. Se realizó un tipo de muestreo bi-etápico: la unidad primaria de muestreo estuvo conformada por conglomerados compuestos por una manzana dentro del ámbito de cobertura del centro asistencial; la unidad secundaria de muestreo fueron viviendas particulares donde habitaba al menos un asegurado a EsSalud. Se analizaron los datos de 62,659 afiliados y se muestran porcentajes ajustados por el factor de expansión. Para las comparaciones, se utilizó la prueba de chi-cuadrado. RESULTADOS Se entrevistaron 25000 viviendas, encuestándose a 79,874 personas, de las cuales 62,659 eran afiliados a EsSalud. Los afiliados son principalmente varones (50.6%) con un nivel de educación técnico superior (39.7%). La población afiliada cuenta mayoritariamente con vivienda independiente (95.0%) y propia (68.1%). Solo el 34.5% de los asegurados practica algún deporte o ejercicio físico. El 14.0% de la población padece de alguna enfermedad crónica; el 3.5% presenta diabetes; y el 7.1%, hipertensión arterial. En los últimos tres meses, el 35.4% de los afiliados necesitaron atención médica; de estos, solo el 73.1% recibieron atención sanitaria y el 10.9% restante se atendieron en farmacias o servicios no formales de atención en salud. CONCLUSIONES Esta encuesta es la primera realizada en la población de afiliados a EsSalud, aplicada a nivel nacional, y cuenta con datos socioeconómicos y demográficos de los asegurados, su distribución, factores de riesgo de la salud, prevalencia de los problemas de salud y el grado de acceso a los servicios de salud.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Inquéritos Epidemiológicos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde , Peru , Fatores Socioeconômicos , Seguro Saúde/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: There are well-known differences in gender outcome in non-small cell lung cancer (NSCLC) and other cancers. In this work, we evaluated several randomised clinical trials to explore the gender influence in the outcome of patients with NSCLC treated with targeted therapy and immunotherapy. METHODS: We performed a series of meta-analysis to compare the gender outcome in the routine setting for overall survival and progression-free survival (PFS) in phase III randomised clinical trials comparing EGFR inhibitors versus chemotherapy (OPTIMAL, LUX-lung 3, LUX-lung 6, EURTAC, ENSURE and WTJOG); ALK inhibitors versus chemotherapy (ASCEND 4, ASCEND 5, PROFILE 1014 and NCT009323893) and anti-PD1 checkpoint inhibitors versus chemotherapy (CheckMate 017, CheckMate 026, CheckMate 057, KEYNOTE 010 and KEYNOTE 024). RESULTS: Female patients with NSCLC have a reduced risk of death compared with men (HR=0.73; 95% CI 0.67 to 0.79; p<0.00001). Women had a better benefit from EGFR inhibitors than men (HR=0.34; 95% CI 0.28 to 0.40; p<0.00001 vs HR=0.44; 95% CI 0.34 to 0.56; p<0.00001, respectively). The benefit from ALK inhibitors was similar for both genders (HR=0.51; 95% CI 0.42 to 0.61; p<0.00001 vs HR=0.48; 95% CI 0.39 to 0.59; p<0.00001, for women and men, respectively). Anti-PD1 inhibitors significantly improved the PFS in male patients when compared with chemotherapy (HR=0.76; 95% CI 0.68 to 0.86; p<0.00001); in contrast, women showed no benefit in 5/5 randomised trials (HR=1.03; 95% CI 0.89 to 1.20; p=0.69). CONCLUSIONS: In this exploratory study, some targeted treatments were influenced by gender. Despite differences in outcomes that could be attributed to different histology, EGFR and smoking status, gender should be evaluated more deeply as prognostic variable in patients with NSCLC.
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PURPOSE: O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation predicts the outcome and response to alkylating chemotherapy in glioblastoma. The aim of this study is to evaluate the prevalence of MGMT methylation in Peruvian glioblastoma cases. PATIENTS AND METHODS: We evaluated retrospectively 50 cases of resected glioblastoma during the period 2008-2013 at Instituto Nacional de Enfermedades Neoplasicas in Peru. Samples consisted of paraffin embedded and frozen tumour tissue. MGMT-promoter methylation status and the expression level of MGMT gene were evaluated by methylation-specific PCR and real-time PCR, respectively. RESULTS: Unmethylated, methylated and partially methylated statuses were found in 54%, 20% and 26% of paraffin-embedded samples, respectively. Methylation status was confirmed in the Virgen de la Salud Hospital and frozen samples. There was an association between the status of MGMT-promoter methylation and the level of gene expression (p = 0.001). Methylation was associated with increased progression-free survival (p = 0.002) and overall survival (OS) (p < 0.001). CONCLUSION: MGMT-promoter methylation frequency in Peruvian glioblastoma is similar to that reported in other populations and the detection test has been standardised.
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Triple negative breast cancer (TNBC) is the most aggressive form of breast cancer with limited options of targeted therapy. Recent findings suggest that the clinical course of TNBC may be modified by the presence of tumor-infiltrating lymphocytes (TILs) and chemokine's expression, such as CCL5. Diverse studies have shown that CCL5 suppresses anti-tumor immunity and it has been related to poor outcome in different types of cancer while in other studies, this gene has been related with a better outcome. We sought to determine the association of CCL5 with the recruitment of TILs and other immune cells. With this aim we evaluated a retrospective cohort of 72 TNBC patients as well as publicly available datasets. TILs were correlated with residual tumor size after neoadjuvant chemotherapy (NAC) and CCL5 expression. In univariate analysis, TILs and CCL5 were both associated to the distant recurrence free survival; however, in a multivariate analysis, TILs was the only significant marker (HR = 0.336; 95%IC: 0.150-0.753; P = 0.008). CIBERSORT analysis suggested that a high CCL5 expression was associated with recruitment of CD8 T cells, CD4 activated T cells, NK activated cells and macrophages M1. The CD8A gene (encoding for CD8) was associated with an improved outcome in several public breast cancer datasets.
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Linfócitos T CD8-Positivos/imunologia , Quimiocina CCL5/metabolismo , Células Matadoras Naturais/imunologia , Linfócitos do Interstício Tumoral/imunologia , Macrófagos/imunologia , Neoplasias de Mama Triplo Negativas/imunologia , Adulto , Idoso , Antígenos CD8/genética , Movimento Celular , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Peru/epidemiologia , Estudos Retrospectivos , Neoplasias de Mama Triplo Negativas/epidemiologia , Neoplasias de Mama Triplo Negativas/mortalidade , Carga Tumoral , Adulto JovemRESUMO
OBJECTIVES: To evaluate the influence of the use of sodium fluorescein (FLS-Na) in surgery of glioblastoma (GB) on the degree of tumor resection and survival in patients treated at the National Institute of Neoplastic Diseases. MATERIALS AND METHODS: A total of 238 cases of GB treated between 2008 and 2013 were reviewed and 150 cases of GB who underwent surgical resection with clinicopathological information and adequate follow-up were selected. RESULTS: The mean age was 51 years, 58.7% of the cases presented a Karnofsky score of at least 90. FLS-Na was administered in 80 cases (53.3%) and a subtotal and total resection was obtained in 69 (46%) and 81 (54%) cases, respectively. The group that received FLS-Na obtained higher rates of total resection than the group operated with white light alone (77.5 vs 27.1%, p<0.001). The median overall survival (OS) was higher in the group subject to total compared to subtotal resection (17 vs 7 months, p<0.001). The median OS in those who received FLS-Na was higher than in those who did not (15.0 vs 8 months, p=0.003). Other factors affecting OS were age (p=0.002), the Karnofsky score (p=0.052) and radiation therapy (p=0.016) and chemotherapy (p=0.011). CONCLUSIONS: The microsurgical technique with administration of FLS-Na was associated with an increase in the rate of total resection and survival.
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Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Feminino , Fluoresceína/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de SobrevidaRESUMO
OBJECTIVES: To assess the clinical and epidemiological characteristics of active tuberculosis in patients with malignancy and to assess the influence of TB treatment on cancer management at the National Institute of Neoplastic Diseases from 2008 to 2013. MATERIALS AND METHODS: Observational study of TB cases diagnosed by positive sputum microscopy in patients with cancer. Clinical information, evolution, and pathologic information of neoplasia was reviewed. RESULTS: 76 cases of active tuberculosis after being diagnosed with cancer were found. The median age was 51.3 years. Median follow-up was 2.1 years. The most common cancers were acute lymphocytic leukemia (14.5%), for the hematologic cancers; and cancer of the cervix (14.5%), breast (10.5%), and gastric (7.9%) for non-hematological cancers. 27.6% of patients had recurrence of the tumor; TB diagnosis confounded the initial staging by 6.9% and was initially stated as cancer recurrence in 11.1% (breast and colon cancers). The diagnosis of tuberculosis delayed or influenced the dose reduction of the antineoplastic treatment in 11.1% of the cases (acute lymphocytic leukemia and non-Hodgkin lymphoma). 8.3% of patients had toxicity to the TB treatment. CONCLUSIONS: Cancer patients may have active tuberculosis infection. The interference effect of diagnosis and treatment of tuberculosis on the assessment of cancer and cancer treatment in our series is minimal.
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Antituberculosos/efeitos adversos , Neoplasias/complicações , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto JovemRESUMO
Evaluar la influencia del uso de fluoresceína sódica (FLS-Na) en la cirugía del glioblastoma (GB) sobre el grado de resección tumoral y la supervivencia en pacientes atendidos en el Instituto Nacional de Enfermedades Neoplásicas. Materiales y métodos. Se revisó un total de 238 casos de GB atendidos entre los años 2008 y 2013 y se seleccionó 150 casos de GB sometidos a resección quirúrgica, con información clínico-patológica y seguimiento adecuado. Resultados. La media de edad fue 51 años, el 58,7% de casos presento Karnofsky de al menos 90. Se administró FLS-Na en 80 casos (53,3%) y se obtuvo una resección subtotal y total en 69 (46%) y 81 (54%) de los casos, respectivamente. El grupo que recibió FLS-Na obtuvo mayores tasas de resección total que el grupo operado solo con luz blanca (77,5 vs 27,1%, p<0,001). La mediana de sobrevida global (SG) fue mayor en el grupo sometido a resección total que a subtotal (17 vs 7 meses, p<0,001). La mediana de SG en los que recibieron FLS-Na fue mayor que en los que no la recibieron (15,0 vs 8 meses, p=0,003). Otros factores que afectaron la SG fueron la edad (p=0,002), el Karnofsky (p=0,052) y la administración de radioterapia (p=0,016) y quimioterapia (p=0,011). Conclusiones. La técnica microquirúrgica con administración de FLS-Na se asoció con un aumento en la tasa de resecciones totales y de supervivencia...
To evaluate the influence of the use of sodium fluorescein (FLS-Na) in surgery of glioblastoma (GB) on the degree of tumor resection and survival in patients treated at the National Institute of Neoplastic Diseases. Materials and methods. A total of 238 cases of GB treated between 2008 and 2013 were reviewed and 150 cases of GB who underwent surgical resection with clinicopathological information and adequate follow-up were selected. Results. The mean age was 51 years, 58.7% of the cases presented a Karnofsky score of at least 90. FLS-Na was administered in 80 cases (53.3%) and a subtotal and total resection was obtained in 69 (46%) and 81 (54%) cases, respectively. The group that received FLS-Na obtained higher rates of total resection than the group operated with white light alone (77.5 vs 27.1%, p<0.001). The median overall survival (OS) was higher in the group subject to total compared to subtotal resection (17 vs 7 months, p<0.001). The median OS in those who received FLS-Na was higher than in those who did not (15.0 vs 8 months, p=0.003). Other factors affecting OS were age (p=0.002), the Karnofsky score (p=0.052) and radiation therapy (p=0.016) and chemotherapy (p=0.011). Conclusions. The microsurgical technique with administration of FLS-Na was associated with an increase in the rate of total resection and survival...