Stella Maris Pezzotto

Variation in smoking-related lung cancer risk factors by cell type among men in Argentina: a case-control study

A high mortality rate for lung cancer (62.7 per 100,000) is found in Rosario, Argentina. To investigate the reasons for this high rate, a case-control study was carried out among 215 male cases with histologically confirmed lung cancer and 433 hospitalized controls for conditions unrelated to tobacco consumption. Odds ratios (OR) of squamous cell (SQ), adenocarcinoma (AD), and small cell (SM) carcinoma of the lung associated with different characteristics of the smoking habit were quantified. Ninety-eight percent of the cases had smoked regularly. Smokers were significantly younger at diagnosis than ex-smokers (P<0.0001), a pattern consistent for all cell types. The ORs for the heaviest cf the lowest consumption categories were 15.3 for SQ, 11.6 for AD, and 11.6 for all lung cancer (P<0.0001). Risks associated with the use of unfiltered cigarettes were three to five times higher than those for filtered cigarettes, depending on cell types. For ex-smokers, risks after 10 years of nonsmoking were about 12 times lower than those of current smokers (P<0.001). To halt further increases in lung cancer, preventive measures in Argentina should be directed primarily towards smoking control.

Prevalencia del habito de fumar en jóvenes y sus padres: asociaciones relevantes con educacion y ocupación

Com o objetivo de conhecer a prevalencia de habito de fumar cigarros entre os jovens, estudaram-se amostras aleatorias de homens de 18 anos e de estudantes universitarios de medicina e de economia, que responderam um questionario sobre o habito, escolaridade e ocupacao, proprios e de seus pais. A prevalencia do habito de fumar foi maior nos homens de ambas as geracoes, nos estudantes de medicina, que nos de economia, e nos pais com educacao universitaria. Achou-se associacao entre o habito dos jovens representativos da populacao geral (p < 0,001), mas nao entre o dos progenitores e de seus filhos universitarios. Visto a participacao fundamental que os universitarios, em especial os medicos, deveriam ter na comunidade, surge a necessidade de programas educativos, nao so nas escolas mas tambem nas universidades.Rosario, with a million inhabitants, is the second major urban concentration in Argentina and serves as the commercial and industrial center for a large area. In view of the lack of information on the present prevalence of smoking in this area as for the country as a whole, a study was performed on random samples of young people and university students of medicine and economics, as well as on their parents. Information was obtained on their life smoking habits, education and occupation. The prevalence of the habit was higher: a) in men, both in the youngsters and their parents; b) in medical students than in those of the economic sciences; c) in parents with university education. The smoking habit of these subjects and parents was highly associated (p less than 0.001) in the sample of young people, although no association was found between the prevalence of smoking among university students and their parents. Peer smoking was the main factor influencing the onset of cigarette smoking given by 69% of the subjects. Knowledge of specific adverse health effects of smoking was poor. Attitudes toward restrictive measures were highly associated (p less than 0.001) with the non-smoker category. Based on these findings, we conclude that while there is a need for educational programs for the population in general, the university as a whole and specifically the school of medicine should implement a program to increase knowledge and awareness on this public health problem.

Prevalence of smoking in young people and their parents: important assocations with education and occupation

Com o objetivo de conhecer a prevalencia de habito de fumar cigarros entre os jovens, estudaram-se amostras aleatorias de homens de 18 anos e de estudantes universitarios de medicina e de economia, que responderam um questionario sobre o habito, escolaridade e ocupacao, proprios e de seus pais. A prevalencia do habito de fumar foi maior nos homens de ambas as geracoes, nos estudantes de medicina, que nos de economia, e nos pais com educacao universitaria. Achou-se associacao entre o habito dos jovens representativos da populacao geral (p < 0,001), mas nao entre o dos progenitores e de seus filhos universitarios. Visto a participacao fundamental que os universitarios, em especial os medicos, deveriam ter na comunidade, surge a necessidade de programas educativos, nao so nas escolas mas tambem nas universidades.Rosario, with a million inhabitants, is the second major urban concentration in Argentina and serves as the commercial and industrial center for a large area. In view of the lack of information on the present prevalence of smoking in this area as for the country as a whole, a study was performed on random samples of young people and university students of medicine and economics, as well as on their parents. Information was obtained on their life smoking habits, education and occupation. The prevalence of the habit was higher: a) in men, both in the youngsters and their parents; b) in medical students than in those of the economic sciences; c) in parents with university education. The smoking habit of these subjects and parents was highly associated (p less than 0.001) in the sample of young people, although no association was found between the prevalence of smoking among university students and their parents. Peer smoking was the main factor influencing the onset of cigarette smoking given by 69% of the subjects. Knowledge of specific adverse health effects of smoking was poor. Attitudes toward restrictive measures were highly associated (p less than 0.001) with the non-smoker category. Based on these findings, we conclude that while there is a need for educational programs for the population in general, the university as a whole and specifically the school of medicine should implement a program to increase knowledge and awareness on this public health problem.

Hipercementosis Apicales y No Apicales en Raíces Dentarias Humanas

El cemento secundario del apice radicular se deposita en forma lenta y continua durante toda la vida util del diente, siendo su funcion compensar el desgaste producido por la masticacion. En raras ocasiones podemos hallar en la raiz dental, a posteriori de una extraccion dentaria, excesos de cementos redondeados u ovalados, bien delimitados y duros al tacto, ubicados en un sector radicular diferente al apice. Nuestro objetivo fue comparar las caracteristicas fisicas y radiologicas de raices dentales normales con aquellas que presentan este tipo de formaciones que alteran la anatomia radicular. Fueron incluidos 20 dientes adultos con raices normales y 20 con raices donde se visualizaron estos depositos. Las variables investigadas fueron edad, sexo, patologias generales y periodontales previas, tipo de diente extraido, ubicacion en el arco dental, motivo de extraccion, caracteristicas de consistencia, color, aspecto y textura de todas las raices. La imagen radiologica fue crucial para la inclusion de dientes con exceso de cemento. Se recolecto un total de 40 dientes adultos, cuya edad promedio fue de 61anos (16-79), 42.5% masculinos y 57.5% femeninos. Patologia general presento el 37.5% y periodontal el 55%, los dientes mas extraidos fueron premolares superiores del lado derecho 15%. La caries fue causa principal de extraccion 72.5%. En ambos grupos las raices fueron de consistencia dura y textura lisa. El aspecto nacarado fue de 70% y 60%, los colores claros 45% y 75%, respectivamente. En las radiografias se observo que el cemento no se diferencio de la dentina en el 40% y 85% de cada grupo (p=0.004). Los adultos pueden desarrollar anomalias de cemento ubicadas en otro sector del apice si bien las caracteristicas fisicas de la raiz se consideran dentro de parametros normales.

Vulnerability of healthy vertebrae in patients with and without previous vertebral fracture

Vertebral deformities are associated with a marked increase in morbidity, mortality, and burden in terms of sanitary expenditures. Patients with vertebral fractures have a negative impact in their health, less quality of life, and loss of functional capacity and independence. The purpose of this study was to explore the vulnerability of healthy vertebrae in patients who have sustained already a compression fracture and in patients who do not have prevalent fractures in the thoracic spine; and to explore the association of the deformity in healthy vertebrae with different variables, such as bone mineral density (BMD), body mass index, age, loss of height, presence of clinical kyphosis, history of other osteoporotic fractures, and falls occurring during the last year. Clinical data and complementary studies from 175 postmenopausal outpatients were analyzed. These women (age: 69.7±11.1 years) had not received any treatment for osteoporosis. Anteroposterior and lateral radiographs of the thoracic spine and bone densitometry of the hip were obtained; morphometry was performed in 1575 thoracic vertebrae from T4 to T12. The angle of wedging of each vertebral body was calculated using a trigonometric formula. Then, the sum of wedge angles of vertebral bodies (SWA) was determined, and Cobb angle was measured. In patients with vertebral fractures, after excluding the angles of fractured vertebral bodies, the mean wedge angle of the remaining vertebrae (MWAhealthy) was calculated. The same procedure was followed in patients without vertebral fractures. MWAhealthy was considered as an indicator of the structural vulnerability of non-fractured vertebrae. Patients with prevalent fractures had lower BMD, wider Cobb angle, and higher sum of wedge angles than patients without vertebral fractures. The proportion of patients with accentuation of clinical kyphosis was higher in the group with prevalent vertebral fractures. A highly significant difference was found in the MWAhealthy, which was higher in patients with prevalent fractures (4.1±1.3° vs. 3.0±1.1°; p<0.001). Patients showing vertebral fractures had 7.1±4.2 cm height loss in average, significantly superior than that found among non-fractured women (3.6±3.2 cm; p<0.01). In multivariate analysis, the increase of MWAhealthy was associated with advancing age (p<0.02), lower femoral neck BMD (p<0.005), presence of clinical kyphosis (p<0.01) and vertebral fractures (p<0.02). This study presents evidence that a series of factors independently influence the increase in wedging deformity of vertebral bodies that are not fractured yet. These factors could contribute to an increased vulnerability of the vertebrae, making them more susceptible to fracture.

A nested case-control study on dietary fat consumption and the risk for gallstone disease

BACKGROUND Gallstone disease (GD) incidence and prevalence rates differ between populations. Diet and lifestyle may be involved in GD development. To our knowledge, no study to date has evaluated quantitative data on diet when studying the relationship between fat consumption levels and GD in an Argentinean population. The present study aimed to assess the association between dietary fat intake and GD. METHODS A nested case-control study design was applied. Data were taken from subjects who participated in a previous cross-sectional study carried out in a random sample of asymptomatic people in Rosario, Argentina. Participants underwent a personal interview, and current weight and height, ancestors ethnicity, and socio-economic status were recorded. Applying a food-frequency questionnaire and a food photography atlas, quantitative dietary data were estimated by combining the intake frequency, portion size and food composition. Logistic regression analysis was used to compute odds ratios and 95% confidence intervals adjusted by age, sex, ancestors ethnicity, body mass index and daily total energy intake as potential confounders. RESULTS In total, 114 patients were studied (49 cases and 65 controls), without any statistically significant differences for age, sex, socio-economic status, body mass index and ancestry. The mean energy intake was higher in cases than in controls, and significant differences were found for dietary fat consumption. Obese or overweight people have a higher GD risk than subjects with normal weight. Increased GD risks were associated with high intakes of energy, total fat, and saturated and monounsaturated fatty acids. CONCLUSIONS According to our results, total fat, saturated and monounsaturated fatty acids high intakes are associated with increased GD risk.

HÁBITOS ALIMENTARIOS Y RIESGO DE CANCER DE PIEL NO MELANOMA

A case-control study was carried out in order to analyze the association between diet and risk of non melanoma skin cancer -basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), with adjustments for demographic, anthropometric and phenotypic characteristics, sunburns history, skin cancer family history, sun-exposure history and skin sensitivity to sun exposure. A full-body skin examination was performed. Dietary data were obtained applying a standardized semi-quantitative questionnaire of consumption frequency. Cases (n=27; age: 65,5±15,1 years) and controls (n=37; age: 63,9±12,3 years) were attended at the same facilities. A decreased risk of BCC and SCC tumors (Adjusted Odd Ratio=0.10; IC 95%= 0.02-0.63; p=0.01) was found for high intakes of green leafy vegetables (more than 40 gr/day). However, results obtained for fruits, cruciferous, vitamin A and carotene-rich

Medición Comparada de Procesos Odontoblásticos y Canalículos Dentinarios

El complejo dentinopulpar comparte el odontoblasto cuyo cuerpo esta ubicado en la parte externa de la pulpa dentaria. De su polo apical se desprende el proceso odontoblastico que se introduce en el canaliculo dentinal atravesando la dentina originando en su recorrido multiples colaterales hasta su finalizacion. Describir el proceso fue ardua tarea de investigadores que combinaron tecnicas histologicas para preservarlo en el interior de los canaliculos utilizando microscopio electronico de transmision o scanning para visualizarlo. En un trabajo previo observamos ambos tejidos unidos por los odontoblastos y los procesos coloreados. El objetivo actual fue medir micrometricamente la longitud de procesos y canaliculos para verificar si ambas son similares tanto en corona como en raiz. Se utilizaron treinta dientes sanos, extraidos por razones ortodoncicas de ambos sexos, cuyas edades oscilaron entre 6 y 18 anos. Se descubrio la pulpa dental, se fijo y se dividieron en partes iguales. Las mitades sin pulpa se prepararon con tecnica por desgaste. Las mitades que conservaron la pulpa se desmineralizaron aplicandoseles Colagenasa tipo II y coloreandolos con la tecnica de Schmorl. Con microscopio optico y una cuadricula calibrada con micrometro objetivo se midio primero el ancho de los campos histologicos y luego la longitud de procesos y canaliculos dentinales. Los resultados fueron analizados con pruebas de chi2, t de Student y test exacto de Fischer con un nivel de significacion del 5%. Observamos que el ancho de los campos histologicos coloreados tuvo una retraccion del 92% respecto al mismo campo en el desgaste y que la longitud de canaliculos siempre fue mayor que la de procesos, si bien se hallaron cuatro coincidencias de longitudes en corona y una en raiz. Estos resultados sugieren que la longitud del proceso aun sigue siendo tema controversial. La precausion profesional en los tratamientos odontologicos es el unico medio para evitar danarlo.

Thin melanoma and sentinel lymph node biopsy: A difficult relationship between them

Introduction: Cutaneous Melanoma (CM) is one of the few malignancies with increasing incidence and mortality rates. The most significant increase was observed in ‘thin’ melanomas (TM) (Breslow ≤1 mm). A low percentage of these patients may present a late recurrence, progression, and death. Purpose: Our primary objective was to show the relationship between patients who suffer from thin melanoma with the predictors of the illness. Our secondary objective was to note the survival according to lymph node biopsy results. Materials and methods: Histopathologically proved CMs with a Breslow thickness ≤ 1mm were retrospectively reviewed from January 2000 to December 2015. The CMs were classified using the AJCC Staging System (2010). In cases where CMs had a Breslow thickness ≤1 mm and were associated with ulceration, mitotic rate (MR) per mm2 >0, Clark level ≥IV, satellitosis, angiolymphatic or perineural invasion, it was suggested to biopsy the sentinel lymph node (SLN) status were compared and divided into two groups, according to the results and the survival analysis. Results: 265 of the 642 patients with CM (41.3%) had a Breslow thickness ≤1 mm, and 65 of them (24.5%) had also ulcerations or a MR >0 or Clark ≥IV. Furthermore, 10.8% had a positive SLN. Clark level ≥IV was associated with a positive SLN (p=0.035). There was a clear difference in the survival distributions according to the lymph node status (ρ=0,014). Conclusions: The sentinel lymph node status was important for the patient progress. Abbreviations: AJCC: American Joint Committee on Cancer, CM: Cutaneous Melanoma, GEMRO: Grupo de estudio de Melanoma Rosario (Rosario Melanoma Study Group), HE: Hematoxylin—Eosin, IHQ: Immunohistochemistry, MM: Malignant Melanoma, MR: Mitotic Rate, OS: Overall Survival, SD: Standard Deviation, SLN: Sentinel Lymph Node, SLNB: Sentinel Lymph Node Biopsy, SMU: Sydney Melanoma Unit, TM: Thin Melanoma Introduction Malignant melanoma is one of the tumors having an increasing annual incidence rate over the past 40 years. The significant increase was observed in thin melanomas, which represent 65%—80% of the total diagnosed melanomas [1,2]. Although the prognosis is very good, a 10% of these patients present a late recurrence, progression, and death. The sentinel node was defined by Morton et al. (1992) [3] as an intermediate—thickness melanoma, and this concept was a subject of controversy for clinical indications in thin melanoma group studies. Our primary objective was to show the relationship between patients who suffer from thin melanoma with the predictors of the illness. Furthermore, we studied the sentinel lymph node (SLN) in order to identify groups at higher risk of having lymph node deposits. Correspondence to: Prof. Stella Maris Pezzotto, Facultad de Ciencias Médicas, Universidad Nacional de Rosario (UNR), Santa Fe 3100, 2000 Rosario, Argentina, E-mail: spezzot@unr.edu.ar

Quality of life in patients with metastatic breast cancer treated with metronomic chemotherapy

AIM The objective of the study was to detect changes in quality of life (QoL) in metastatic breast cancer patients treated with metronomic chemotherapy with daily low doses of cyclophosphamide and celecoxib. MATERIAL & METHODS Patients included in a Phase II trial, treated with metronomic cyclophosphamide and celecoxib were included in the QoL study. Assessment of QoL was carried out every 2 months by the Functional Assessment of Cancer Therapy Breast (FACT-B) questionnaire, Brief Pain Inventory and Eastern Cooperative Oncologic Group scale. Data were analyzed at three time points: baseline (BL); middle of treatment (MT); and end of treatment (ET). RESULTS A total of 20 patients were included. All patients were heavily pretreated. Treatment showed a good and safe therapeutic profile. With FACT-B questionnaire, no significant differences were observed during the response period (BL-MT). However, a significant increase was observed in the Emotional well-being and Additional concerns axes, when the last time point was included in the analysis (BL-MT-ET). A significant decrease in the proportion of patients with pain was found when comparing BL with ET (p = 0.046). The assessment with Eastern Cooperative Oncologic Group scale showed that 26.7% (4/15) of the patients improved their functional status and 40% (6/15) showed no changes, while 33.3% (5/10) worsened it. CONCLUSION Patients treated metronomically for several months did not worsen their QoL. A high proportion of patients showed improvement or no changes and there were less patients with pain at the end of the treatment.